QOF Plus Year 1 - Imperial College London
QOF Plus Year 1 - Imperial College London QOF Plus Year 1 - Imperial College London
Continued…Indicator+ PATIENT EXPERIENCE 8. The practice has a system in place for taking thespecial needs of carers into account, including when allocatingappointments and issuing prescriptions+ PATIENT EXPERIENCE 9. A named carer is recorded for at least 90% ofpatients on the learning disability register+ PATIENT EXPERIENCE 10. The practice scores better than the nationalaverage on the local response to the statement “I waited more than 2working days for a GP appointment” posed as part of the national patientsatisfaction survey+ PATIENT EXPERIENCE 11. The practice scores better than the nationalaverage on the local response to the question “Have you had a problemgetting through to your GP practice/health centre on the phone?” posed aspart of the national patient satisfaction surveyQOF+points552020BackgroundA recent comprehensive review by Coulter and Ellins (2006) highlights that “measurement ofpatients’ experience is a useful component of a broader quality improvement strategy” and that“there is an association between poor quality experience and worse health outcomes.” Theproposed patient experience indicators therefore form an integral part of the Hammersmith andFulham primary care quality improvement strategy.The ‘inverse care law’ refers to the reduced availability and utilisation of services by those withthe greatest need (Hart, 1971). This has serious consequences for both individual and society,reducing the effectiveness and outcomes of healthcare while costs increase. Given this, there is astrong imperative to find ways of facilitating and broadening access (Coulter and Ellins, 2006).Chapman et al. 2004 describe four dimensions of healthcare access: availability, utilisation,relevance and effectiveness, and equity. These are:Availability describes the supply side of health services; whether resources are suppliedadequately and in proportion to need.Utilisation refers to the use of health services, indicating the degree of fit between userand the healthcare system. Measures the extent to which the health serviceaccommodates the patient and community served, and includes dimensions of usability,acceptability and affordability.Relevance and acceptability measure whether the right service is provided to adequatelyaddress the health needs of the target population and whether it has been developed totake into account the local socio-cultural setting.Equity is a social justice dimension indicating the extent to which resources are mobilisedto reflect need in a given population.78
Rosen et al. (2001) categorised initiatives to improve access to healthcare in terms of absoluteand relative strategies. The aim of absolute strategies is to increase the overall availability ofservices. Relative strategies aim to reduce inequalities and improve fairness. The relativestrategies adopted through the proposed indicators specifically target groups including ethnicminority groups and people with learning or physical disabilities) for whom services are known tobe inadequate, inappropriate or difficult to make use of.The recently published results for the 2007/8 Picker Institute Patient Survey identified twoparticular areas where performance in Hammersmith and Fulham is poor compared to theaverage performance of the 69 Picker Institute Trusts participating in the Patient Survey. Theseareas are ‘Making an Appointment’ and ‘Seeing a Doctor’. The proposed indicators have beendesigned to support practices in focussing on these areas.Priority and relevance to national policyThe concepts of patient experience and patient-centredness in healthcare have becomeincreasing prominent over the last decade and this has been increasingly reflected in nationalDepartment of Health national policy and national guidance. Correspondingly, the measurementof aspects of patient experience, including patient experience of access, has featured in the KeyPerformance Indicators of the Healthcare Commission and there are indicators relating to patientexperience in the national Quality and Outcomes Framework.Local contextA high proportion of children speak English as an additional language in Hammersmith andFulham – 45% at primary school (ranging from 6% to 67% between schools) and 39% atsecondary school (ranging from 7% to 56% between schools). 158 languages are spoken bychildren who attend local schools. After English, the main languages are Somali and Arabic(Zeuner, 2008).A relatively high percentage of residents in Hammersmith and Fulham (22%) are from non-whiteethnic groups. The largest non-white ethnic groups are Black Caribbean and Black African (both4.4%) (Zeuner, 2008).There are a total of 10,850 residents on disability registers in Hammersmith and Fulham. Ofthese, 350 are registered as deaf or hard of hearing and 470 are registered with a learningdisability. In terms of health deprivation and disability, around 17% of the population live withinthe most deprived fifth of areas nationally (Zeuner, 2008).Seven percent of people (11,600 people) in Hammersmith and Fulham provide unpaid care. Ofthese, almost 2,000 people provide care for at least 50 hours per week. The profile of carers inHammersmith and Fulham is similar to that in England. Adults in their fifties are most likely to beproviding care, with more than 20% doing so. A greater proportion of women than men arecarers providing care to a partner or relative (Zeuner, 2008).79
- 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: QOF+ report onpatient experiencePro
- 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: Percentage of practices at or below
- Page 142 and 143: Percentage of practices at or below
- Page 144 and 145: Percentage of practices at or below
- Page 146 and 147: Percentage of practices at or below
Continued…Indicator+ PATIENT EXPERIENCE 8. The practice has a system in place for taking thespecial needs of carers into account, including when allocatingappointments and issuing prescriptions+ PATIENT EXPERIENCE 9. A named carer is recorded for at least 90% ofpatients on the learning disability register+ PATIENT EXPERIENCE 10. The practice scores better than the nationalaverage on the local response to the statement “I waited more than 2working days for a GP appointment” posed as part of the national patientsatisfaction survey+ PATIENT EXPERIENCE 11. The practice scores better than the nationalaverage on the local response to the question “Have you had a problemgetting through to your GP practice/health centre on the phone?” posed aspart of the national patient satisfaction survey<strong>QOF</strong>+points552020BackgroundA recent comprehensive review by Coulter and Ellins (2006) highlights that “measurement ofpatients’ experience is a useful component of a broader quality improvement strategy” and that“there is an association between poor quality experience and worse health outcomes.” Theproposed patient experience indicators therefore form an integral part of the Hammersmith andFulham primary care quality improvement strategy.The ‘inverse care law’ refers to the reduced availability and utilisation of services by those withthe greatest need (Hart, 1971). This has serious consequences for both individual and society,reducing the effectiveness and outcomes of healthcare while costs increase. Given this, there is astrong imperative to find ways of facilitating and broadening access (Coulter and Ellins, 2006).Chapman et al. 2004 describe four dimensions of healthcare access: availability, utilisation,relevance and effectiveness, and equity. These are:Availability describes the supply side of health services; whether resources are suppliedadequately and in proportion to need.Utilisation refers to the use of health services, indicating the degree of fit between userand the healthcare system. Measures the extent to which the health serviceaccommodates the patient and community served, and includes dimensions of usability,acceptability and affordability.Relevance and acceptability measure whether the right service is provided to adequatelyaddress the health needs of the target population and whether it has been developed totake into account the local socio-cultural setting.Equity is a social justice dimension indicating the extent to which resources are mobilisedto reflect need in a given population.78
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