QOF Plus Year 1 - Imperial College London

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How might a local QOF operate in practice?There is ongoing debate about how a local QOF could work in practice. The Department of Healthhas proposed that to help address local health needs more effectively, PCTs should be able toselect local indicators from a national menu of indicators, for use in local voluntary incentiveschemes (DoH, 2008).An alternative is for indicators to be developed locally by PCTs. However, there are practicallimitations associated with this approach including:the need for technical expertise in the development of evidence-based indicators andbusiness rules for extraction of clinical data from GP systems;the IM&T support required to extract data from clinical systems and to link this withpayment calculations (DoH, 2008).Why have a local QOF for Hammersmith and Fulham?Evaluations of recently introduced LES and local Shared Care schemes (including CVD PrimaryPrevention, Smoking Cessation and Alcohol) in Hammersmith and Fulham highlighted a numberof problems with these schemes, in terms of their complexity and design and the level of uptakeby practices. These highlight a need for widespread implementation in a way that is easilyunderstood. There is also a need to reduce health inequalities and recognition that QOF may be avehicle to achieve this. Although it has been proposed that PCTs should have flexibility to selectlocal indicators from a national menu published by NICE, the infrastructure required to supportdevelopment of local QOFs through this approach is not anticipated to be in place until 2011/12at the earliest (DoH, 2008). It was therefore proposed that NHS Hammersmith and Fulham woulddevelop a local QOF scheme to run initially for 3 years from 2008/9-2010/11, with technicalexpertise in indicator development being provided by the Department of Primary Care and SocialMedicine at Imperial College London in conjunction with national and international experts in thisfield, and IM&T support being provided by the PCT’s Health Informatics Team.The need for clinical engagementEffective local clinical engagement is crucial to the success of service improvement initiatives andits integral role has been highlighted in the competencies of World Class Commissioning (DoH,2008) and by The NHS Alliance (2003) which states that “front-line clinical staff should beeffectively involved in redesign, service provision and in ensuring services are used costeffectively.”The NHS Alliance further highlights that the engagement of front-line professionalsat a strategic level would allow PCTs to draw on a bank of untapped knowledge resulting from thewider experiences of primary care. The involvement of local practices in helping shape QOF+ wastherefore seen as a central element of the design and development of the scheme.6
AimsThis paper describes the design and development of a local QOF for Hammersmith and Fulhamwhich is in line with current national guidance, developed through the process of effective clinicalengagement and which aims to have a greater emphasis on prevention, address local needs,accelerate improvement and reduce inequity.ReferencesAshworth M, Medina J, Morgan M (2008). Effect of social deprivation on blood pressure monitoringand control in England: a survey of data from the "quality and outcomes framework." British MedicalJournal 337:a2030Baker D, Middleton E (2003) Cervical screening and health inequality in England in the 1990s.Epidemiological Community Health 57:417-23.Campbell S, Reeves D, Kontopantelis E, Middleton E, Sibbald B, Roland M. Quality of Primary Care inEngland with the Introduction of Pay for Performance (2007). New England Journal of Medicine357:181-90.Darzi A (2008) High Quality Care for All, the final report of the NHS Next Stage Review Final Report byLord Darzi The Stationary Office. LondonDepartment of Health (2008) Developing the Quality and Outcomes Framework: Proposals for a new,independent process. [Online, Accessed November 03 2008] Available at:http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_089778Department of Health (2008) World Class Commissioning. [Online, Accessed August 10 2008] Availableat:http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/index.htm7
Page 1: Towards world class healthcare for
Page 6 and 7: QOF+ report on breastfeeding ......
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Page 10 and 11: CreditsProject boardJosip CarMiles
Page 12: AcknowledgementsWe are indebted to
Page 15 and 16: Executive summaryIntroductionPrevio
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
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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
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Page 55 and 56: Local context24% of adults (35,000)
Page 57: ReferencesBritish Medical Associati
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Page 62 and 63: Health impactThere are significant
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Page 67 and 68: Local contextIn 2006/7, the percent
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Priority and relevance to national
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Specific reasons for this framework
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Workload and training implicationsT
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QOF+ report on newpatient screening
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Review of evidence to support the p
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QOF+ report onpatient informationPr
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Priority and relevance to national
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Degree of perceived support from pa
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ReferencesCarpenter A and Mayers A
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QOF+ report onpatient experiencePro
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Rosen et al. (2001) categorised ini
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The National 2007 Quality and Outco
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ReferencesBaker, R (2007) Quality a
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BackgroundThe United Nations Conven
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In March 2008, a PCT audit of signi
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Impact on health inequalitiesPovert
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Training and support requirements f
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Information on self-directed online
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New patient screeningProposed train
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Patient experienceLearning disabili
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Appendix 1Background to the QOF+ de
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Appendix 2Methodology for the exten
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PrevalenceRegistersizeAsthma 5.75%
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While both threshold types are remu
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The low level of remuneration for c
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Exception reportingMany QOF (and a
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indicators compared to national rat
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114
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Appendix 3Current levels of attainm
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Percentage of practices at or below
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Appendix 4Methodology for the desig
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As a result of the prioritisation p
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Methodology for the development of
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Assessment of new clinical and reco
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Communication with the PCT’s heal
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Appendix 5Methodology for the devel
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Appendix 6Summary of the QOF+ schem
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QOF Plus Year 1 - Imperial College London

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