Scottish and Irish data ... and that's it.

The data for Scotland and Northern Ireland was released last Monday and is now on the site. It has been a little more awkward uploading the data this year due to the changes in the areas and the appearance of areas without prevalences (palliative care) and depression having two different prevalences. I hope this makes some sense when viewing the data but nothing is set in stone and bright ideas welcome!

Wales also released some data this week but this did not go down to practice level and is therefore not particularly useful for many purposes. The statistical release was described as release one so there may be more although the site also suggests that there will not be an update for a further year. I am enquiring about further data.

Even more oddly is the English data. The Information Centre has spreadsheets of data at national, SHA and PCT level but not practice level. Practice level data is available but only one practice at a time through their own web interface. I have emailed them asking about spreadsheets but have not year heard back. In fairness they were probably quite busy on Friday.

I will keep you informed about their replies.

New Business Rules (v10)

There is presumably some schedule behind the production of new business rules for QOF. These are the rules that govern the data extraction from practice systems and are negotiated across all four countries. For this reason they tend to be a bit of a camel.They pop up every six months or so, and the version numbers seem to increase by 0.5 each time. Counter intuitively it is the ones ending in .5 that are the big ones but with version ten of the business rules being recently released what is new?

Well not a lot. This has its downsides. Mental health is still a bit of a mess with its Hotel California register (once you are on it you can never leave). For the most part this will be something of a relief to practices who don't fancy changing all of their codes again.

There are a few changes worth noting. Firstly smoking exception codes have disappeared, but only for Records 22. The exception codes (for informed dissent and unsuitability) are still there for high risk groups counted in the smoking indicators.

Also in relation to smoking patients under 20 with asthma are no longer in the high risk group. I don't know why, especially as patients of that age with diabetes, heart disease or strokes are still in there, but there you go.

More important changes have been made to dementia assessment. There is now a specific code for annual review ( 6AB ) and the old, vaguer, codes no longer count.

In a similar vein the old LVD exception codes no longer apply (those starting 9h1 ) and have been superseded with 9hH codes.

My suggested action plan for practices would be

  • Check the review codes for dementia (especially on templates) since April and make sure they are 6AB
  • Check the exception codes for heart failure (templates again) and make sure you are using 9hH codes

Happy coding!

Osteoporosis and Crystal Balls

Waiting, waiting. We are waiting for this years data but just around the corner is also the report from the review group as to what they would like to see in next year's QOF.

Well a rather heavy hint has arrived in the form of Evaluation of standards of care for osteoporosis and falls in primary care commissioned by the Information Centre from the Kings Fund. (it was published co-incidentally with the National Library for Health's Osteoporosis & Fragility Fractures National Knowledge Week which I seem to have missed).

The King's Fund document is a very thorough review of current information in practice systems about osteoporosis (basically not a lot) and the possibilities of generating some useful QOF targets. It seems to be possible. It is however a relentlessly practical document - for which its authors deserve a lot of credit. It is acknowledged that it is very difficult to work out differences in coding from differences in practice. New codes and a proper definition of treatment are required. The huge (and probably undefinable) strain on investigative resources in secondary care are also highlighted. One final conclusion stands out as understanding the problems with QOF.

A preferred set of codes would need to be agreed and disseminated to GPs at least three months before implementation.

You would not normally think that you needed to point out that design needs to come before implementation, but in the wake of last year's mental health mess apparently you do.

Only one problem remains - what goes out for this to come in? No word yet and very little time if it is to be implemented properly next year.