QOF Plus Year 1 - Imperial College London

Workload and training implicationsIncreased workload for primary care teams will be a key issue. This workload will result from theinformation gathering process and the increased contact between primary care practitioners andpatients identified at increased CVD risk. In the long term, there may be a possible reduction inworkload as the identification and management of patients at increased CVD risk may lead toreduced presentation of problems at a later stage.General practice records are now universally computerised and are likely to contain much of theinformation necessary to generate a prior estimate of cardiovascular risk based on existing data(e.g. smoking status, blood pressure and serum lipid profiles) in a high proportion of people(Hobbs et al., 2007). Missing data can be estimated from age- and sex-specific values drawn frompopulation surveys (Marshall, 2006), and automated computer-based risk calculators could beintroduced.The NICE Guideline on Lipid Modification (Cooper et al., 2008) suggests that “using therecommended CVD risk equations, a prior estimate of CVD risk based on pre-existing informationcan be obtained and the practice population can be ranked from highest to lowest risk.” It isproposed that Oberoi software is used to generate a CVD At-Risk Register, using a systematicstrategy to identify asymptomatic people between the ages of 32-74 without diabetes andwithout CVD but who are likely to have a high (20% or greater) 10-year risk of developing CVD(formally estimated through computerized Framingham 1991 10-year risk equations, using CVDrisk factors already documented in their primary care medical records). Starting with those athighest risk, the practice would then invite people to attend for a formal clinical assessment andrisk factor estimation based on the measurement of blood pressure, lipids and current smokingstatus and taking account of other relevant factors such as family history, ethnicity and social orclinical circumstances. Training will be required for primary care staff in cardiovascular riskassessment and communication of risk. The practice will retain responsibility for the creation ofthe CVD at-risk register, which will be dynamic and will require continual updating. However,additional PCT support for this process will be available.In order to evaluate the inclusion in QOF+ of indicators relating to CVD primary prevention, it isimportant for practices to submit anonymised data for this purpose (e.g. uptake of screening byage group, sex, ethnic group, deprivation etc; distribution of risk factors by patient group;changes in risk factors over time; economic appraisal). For details of the proposed training package see section 14.3.1 (p92).25