QOF Plus Year 1 - Imperial College London

More documents

Recommendations

Info

ForewordQOF Plus has high ambition - to deliver world class healthcare. It focuses on helping peoplelive healthier and longer lives, and above all aims to dramatically reduce health inequalities.To achieve this vision of better care for all QOF Plus builds on existing systems for quality in primary careand uses the best international evidence to extend these. We know that improving quality is not easy. Yetwe also know that it is possible when priorities and the approach to change are right. With QOF Plus wehave focused on what matters and makes a difference for both patients and clinicians. We have built intothe implementation the best evidence on support for quality improvement. In particular, we want toensure that individual practices and clinicians are enabled in transforming their clinical practice to make itof consistently high quality.This publication is accompanied by a support resource pack, guidance on business and financial rules,EMIS and Vision templates for health monitoring, details of a series of training events, visits andworkshops. Most importantly, QOF Plus is supported by a committed clinical, academic and managementteam which aims to provide a range of multimodal supportive strategies to address, in real time, areas ofchallenge. This is the most significant investment into quality improvement in primary care since theintroduction of QOF.This innovative scheme, developed jointly with experts in our local Department of Primary Care and SocialMedicine at Imperial College, combines a strong evidence-based approach with meaningful engagementand consultation with local practices and stakeholders. QOF Plus has been designed in line with nationalguidance and addresses a range of important national and local health service priorities. It builds on theanalysis of the public health needs of Hammersmith and Fulham, and on what local people have told usthey want.Advice offered by national and international experts in health care quality improvement has played asignificant role in helping determine the vision and implementation strategy for QOF Plus, ensuring thatwe learn from past experience in the field. The key individuals involved in designing and developing QOFPlus believe passionately in – and are fully committed to – the principles embodied by the scheme,namely achieving excellence in healthcare for all people and reducing health inequalities; ensuring thehealthcare needs of those most vulnerable are addressed. This team is championing the scheme and will,in partnership with patients and colleagues in primary care, work to make it a success.I am sincerely grateful to all that have contributed to this important project that brings new dynamism toprimary care embodying some of the key principles of Lord Darzi’s Next Stage Review. I believe QOF Pluswill make a real difference to the people of Hammersmith and Fulham. I also hope that this work willmake a valuable contribution to the current national debate about the future direction of QOF, and serveas a model for other PCTs wishing to initiate similar schemes.Sarah WhitingCEO, NHS Hammersmith and Fulham, December 2008
Executive summaryIntroductionPrevious work has highlighted several limitations of the national Quality and Outcomes Framework (QOF)including insufficient focus on health outcomes, primary prevention, prioritised local health needs andbenefits. QOF may not encourage practices in reaching the more challenging patients, as practices do notreceive further incentives once they have received the upper payment threshold. It is anticipated thatintroduction of a local QOF will help address these limitations.AimsThis document describes a joint venture by NHS Hammersmith and Fulham and the Department ofPrimary Care and Social Medicine at Imperial College London to design and develop a local QOF forHammersmith and Fulham (QOF+) which is in line with current national guidance, developed through theprocess of effective clinical engagement and which aims to have a greater emphasis on prevention,address local needs, accelerate improvement and reduce inequity.MethodologyEngagement with local practices and other local provider services, feedback from patients and discussionswith national and international experts in health care quality improvement provided insights whichinformed the development of the scheme.A number of existing QOF indicators were identified as candidates that might benefit from additionalincentivisation through the provision of revised upper targets. Indicator selection was weighted towardsthose whose attainment confers significant potential health benefits at a population level and wherecurrent attainment in Hammersmith and Fulham is below that seen nationally.Potential sources for new indicator areas were identified and prioritised on the basis of being both localand national priorities. These were subjected to a structured consultation with local stakeholders to selectareas for indicator development for the first year of the scheme through a consensus process.Literature reviews of the evidence base were undertaken for each selected indicator area to informdevelopment of indicators.Proposed new indicators were assessed using the Organisation for Economic Cooperation andDevelopment (OECD) criteria of importance, scientific soundness and feasibility. Each indicator was alsoassessed for clarity. This assessment was informed by the views of local practices, a local stakeholderpanel (through a structured consultation with the aim of achieving consensus for the clinical and recordsdomains), local provider services and national and international experts in the proposed indicator areas.
Page 1: Towards world class healthcare for
Page 6 and 7: QOF+ report on breastfeeding ......
Page 8 and 9: QOF+ report on patient safety .....
Page 10 and 11: CreditsProject boardJosip CarMiles
Page 12: AcknowledgementsWe are indebted to
Page 18: Support with QOF+If you have a prob
Page 22 and 23: The quality and outcomes framework
Page 24 and 25: Effect of measurement on health ine
Page 26 and 27: How might a local QOF operate in pr
Page 28 and 29: Doran T, Fullwood C, Kontopantelis
Page 30 and 31: Continued…QOFQOF+IndicatorUpperTh
Page 32 and 33: Alcohol Chapter 4 (p27)IndicatorQOF
Page 34 and 35: RecordsIndicator+ PRESCRIPTION 1. T
Page 36 and 37: Patient experience Chapter 12 (p77)
Page 39 and 40: C3QOF+ report on cardiovasculardise
Page 41 and 42: Creation of practice CVD at-risk re
Page 43 and 44: achieved through primary prevention
Page 45 and 46: Workload and training implicationsI
Page 47 and 48: QOF+ report on alcoholProposed indi
Page 49 and 50: Local contextThe Hammersmith and Fu
Page 51 and 52: Workload and training implicationsR
Page 53 and 54: QOF+ report on smokingProposed indi
Page 55 and 56: Local context24% of adults (35,000)
Page 57: ReferencesBritish Medical Associati
Page 60 and 61: The NICE Clinical Guideline on Ante
Page 62 and 63: Health impactThere are significant
Page 65 and 66:
QOF+ report on breastfeedingPropose
Page 67 and 68:
Local contextIn 2006/7, the percent
Page 69 and 70:
Degree of perceived professional co
Page 71 and 72:
QOF+ report on ethnicityProposed In
Page 73 and 74:
Associated Morbidity and MortalityT
Page 75:
Workload and training implicationsP
Page 78 and 79:
Priority and relevance to national
Page 80 and 81:
Specific reasons for this framework
Page 82 and 83:
Workload and training implicationsT
Page 85 and 86:
QOF+ report on newpatient screening
Page 87 and 88:
Review of evidence to support the p
Page 89 and 90:
QOF+ report onpatient informationPr
Page 91 and 92:
Priority and relevance to national
Page 93 and 94:
Degree of perceived support from pa
Page 95 and 96:
ReferencesCarpenter A and Mayers A
Page 97 and 98:
QOF+ report onpatient experiencePro
Page 99 and 100:
Rosen et al. (2001) categorised ini
Page 101 and 102:
The National 2007 Quality and Outco
Page 103:
ReferencesBaker, R (2007) Quality a
Page 106 and 107:
BackgroundThe United Nations Conven
Page 108 and 109:
In March 2008, a PCT audit of signi
Page 110 and 111:
Impact on health inequalitiesPovert
Page 112 and 113:
Training and support requirements f
Page 114 and 115:
Information on self-directed online
Page 116 and 117:
New patient screeningProposed train
Page 118 and 119:
Patient experienceLearning disabili
Page 120 and 121:
Appendix 1Background to the QOF+ de
Page 122 and 123:
Appendix 2Methodology for the exten
Page 124 and 125:
PrevalenceRegistersizeAsthma 5.75%
Page 126 and 127:
While both threshold types are remu
Page 128 and 129:
The low level of remuneration for c
Page 130 and 131:
Exception reportingMany QOF (and a
Page 132 and 133:
indicators compared to national rat
Page 134 and 135:
114
Page 136 and 137:
Appendix 3Current levels of attainm
Page 138 and 139:
Percentage of practices at or below
Page 140 and 141:
Page 142 and 143:
Page 144 and 145:
Page 146 and 147:
Page 148 and 149:
Page 150 and 151:
Appendix 4Methodology for the desig
Page 152 and 153:
As a result of the prioritisation p
Page 154 and 155:
Methodology for the development of
Page 156 and 157:
Assessment of new clinical and reco
Page 158 and 159:
Communication with the PCT’s heal
Page 160 and 161:
Appendix 5Methodology for the devel
Page 162 and 163:
Appendix 6Summary of the QOF+ schem
show all

QOF Plus Year 1 - Imperial College London

Create successful ePaper yourself

Delete template?

Save as template?