CLINICAL GOVERNANCE LEADS MEETING 11 +12 DECEMBER 2007 QOF

QOF Profiling Reviews All Practices profiled during July on 2006/7 data Qmas, qof, prevalence, exceptions, apollo, admissions, referals, prescribing Practices asked to respond to questions raised by the profiling +/- arranged visit

QOF Profiling Review Outcome 2007/8 11 QOF Review Visits 6 former Bedford 5 former Heartlands 7 Informal Practice Visits 3 former Bedford 4 former Heartlands

QOF Profiling: submission evidence To ensure a consistent approach: all practices were asked to submit 2 examples of a Mental Health, Cancer and Dementia annual review. (unless already validated from visits etc)

Results What % of submitted reviews met the Brown Book Standards? Mental Health Reviews - 53% Cancer - 61% Dementia - 45%

Some issues raised Prevalence Exception codes Coding issues +/- IT issues Not providing enough data to evidence a claim

Low Prevalence? Practice audits discovered following reasons for low prevalence:- Demographics Read Code not used or not recognised by QMAS Patients with the disease but not on the register CKD ! Event type needs to be first ever or new event – particularly for Cancer, Depressions, CHD (for MIs), CKD and Stroke

Exceptions EMIS Templates designed in such a way that exceptions codes (particularly Maximum Tolerated) can be easily entered without clinician realising exception code has been added to the record Isoft Template error excepting patients for stroke/AF

Exceptions Use of max tolerated codes, especially epilepsy and hypertension Use of blanket computer searches to identify and except people Remember – each exception MUST be an individual judgement with regards to that patient Remember – to explain in the clinical record why you have applied that exception to that patient

Exceptions Use of patient unsuitable instead of informed dissent Coding at incorrect level – excepting at high level rather than individual indicators Remember – each exception MUST be an individual judgement with regards to that patient Remember – to explain in the clinical record why you have applied that exception to that patient

New Queries/Clarification QOF queries New Queries/Clarification

QOF Queries ‘New’ codes for Dementia annual review and MH dna – you may need to amend codes you have already applied Depression 1 – the two question must be asked face to face (not validated when asked by letter). Remove any codes added in response to letter Depression 2 - check your prevalence - should be 7-10% ish, Episode type for Cancer, Depression, CHD (MIs) CKD and Stroke

Medicines 11 & 12 Brown Book 06/07 different guidance to Blue Book 04/05 Brown Book states …

Medication Reviews Med 11 & 12 All patients should have the chance to raise questions and highlight problems about their medicines Medication review improve or optimises impact of treatment on pt Review undertaken in systematic way by a competent person Any changes resulting from review are agreed with patients Review documented in patient notes Impact of changes monitored

Medication Reviews Med 11 & 12 All patients should have the chance to raise questions and highlight problems about their medicines Medication review improve or optimises impact of treatment on pt Review undertaken in systematic way by a competent person Any changes resulting from review are agreed with patients Review documented in patient notes Impact of changes monitored