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Thanks, Robert. It would be great if some of us got involved. A Cochrane Review has just appeared on "The effect of financial incentives on the quality of health care provided by primary care physicians" http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008451.pub2/pdf Jonathan On 28 Sep 2011, at 14:54, ACB Office wrote: > ACB members will be interested in this guidance paper for commissioners > > The 'think tank' is trying to get local commissioners to incentivise best practice amongst providers using the existing tools CQUIN and QOF. It struck me that CQUIN is most relevant to us. It may be in our interest to ensure that there is a strong link between CQUIN and QOF. We know that QOF actually changes GP behaviour. > > The full document is available as a download on the ACB website, http://www.acb.org.uk/site/guidelines.asp. The following quotes from the document are relevant to Clinical Biochemistry > > • Local commissioning might look different in the various NHS regions. > > • “Anna Morton from NHS Diabetes recommended that a diabetes representative, from each stage of the care pathway, should be present at every step of the commissioning process” (p14 para 5 ‘Commissioning bodies’) > Opportunities here for clinical biochemistry if we are seen as a provider of services rather than a passive receiver of specimens. > • “Providers should be fully engaged with the commissioning process, as it is at this level where great innovation can happen. Financial incentives can be very powerful, and providers should be encouraged to establish new, more efficient means of delivering the service”.(p15 para 2 ‘Commissioning Structure’) > • "CQUIN makes a proportion of providers’ income conditional on quality and innovation goals." So if we can influence CQUIN we may be able to drive best practice wrt the use of clinical biochemistry investigations. > > Case Histories > > The Yorks and Humber region are cited as having developed CQUIN indicators including one for prioritizing diabetes care in children. > There is coincidentally an initiative from the ‘Lead Scientists’. The ‘Lead Scientists’ are SHA appointments who are liaising between the SHA and regional SHAs, implementing MSC and promoting Healthcare Science in the English regions. The initiative is to introduce ‘Action Learning Sets’ in relevant areas. One of these involves Yorks and Humber plus at least two other regions and ultimately will involve all English regions. It is an Action Learning set on ‘Point of Care Testing’. The scope is very broad and desperately needs focusing if it is to achieve anything. It could take as its theme, providing POCT for monitoring adolescents and children with diabetes. We know there is some interest in this in Sheffield. We also have a pseudo outcome measure in HbA1c. If we could combine with this a way of stopping the use of blood glucose monitoring in patients with type 2 diabetes, (shown to be ineffective in an evidence based review published as a Health Technology Assessment), there could be an efficiency saving as well. > > This action learning set could then deliver a CQUIN relating to quality of care for children with diabetes. > > > Dr Robert Hill > Consultant Clinical Biochemist > Director of Scientific Affairs > Association for Clinical Biochemistry > ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/