1. CLINICAL GOVERNANCE LEADS MEETING
DECEMBER 2007
QOF

2. 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

3. 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

4. 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)

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

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

8. 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

9. 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

10. 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

11. 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

12. New Queries/Clarification
QOF queries
New Queries/Clarification

13. 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

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

15. 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

16. 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