QOF Plus Year 1 - Imperial College London
QOF Plus Year 1 - Imperial College London QOF Plus Year 1 - Imperial College London
Assessment of new clinical and records indicatorsStructured consultation with local stakeholders drawn from the PCT and from primary care wasused further inform indicator development. As part of this consultation, local stakeholders wereasked to assess each proposed new indicator in the clinical and records domains using the OECD(Organisation for Economic Co-operation and Development) criteria of importance, scientificsoundness and feasibility as defined above (Marshall et al., 2004), and also to assess eachindicator for clarity. Each indicator was rated using a 9-point Likert scale. Local stakeholders werealso asked to comment on any aspect of the indicator – including wording of the indicator andproposed thresholds.The consultation method used incorporated aspects of both the Delphi Technique and the RANDAppropriateness Method as described above. After obtaining questionnaire responses from thelocal stakeholder panel in the first round, a second round of structured consultation was used toachieve consensus among respondents. Respondents were provided with a summary of thepanel’s responses from the first round and asked to consider their own responses in light of this,rating each indicator again using the same method as in the first round.As a result, all proposed new indicators were rated by the panel as scientifically sound, relevant,feasible and clear, and consensus was achieved for all indicators.Assessment of new indicators in non-clinical domainsThe process of assessment was informed by consultation with practices on the group’s QOF+proposals for non-clinical indicators. Feedback received from practices was used by the QOF+Development Group to help assess the indicators further in terms of acceptability, importance,soundness (face-validity), feasibility and clarity of the proposed indicators.Response to feedback on proposed new indicatorsA number of proposed indicators were assessed by the group as being either not acceptable topractices, not sound in terms of face validity or not feasible, following internal review and takingaccount of feedback from practices and from local and national experts. These includedindicators in the patient experience and patient safety domains. These indicators weresubsequently removed.There is currently much debate in the literature about the value of paying practices according tothe results of patient surveys, with concern about the potential perverse effects associated withthis approach (Elwyn et al. 2007). Concerns about indicators relating to the results of patientsurveys were also expressed locally by a number of practices as part of the consultation process.This stimulated further debate within the QOF+ Development Group relating to the justificationfor inclusion of these indicators. As a result, these indicators were removed. However, during thefinal phases of the QOF+ development process, the results of the Picker Institute Patient Surveyfor Hammersmith and Fulham were published, and these showed that Hammersmith and Fulhampractices were performing below the national average for areas relating to patient access,including being seen within 48 hours, and experiences with getting through to practices on thephone. As a result, the PCT considered inclusion of indicators relating to the results of a localpractice Picker Institute patient survey for these two dimensions compared with the national136
average. It was felt that including these indicators in a local QOF would not be out of line with thedirection of travel nationally, and that they should be seen as one aspect of a broader approachincorporating indicators relating to patient survey feedback sessions and evidence ofimplementing actions in low scoring areas. The QOF+ Development Group sought further adviceon this issue from Professor Richard Baker, who chaired the national QOF patient experienceexpert group which formed part of the QOF Review (Lester, 2006). Professor Baker supported thePCT’s proposed approach.Final consultation with local practicesDuring the final month of the scheme’s development, the QOF+ Development Group consultedwith practices (GPs, practice nurses and practice managers) on the group’s QOF+ proposalsthrough regular consultation conducted through email.Methodology for point allocation for the new QOF+ indicatorsThe QOF+ Development Group provided recommendations for QOF+ point allocations. This wasinformed by considering point allocations for comparable existing QOF indicators, currentachievement of QOF indicators by practices in Hammersmith and Fulham, and perceivedworkload implications for practices.In addition, a structured consultation with local stakeholders was used to inform the process ofpoint allocation for the clinical and records indicators, consistent with the methodology used inthe national Quality and Outcomes Framework (National Primary Care Research andDevelopment Centre, 2008). The local stakeholders were drawn from the PCT (including the LocalDirector of Public Health and Medical Director), public health and primary care, and included alocal GP, practice nurse and practice manager. The QOF+ Development Group also made somemodifications to the wording of indicators, incorporating feedback from the structuredconsultation of local stakeholders.The local Director of Public Health and Medical Director approved the final allocation of QOF+points, in accordance with the guidance from the NHS Primary Care Contracting Website (PrimaryCare Contracting, 2008) which states“There is no set workload represented by a QOF point. However, any local frameworksused by PMS contractors should be comparable to the National QOF in terms of the workneeded to earn the same amount of money. A senior clinician, probably the localDirector of Public Health, needs to make this judgement.”137
- 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
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- Page 136 and 137: Appendix 3Current levels of attainm
- Page 138 and 139: Percentage of practices at or below
- Page 140 and 141: Percentage of practices at or below
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- Page 150 and 151: Appendix 4Methodology for the desig
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- Page 160 and 161: Appendix 5Methodology for the devel
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average. It was felt that including these indicators in a local <strong>QOF</strong> would not be out of line with thedirection of travel nationally, and that they should be seen as one aspect of a broader approachincorporating indicators relating to patient survey feedback sessions and evidence ofimplementing actions in low scoring areas. The <strong>QOF</strong>+ Development Group sought further adviceon this issue from Professor Richard Baker, who chaired the national <strong>QOF</strong> patient experienceexpert group which formed part of the <strong>QOF</strong> Review (Lester, 2006). Professor Baker supported thePCT’s proposed approach.Final consultation with local practicesDuring the final month of the scheme’s development, the <strong>QOF</strong>+ Development Group consultedwith practices (GPs, practice nurses and practice managers) on the group’s <strong>QOF</strong>+ proposalsthrough regular consultation conducted through email.Methodology for point allocation for the new <strong>QOF</strong>+ indicatorsThe <strong>QOF</strong>+ Development Group provided recommendations for <strong>QOF</strong>+ point allocations. This wasinformed by considering point allocations for comparable existing <strong>QOF</strong> indicators, currentachievement of <strong>QOF</strong> indicators by practices in Hammersmith and Fulham, and perceivedworkload implications for practices.In addition, a structured consultation with local stakeholders was used to inform the process ofpoint allocation for the clinical and records indicators, consistent with the methodology used inthe national Quality and Outcomes Framework (National Primary Care Research andDevelopment Centre, 2008). The local stakeholders were drawn from the PCT (including the LocalDirector of Public Health and Medical Director), public health and primary care, and included alocal GP, practice nurse and practice manager. The <strong>QOF</strong>+ Development Group also made somemodifications to the wording of indicators, incorporating feedback from the structuredconsultation of local stakeholders.The local Director of Public Health and Medical Director approved the final allocation of <strong>QOF</strong>+points, in accordance with the guidance from the NHS Primary Care Contracting Website (PrimaryCare Contracting, 2008) which states“There is no set workload represented by a <strong>QOF</strong> point. However, any local frameworksused by PMS contractors should be comparable to the National <strong>QOF</strong> in terms of the workneeded to earn the same amount of money. A senior clinician, probably the localDirector of Public Health, needs to make this judgement.”137
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