Changes to QOF - details available

The BMA has moved faster than I have ever seen in getting details of the new QOF indicators out. After a rather vague press release this morning this afternoon produced a letter from Lawrence Buckman with a link to the details of the QOF changes.

It is only three pages and well worth a read. Highlights include the addition of a requirement for albumin:creatinine ratio in all patients on the chronic kidney disease register. This may raise a few eyebrows in biochemistry labs around the country who may not know what is going to hit them. (If they want to know what is going to hit them then a quick browse around the CKD register on the site may be useful. Around 1.8 million urine samples are headed their way.)

The current contraception indicators have gone and are replace by 8 points - six of which are for plugging coils and implants. It will be interesting to see the evidence base for this one. This will be at least a small crumb of comfort to university practices likely to be hit hard by the loss of the square root formula.

There is a bit about primary prevention in those newly diagnosed with hypertension - which should be a manageable number. In essence this boils down to finding out if they smoke, eat badly, drink alcohol and take no exercise and telling them not to do these things. I am really trying not to be cynical but very few patients are under any illusions about any of these things and it always seems a little lame.

There is a tidy up in diabetes with three thresholds including a tough 7% HbA1c (again evidence will be interesting to see). Inhaler technique is out and the MRC assessment - which is purely function is in. Actually quite a usable scale and much easier than finding an inhaler and watching them use it.

Finally depression. There is a new indicator for the reassessment of depression severity after 5-12 weeks using PHQ-9 or whatever. The patients aren't free of the questionnaires yet!

The last word has to go to Laurence Buckman - chair of the General Practitioners Committee and now Youtube star.

QOF changes 2009 onwards

Results of negotiations on next year's contract have been released last night. There is quite a bit of information although the final details are not absolutely clear.

First off there is a bit about money. There is agreement on how uplift for 2009/10 will be allocated. This may prove to be a bit academic in the current climate as it is not entirely clear whether there will be any extra cash on the table. This will be up to the DDRB. The cash will be divided up with 37% going to the Global Sum - 11% to the correction factor (to maintain MPIG) - 26% to QOF and 26% to Enhanced Services.

The effect of the above is likely to allow the Global Sum and MPIG to rise roughly together but a larger percentage increase in QOF and even large in Enhanced Services. Thus QOF is going to be a more significant income source to practices than it was before.

So what of the QOF itself? Well the big thing to go is the survey. The Department of Health has decided to do its own, by post. This is probably a relief to practices, to whom the administration was a hassle, and to those patients who feel bombarded by surveys. It may be a bit of a kick in the teeth for the nice people at GPAQ but there is of course nothing to stop people from continuing to pass them out anyway.

This will free 55 points from PE 2 and PE 6. There are also another 17 points being shaved off other (undisclosed) indicators. There is probably an interesting bit of work to show the effects of shaving points on overall achievement in those areas. These 72 points are going into new clinical indicators for which we have some vague suggestions. Official(ish) bits in bold.

  • Helping to prevent the development of cardiovascular disease in people diagnosed with high blood pressure (13 pts) - other than controlling their blood pressure I assume. Possibly cholesterol measurement but this does not seem enough points for this - just measuring BP currently gets 20 points.
  • Advice on long term contraception(10 pts) - for whom? Is this to combat teenage pregnancy. Long term contraception tends to be used in the over 30s - aiming to change this?
  • A new indicator for depression to reduce early cessation of treatment (20 pts) - no idea how this might work.
  • Beta blockers for heart failure (9 pts) - which is one of this year's new DESs
  • Improvements to the indicators for chronic kidney disease (11 pts), diabetes (7pts) and chronic lung disease (2pts) - or at the very least changes.

In addition the square root formula has gone from next year, and with the uplift for those practices with less than 5% of the maximum prevalence will go in 2010/11. These changes turn things into a much simpler item of service payment once over the 40% threshold.

Developments awaited.

Updated 12:45 with points data and square root stuff.

Prevalences for 2008 (minus Wales)

2005 2006 2007 2008
Atrial Fibrillation 1.30% 1.30%
Asthma 5.82% 5.83% 5.79% 5.72%
Hypertension 11.37% 12.03% 12.56% 12.77%
Cancer 0.51% 0.72% 0.91% 1.08%
Coronary Heart Disease 3.71% 3.71% 3.67% 3.60%
Chronic Kidney Disease 2.34% 2.92%
COPD 1.42% 1.44% 1.49% 1.51%
Dementia 0.41% 0.43%
CHD and/or Diabetes 6.40% 6.44%
Diabetes 3.35% 3.55% 3.65% 3.83%
Epilepsy 0.61% 0.63% 0.62% 0.61%
Heart Failure 0.45% 0.46% 0.80% 0.76%
Learning Disabilities 0.28% 0.28%
Mental health (05-06) 0.55% 0.72%
Mental health (07-08) 0.72% 0.74%
Obesity 7.51% 7.66%
Smoking with chronic disease 18.21% 17.30%
Stroke 1.52% 1.61% 1.66% 1.66%
Hypothyroidism 2.27% 2.46% 2.63% 2.76%

Most of this should be fairly self explanatory. The Welsh data for 2008 is not included as there is no data yet available. Mental health features in two separate rows as the definitions changed after the first two years.

There are a couple of made up prevalences in there. First is the screening population for depression which is made up of all those patients with either diabetes or heart disease or both. The smoking indicator is also based on many of the other areas. Included here is the proportion of patients with chronic diseases who smoke.

2007/8 QOF data (mostly) available now!

Another year has passed and there is a new set of QOF data to pore over. Northern Ireland published first this year about a fortnight ago whilst Scotland and England both published last Tuesday. All of the data for these countries is now online at the QOF Database. You can search for or browse the data.

I will publish the Welsh data when it becomes available. Database download will also be available soon as will overall prevalences.

Palliative care data is not visible yet either. This is due to differences in the way that this has been reported. England gives a prevalence, the other countries just give a yes or no to the presence of a register. This will take a couple of tweaks to display sensibly and I will do this soon. In any case the prevalence is difficult to make a lot of sense of. These tend to be small numbers which inevitably vary quite considerably over time.

In other site news I have removed the links to the QOF changes pages as these have become out of date as well as the extended hours calculator. In the latter case the national directed enhanced service is much less relevant as many local enhanced services filled the gap caused by its tardy arrival.

For the future I am working on ways of keeping practice data up to date, particularly addresses. I also hope to bring in links to practice websites. As I am a one man band and there are about ten thousand practices automation is going to be essential and this is taking a little time to code. It is likely to come in gradually.