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Usually we have a couple of weeks off after the end of March when the QOF for the previous year has been completed and uploaded, and there is time to look at the planning for the coming year.
*This* year I think I need to start planning NOW: by the time details are released, it will be too late!
As I understand it, and disregarding any additional workload imposed by the effects of the Health and Social Care Bill, the major new elements of the new QOF and requirement to register with the CQC, most of the reallocated QOF points will be devoted to "use of NHS resources" interpreted as reducing expenditure on prescribing, reducing emergeny admissions and reducing referrals.
So QOF questions:--
(all information from the press - so reliability not guaranteed: all published before 1st April)
1. GP said that practices would be judged on prescribing "against the top 25 percentile of their local community": who counts as the "local community" and what are the targets?
- if only the top 25% are eligible for full points (with undisclosed ranges for the rest) are the treasury calculations based on a saving of 75 x value of points allocated to prescribing or something only slightly lower?
- the top 25% target will be based on the previous year's figures: will these be based on numbers of prescriptions issued (as it is in East of England for balanced score card purposes), on weighted capitation or on relative quantities i.e. relative or absolute cost?
2. When do we get information on the particular drug groups being targeted? I've given up asking for any evidence base.
3. What wil the baseline for reducing referrals and emergency admissions be and how will it be set?
- in Bedfordshire, there are 67 "respite beds" in the north of the county and 4 (all in Leighton Buzzard i.e. not Dunstable) in the south. Logically this ought to affect the baseline figures for emergency admissions.
- what will count as a referral - and will the inability to refer to spinal services for 9 months of the past year (due to no services) reduce the baseline used to asses the referral level to be reduced for the coming year? (last I heard, hoping to get a service back by September: if so, there will be a catch-up increase in delayed referrals.
- again, is this a "local area" (and how local is local?), a within practice, a regional (SHA areas even when abolished), or National comparison ?
- what referrals/ first OP referrals will count? Already over 30% (don't have the precise figure to hand) are not made by GPs: these are a mixed bag of direct non-GP referrals from the community - dentists, opticians, retinopathy screening etc - and inter-hospital referrals both between consultants and direct referrals from A&E to out-patient clinics, whether or not allowed under contracts.
- will pathway referrals be included? Or are practices expected to refuse indicated referrals - to the possible detriment of the patient?
My Plan.
- assume that the prescribing QOF will be the same as the East of England scores pro tem: hopefully if they are different we will not see a repeat of the 5 DES situation from 2008.
- keep all the discharge summaries (now the only information about a patient admission) until we get some more information.
- if no information within April (when we are told details will be released) start a spreadsheet of means of admission, cause and whether already on list of patients at risk of admission.
Anyone any additional or better ideas?
CQC.
Haven't really looked into this one yet - but my practice manager went to a PMs meeting on Wednesday and came back with a checklist (she had to print off the massive manual from the internet: it's out of print!).
Taking a quick glance through (all practices apparently have to register in September) one of the interesting requirements is that any death of any service user will have to be notified to CQC and may be investigated.
It will look bad for practices like mine heavily biased to an elderly population - and totally disastrous for Hospices!
Does anyone have any hope or expectation that sector specific requirements will be developed?
Really would like your views and strategies,
Mary Hawking