The business rules for the QOF are rather murky place and I am grateful to a couple of people who have pointed out some odd things happening in the smoking cessation areas
Just as a reminder smoking cessation advice now applies to all patients in the practice who are over 15 years old and smoke. There is a difference between those with chronic disease and those without that those with chronic disease should have the advice annually (well, within 15 months of the end of the QOF year) and those without within two years (27 months). So for this year the smoking cessation advice requirements applied since January 2011, or 14 months before the business rules actually came out.
Despite fairly minimal change to the wording the actual smoking cessation indicator has changed. Two codes are now needed to pass this indicator. One code from each of the two following groups. The fist group is basically the same codes as before. The patient should receive advice or be referred or pointed to self referral to a smoking cessation clinic.
|8CAL||Smoking Cessation Advice|
|8HTK||Referral to stop smoking clinic|
|8HkQ||Referral to NHS stop smoking service|
|8H7i||Referral to smoking cessation advisor|
|8IAj||Smoking cessation advice declined|
|8IEK||A declined code|
|9N2K||Seen by smoking cessation advisor|
|13p50||Practice based smoking cessation programme start date|
|9Ndf||Consent given for follow up by smoking cessation team|
|9Ndg||Declined consent for follow up by smoking cessation team|
This is all pretty sensible. Most of the evidence points to a good smoking cessation clinic improving quit rates. However there is now a second part that requires a prescription to be issued. Note in both these areas there is a declined code. I use EMIS PCS at work and the declined codes are not yet available on the system. That is 17 months after they could first require to be entered.
|745H||Smoking cessation therapy (and all its subtypes)|
|8B3f||Nicotine replacement therapy provided free|
|8B2b||Nicotine replacement therapy|
|8B3Y||Over the counter nicotine replacement therapy|
|8IEM||A declined code|
|Rx||Smoking cessation product prescription|
Quite how this helps anything is beyond me. We have a local smoking cessation clinic that does not (or nor does it need to) inform me every time they advice someone to get some patches at the chemist. Logically the most sensible thing for me to do would be to throw patches at patients like confetti. This is likely expensive for my PCT/CCG and, in the curse of QOF, it seems that nicotine therapy may actually reduce quit rates.
Even the evidence quoted in the official guidelines is confused and muddled.
It would be nice if these retrospective changes were corrected in the next ruleset although past experience suggests that this is policy and not error and change is unlikely.