QOF Plus Year 1 - Imperial College London

tight timescale of this project, it was beyond the scope of QOF+ to incorporate all the LESschemes currently offered by the PCT. However, it was felt that it would be feasible to considerinclusion of selected existing LES schemes which were more likely to fit into the QOF+ framework.The LES which were considered for inclusion within QOF+ for year 1 included CVD PrimaryPrevention, Smoking Cessation, Immunisations and Choose and Book (which was underdevelopment by the PCT).Following further discussion, it was decided to:consider adapting the existing CVD Primary Prevention and immunisations LES for QOF+,stop development of new indicators for Choose and Book through QOF+ as there wasalready a proposed LES for this and there were practical issues around indicatordevelopment (e.g. most GPs do not read-code referrals so it would be difficult to use anindicator to evaluate what percentage of referrals were made through Choose andBook), and toconsider development of indicators for smoking cessation in parallel to the existing LESon smoking cessation.Following review of the long list, it was agreed that areas that were already incorporated into thenational QOF should not be included as new indicators for the clinical domains of QOF+, but couldinstead be considered in terms of raising thresholds of the existing indicators. These areas includeheart failure, CVD, hypertension, stroke, diabetes, COPD, CKD, mental health, dementia, palliativecare (BMA, 2006).Remaining indicator areas were classified using the OECD framework of Health Promotion,Preventative Care, and Diagnosis and Treatment (Marshall et al., 2004), as well as the followingdomains of quality: Patient-centredness/Empowerment, Organisational and Safety. A decisionwas initially taken not to include organisational indicators or indicators related to primary careaccess within QOF+, in view of the presence of this area within the national QOF, and in view ofthe limited timescale for roll-out of the scheme. In addition, the QOF+ Development Group wasaware of the possibility that incentive arrangements for organisational quality through thenational QOF may change as a result of the roll-out of practice accreditation schemes including ascheme developed by the Royal College of General Practitioners (National Primary Care Researchand Development Centre, 2008).However, additional funding for QOF+ became available at a later stage of the project, and it wasthen decided to incorporate aspects of the Imperial College Data Quality project into QOF+.Additional domains relating to patient experience, patient safety, patient information and patientregistration (new patient screening for Tuberculosis) were developed further by NHSHammersmith and Fulham using a separate methodology.131