Some of my points are missing

Yesterday the changes to the GMS contract for the year from the first of April came out. there are quite a few of them and the full details are on the BMA contract page. Of course I turned to the QOF changes first of all. You can read the full QOF changes here.

You can almost feel the negotiations behind them. Raising the upper threshold on three indicators from 70% to 71% seems likely the result of a very long and banal meeting. Other areas have other minor differences and some, such as mental health see big changes. There is also a lot of "to be announced" around prescribing and referral audits.

I am trying to write and article for a trade magazine about the changes but I have hit a problem. The numbers just don't add up.

Page one goes pretty much as billed with 92.5 points being removed. Page two then gets a little odd. CHD11 (ACEi after MI)become CHD14 with 3 extra points. DM9 (foot pulses) gains a point but also does most of what DM 10 currently doing. Is this duplicated or is there another three points lost here? So at the end of page two we have lost 92.5 or possibly 95.5 points and gained 4.

Page three - MH 9 gains four points in its split up but depression loses 20. So total 8 gained and 112.5 (or 115.5) down.

Page four has lots of new indicators so gains 40. Now 48 up.

Page five gains 48.5 but loses another 4. Final total 96.5 gained with at least 116.5 lost. 20 points have gone adrift somewhere. Even worse there may be another 3 if they don't want to pay twice for foot checks. And actually I wonder whether they will really want to have two indicators for aspirin and beta blockers in CHD which would lose another 14.

So where are my 20 points?

Updated 14/3/11 They have been found and it seems to have been the slip of a keyboard. QP9-11 which relate to reviewing emergency admissions should have 47.5 rather than 27.5 points. That is a lot of points, nearly 5% of QOF - more than all of asthma.

QOF error in your favour - receive £???

This statement has appeared on the Primary Care Contracting site

An error has been identified within the QMAS system which calculates payments to GP contractors under QOF and which has resulted in GP practices being underpaid for achievement under the QOF additional services indicators since 2004/05. The Department of Health will provide PCTs with resources to make good these underpayments.

... and that is all we have. There is no detail of what the error is. The additional service domain contains Child Health Surveillance, Cervical Cytology and Contraception/Sexual Health. There is a prevalence adjustment here and I would guess that that is where the problem is.

It is worth noting that this seems to have purely been an underpayment and some practices could be due six years of back pay.

QMAS is used to calculate the QOF in England and Scotland although PCC only deals with England as far as I know.

A notice on QMAS says the system will be off for a couple of days from the 11th February. I have no idea if this is connected.

Does QOF work?

There is quite a bit of publicity today for a paper in the BMJ asking whether hypertension targets have any effect on outcomes. Neither blood pressure or cardiovascular morbidity seem to have been affected.

It was with a sense of dread that found the paper. QOF has had more than its fair share of thinly disguised rants appearing as research. I was however very pleasantly surprised to find a well constructed piece of research with tightly defined methods and considerably clarity of thought. Maybe it takes researchers in the USA (Harvard to be exact) to look at these things objectively.

There is considerably debate about performance related pay and very variable evidence about how effective it is. There has been some research in the USA where schemes tend to make up a much smaller proportion of practice income than in the NHS.

It is of course disappointing although not particularly surprising to see a lack of observable effect. QOF is not, of course, a controlled intervention and it is possible to argue that we will never know what would have happened without it but this is pretty weak.

Now for the political bit. The cash for the QOF came, to a large extent, from a transfer from the old capitation payments. So the pay which previously went to practices and was used for treatment of hypertension was paid, in a different way, to practice for the same treatment of hypertension.

So little change but I am strangely cheerful that it has been demonstrated in such a high quality piece of research. More please.

Bringing QRISK to Facebook

This has nothing to do with QOF. Earlier this year the the good people at QResearch put the QRisk2 formula onto the internet with an open licence. This is freely available to download and use. This is quite something. There have always been problems with trying to apply JBS formulae as, for most people, the data to input is not there. Qrisk2 is based in large part on information that is easily available and the QResearch group provide formula that can estimate some of the other data.

I have put the formula onto Facebook with a fairly simple form. There is a limit to how simple it can be but hopefully it is at least usable.

The results are presented again as simply as seems reasonable. One of the things that can be done with the formula is some "what if" calculations. We can see the effects of stopping smoking or losing weight. There is even data drawn from NHS Choices which gives the closest NHS Smoking Cessation Clinics if you are in England, although this is not currently available due to a bug at NHS Choices.

The app is at http://apps.facebook.com/cvdrisk . Feel free to have a play around. You can change your data as often as you wish and see the effects. All your data is deleted when (or hopefully if) you remove the app from your Facebook account. Facebook will post that you are using the app but none of your data is posted back to Facebook unless you specifically type it in. You can post reviews or questions on the Facebook profile page.

Ooops

Many thanks to the reader who pointed out that, in England, I had transposed the two depression prevalence figures. I have now corrected this on the site. If you have downloaded the data there is now an updated version on the download page.

If you don't fancy downloading it all again you can switch in Access with some queries. I have not worked how to export these. If you are using MySQL the code is

update `achievement` set area='' WHERE `practiceid`regexp '^[ABCDEFGHIJKMLMNOPQRSTUVXYZ][0-9][0-9][0-9][0-9][0-9]$' and area ='DEP Prev 1';
update `achievement` set area='Dep Prev 1' WHERE `practiceid`regexp '^[ABCDEFGHIJKMLMNOPQRSTUVXYZ][0-9][0-9][0-9][0-9][0-9]$' and area ='DEP Prev 2';
update `achievement` set area='Dep Prev 2' WHERE area ='';
update `pcoach` set area='' WHERE `pco`regexp '5[A-Z][A-Z]' and area ='DEP Prev 1';
update `pcoach` set area='DEP PREV 1' WHERE `pco`regexp '5[A-Z][A-Z]' and area ='DEP Prev 2';
update `pcoach` set area='DEP PREV 2' WHERE area ='';

I had also missed the reconfiguration of the PCT in Hertfordshire which is now corrected in the downloads also (there is not a simple patch for that).

Sorry!

CPD+ on QOF Database

I tend to have a few ideas for projects floating around at a time, most of which come to nothing. One of these was an improved method for saving all of the stuff that I read for appraisal. At the time all that was out there was the official Appraisal Toolkit that was too horrible to use. Thankfully this is, if not quite dead, certainly having the curtains pulled around it.

I never actually managed more than about 20 lines of code as a proof of concept on this one but am very excited to find that those good folks at Healthcarerepublic have actually put finger to keyboard and written something very much along the same lines with their CPD+ system. It is also free, which is nice.

It is pretty basic at the moment but crucially it does allow one click to enter data into the log. There are instructions on the CPD + site but to make things even easier you can click on the CPD+ logo after every blog post at at the bottom of every table on the site. There is also a button at the bottom of each blog posting which is a stupidly complex thing to actually get into a Blogger template. Feel free to use the code yourselves.

I hope you find this useful.

2010 QOF data now online

I am delighted to be able to say that the data for 2010 is now available on the site. This is a little later than usual this year. This is a little due to a later publication of the data by the Information Centre and rather more due to my hard drive crashing. I still had the data but getting the system set up around it took a bit of time. I talk a little about that process on E-Health-Insider.

There is still a bit of work to do and I will get the database download going in the next few days.