1. QOF Changes 2015/16 Kate Pilton Development Manager

2. Introduction As part of the 2015/16 GMS contract changes, NHS Employers and the General Practitioners Committee (GPC) of the BMA agreed a number of changes to QOF effective from 1 April 2015 The threshold changes planned for 1 April 2015 have been deferred for one year to 1 April 2016

3. Introduction Changes to Clinical Domain – Atrial Fibrillation – Coronary Heart Disease – Dementia – Chronic Kidney Disease Changes to Public Health Domain – Obesity

4. QOF Point Value/List Size An adjustment to the value of a QOF point value for 2015/16 taking account of population growth and relative changes in practice list size from 1 January 2014 to 1 January 2015 The national average list size as of 1 January 2015 is 7,233 and the value of a QOF point for 2015/16 will be £160.12

5. QOF Point Value/List Size QOF Point Value 2015/16£160.12 2014/15£156.92 England Average List size 2015/167233 2014/157052 2013/14 6911 2004/135891

6. List Size & Prevalence List size measured on the first day of each quarter Clinical indicators National Prevalence Day, 31 March

7. List Size & Prevalence Practice List Size/National Average List Size X Practice Disease Prevalence/National Average Disease Prevalence X £160.12 = £’s per point

8. Prevalence www.gpcontract.co.uk S1 Prevalence

9. Guidance Click here to download guidance

10. Summary of Changes Click here to download summary

11. Business Rule Sets V31 http://www.hscic.gov.uk/qofbrv31

12. Clinical Domain Changes

13. Atrial Fibrillation (AF) Retired – AF005 In those patients with atrial fibrillation in whom there is a record of a CHADS2 score of the percentage of patients who are currently treated with anti-coagulation drug therapy or antiplatelet therapy – Was 6 points

14. Atrial Fibrillation (AF) New indicator – AF006 The percentage of patients with atrial fibrillation in whom stroke risk has been assessed using the CHA2DS2-VASc score risk stratification scoring system in the preceding 12 months (excluding those patients with a previous CHADS2 or CHA2DS2-VASc score of 2 or more) – 12 points – Thresholds 40-90

15. Atrial Fibrillation (AF) The scoring system recommended is CHA2DS2-VASc, which is validated and gives a score that allows a better stratification of low-risk patients than the CHADS2 score There is a clinical benefit in using a stroke risk score to identify patients at risk The review of cohort studies found that there may be a slight benefit of CHA2DS2-VASc over the other scores considered (CHADS2, ACCP and the ACC/AHA/ESC)

16. Atrial Fibrillation (AF) Replacement – AF004 In those patients with atrial fibrillation whose latest record of a CHADS2 score is greater than 1, the percentage of patients who are currently treated with anti-coagulation therapy – 6 points Replaced with – AF007 In those patients with atrial fibrillation with a record of a CHA2DS2-VASc score of 2 or more, the percentage of patients who are currently treated with anticoagulation drug therapy – 12 points – Thresholds remain the same 40-70

17. Secondary Prevention of Coronary Heart Disease (CHD) Retirement – CHD006 The percentage of patients with a history of myocardial infarction (on or after 1 April 2011) currently treated with an ACE-I (or ARB if ACE-I intolerant), aspirin or an alternative anti-platelet therapy, beta-blocker and statin – Was 10 points

18. Dementia (DEM) Wording & points change – DEM002 now DEM004 – The percentage of patients diagnosed with dementia whose care plan has been reviewed in a face-to-face review in the preceding 12 months – Was 15 points now 39 points – Thresholds remain the same 35-70

19. Dementia (DEM) Wording & timeframe change – DEM003 now DEM005 – The percentage of patients with a new diagnosis of dementia recorded in the preceding 1 April to 31 March with a record of FBC, calcium, glucose, renal and liver function, thyroid function tests, serum vitamin B12 and folate levels recorded between 12 6 months before or 6 months after entering on to the register

20. Dementia (DEM) Where a patient does not already have a care plan or an advanced care plan in place, it is expected that the practice will develop a care plan The face-to-face care plan or advanced care plan review focuses on support needs of the patient and their carer

21. Dementia (DEM) In particular the review should address the following key issues: – An appropriate physical, mental health and social review for the patient – A record of the patients’ wishes for the future – Communication and co-ordination arrangements with secondary care (if applicable)

22. Dementia (DEM) Identification of the patients’ carer(s); and 1.Obtain appropriate permissions to authorise the practice to speak directly to the nominated carer(s) and provide details of support services available to the patient and their family, if applicable, the carer’s needs for information commensurate with the stage of the illness and his or her and the patient’s health and social care needs 2.As appropriate, the carer should be included in the care plan or advanced care plan discussions 3.If applicable, the impact of caring on the care-giver 4.Offer the carer a health check to address any physical and mental health impacts, including signposting to any other relevant services to support their health and wellbeing

23. Chronic Kidney Disease (CKD) Wording change – CKD001 now CKD005 – The contractor establishes and maintains a register of patients aged 18 or over with CKD (US National Kidney Foundation) with classification of categories G3a to G5 (previously stage 3 to 5)

24. Chronic Kidney Disease (CKD) The NICE guideline on CKD recommends that CKD should be classified using a combination of GFR and ACR categories The 2014/15 indicator CKD001 recommended classification using the US National Kidney Foundation classification system The classification system for CKD was included in the scope for the guideline update and as a result of this work, the staging system was replaced with a system that classifies GFR and ACR by categories This was to systematically take into account proteinuria when considering GFR So the terminology within the guideline recommendations now refers to categories rather than stages

26. Chronic Kidney Disease (CKD) Retired – CKD002 The percentage of patients on the CKD register in whom the last blood pressure reading (measured in the preceding 12 months) is 140/85 mmHg or less (11 points) – CKD003 The percentage of patients on the CKD register with hypertension and proteinuria who are currently treated with an ACE-I or ARB (9 points) – CKD004 The percentage of patients on the CKD register whose notes have a record of a urine albumin:creatinine ratio (or protein:creatinine ratio) test in the preceding 12 months (6 points)

27. Public Health Domain Changes

28. Obesity (OB) Wording change OB001 now OB002 – The contractor establishes and maintains a register of patients aged 18 16 years or over with a BMI ≥30 in the preceding 12 months – 8 points (no change)

29. Questions

30. Contact Details kate.pilton@lpft.nhs.uk www.lincslmc.co.uk 01522 576659

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