Lincolnshire LMC Presentation on Qof Changes 2014-15

QOF Changes 2014/15
Kate Pilton
Practice Development Manager
Introduction
• Most radical changes to QOF since its
introduction
• Reduction in the level of micromanagement &
box ticking
• Transfer of QOF points into core funding
• Greater resource for practices to manage
patients according to clinical judgement
Summary of QOF Point Changes
•
•
•
•
•
341 points removed from QOF
238 points to core funding
103 points to enhanced services
Total QOF points for 2014/15 will be 559
All funding being transferred to core funding will
not be subject to 6% Out of Hours deduction
• OOH deduction reduced to 5.46%
• £4.02 per weighted patient
Summary of QOF Point Changes
Amendment
Clinical Domain
Points
Change
Points Going To
-185 Core funding
3 points from LD002 going to ES
Public Health Domain
-33 Core funding
Patient Experience
-33 Core funding
Quality & Productivity
-100 Unplanned admissions ES
Points Added to Amended HYP002
+10
Total
341
Increases in Core Funding
http://www.sslmcs.co.uk/uploads/New%20GMS%20Contract%20Page/2014_04_04__implementing_the_2014-15_gp_contract_-_pms_update.pdf
Ready Reckoner
• Ready reckoner for GMS practices
• Developed between NHS England & GPC
• Estimate change in income due to contractual
changes
• http://bma.org.uk/working-for-change/negotiating-for-theprofession/bma-general-practitionerscommittee/priorities/mpig/practice-funding-ready-reckoner
QOF Point Value/List Size
• QOF Point Value
• 2014/15
• 2013/14
£156.92
£156.92
• England Average List size
• 2014/15
• 2013/14
• 2004/13
7052
6911
5891
List Size & Prevalence
• List size measured on the first day of each
quarter
• Clinical indicators
• National Prevalence Day, 31 March
List Size & Prevalence
Practice List Size/National Average List Size
X
Practice Disease Prevalence/National Average Disease Prevalence
X
£156.92 = £’s per point
Prevalence
• www.gpcontract.co.uk
• S1 Prevalence
Guidance
• QOF Guidance 2014/15
http://www.nhsemployers.org/Aboutus/Publications/Documents/2014-15-QOF-guidance-stakeholders.pdf
Business Rule Sets
• V28
http://www.hscic.gov.uk/qofbrv28
Clinical Domain
Changes
Asthma(AST)
• Coding Changes
• Diagnosis
• Codes excluded
V2
CTV3 (S1)
Rubric
H333.
Xa1hD
(Acute) exacerbation of asthma
• Smoking Habit
• Codes excluded
V2
CTV3 (S1)
Rubric
137g.
XaIuQ
Cigarette pack years
137n.
Ub0p2 Ub0p3 Total time smoked
Atrial Fibrillation (AF)
• Retired
• AF002 The percentage of patients with atrial
fibrillation in whom stroke risk has been
assessed using the CHADS2 risk stratification
scoring system in the preceding 12 months
(excluding those whose previous CHADS2
score is greater than 1)
• 10 points
Atrial Fibrillation (AF)
• Wording change
• AF003 In those patients with atrial fibrillation in whom
there is a record of a CHADS2 score of 1 (latest in the
preceding 12 months), the percentage of patients who are
currently treated with anti-coagulation drug therapy or
anti-platelet therapy
• Thresholds & points remain the same
• 57-97% 6 points
• Business rules timeframe
– 12 months CHADS2
– 6 months drug therapy (apart from OTC 12 months)
• Exception & exclusion timeframe
– 12 months exceptions
– 6 months exclusion for registration & diagnosis
Secondary Prevention of Coronary
Heart Disease (CHD)
• Retired
• CHD003 The percentage of patients with
coronary heart disease whose last measured
total cholesterol (measured in the preceding
12 months) is 5 mmol/l or less
• 17 points
Secondary Prevention of Coronary
Heart Disease (CHD)
• Wording & timeframe change
• CHD004 now CHD007 The percentage of patients with coronary heart
disease who have had influenza immunisation in the preceding 1 August 1
September to 31 March
• Codes excluded
V2
CTV3 (S1)
Rubric
65EE
Xaa9G
Administration of intranasal influenza vaccination
65EE0
XaaED
Administration of first intranasal influenza
vaccination
65EE1
XaaEF
Administration of second intranasal influenza
vaccination
9OX52
XaaDp
First intranasal influenza vaccination declined
9OX53
XaaDq
Second intranasal influenza vaccination declined
Heart Failure (HF)
• No changes
Hypertension (HYP)
• Points, threshold & timeframe change
• HYP002 now HYP006 The percentage of patients with
hypertension in whom the last blood pressure reading (measured in
the preceding 12 months) is 150/90 mmHg or less
• Timeframe was previously 9 months
• Threshold changed from 44-84% to 45-80%
• Points changed from 10 to 20 points
• Changes to recognise the shift in workload as a result in the
retirement of HYP003 (BP 140/90 or less)
• Business rules timeframe
– 12 months
• Exception & exclusion timeframe
– 12 months exceptions
– 9 months exclusion for registration & diagnosis
Peripheral Arterial disease (PAD)
• Retired
• PAD003 The percentage of patients with
peripheral arterial disease in whom the last
measured total cholesterol (measured in the
preceding 12 months) is 5 mmol/l or less
• 3 points
Stroke & TIA (STIA)
• Wording & Timeframe Change
• STIA002 now STIA008 The percentage of patients with a
stroke or TIA(diagnosed on or after 1 April 2008 2014) who
have a record of a referral for further investigation between
3 months before or 1 month after the date of the latest
recorded stroke or the first TIA
• Threshold 45-80%
• 2 points
• Business rules timeframe
– From 1 April 2014
• Exception & exclusion timeframe
– 12 months exceptions
– 3 months exclusion for registration & diagnosis
Diabetes Mellitus (DM)
• Indicators Retired
• DM005 Albumin:creatinine ratio test
– 3 points
• DM011 Retinal screening
– 5 points
• DM013 Dietary review
– 3 points
• DM015 Erectile dysfunction
– 4 points
• DM016 ED Assessment & treatment
– 6 points
Diabetes Mellitus (DM)
• DM001 now DM017
• The contractor establishes and maintains a register of all
patients aged 17 or over with diabetes mellitus, which
specifies the type of diabetes where a diagnosis has been
confirmed
• Renumbered to reflect the addition of “Diabetes in
remission” to the register
V2
CTV3 (S1)
Rubric
C10P.
Xaagd
Diabetes mellitus in remission
C10P0
Xaage
Type 1 diabetes mellitus in remission
C10P1
Xaagf
Type 2 diabetes mellitus in remission
Hypothyroidism (THY)
• All indicators retired
• THY001 Hypothyroidism register
– 1 point
• THY002 TFT
– 6 points
Chronic Obstructive Pulmonary
Disease (COPD)
• Change to flu dates only
Dementia (DEM)
• No changes
• Be careful with dates
Depression (DEP)
• Retired DEP001 Bio psychosocial assessment
• DEP002 now DEP003
The percentage of patients aged 18 or over with a new diagnosis
of depression in the preceding 1 April to 31 March, who have been
reviewed not earlier than 10 2 days weeks after and not later than
35 8days weeks after the date of diagnosis
• Threshold 45-80%
• 10 points
• Business rules timeframe
– From 1 April to 31 March
– 15 months
• Exception & exclusion timeframe
– 12 months exceptions
– 3 months exclusion for registration & diagnosis
Mental Health (MH)
• Retirements
– MH004 Cholesterol
– MH005 HbA1c
– MH006 BMI
Cancer (CAN)
• Wording & timeframe change
• CAN002 now CAN003 The percentage of patients with cancer,
diagnosed within the preceding 15 months, who have a patient
review recorded as occurring within 3months 6 months of the
contractor receiving the date of diagnosis
• Thresholds & points remain the same
• 50-90% 6 points
• Business rules timeframe
– 15 months (diagnosis) 6 months (review)
• Exception & exclusion timeframe
– 12 months exceptions
– 3 months exclusion for registration & diagnosis
Chronic Kidney Disease (CKD)
• No changes
Epilepsy (EP)
• Retirements
– EP002 seizure free last 12 months
– EP003 women aged 18 or over and who have not
attained the age of 55 who are taking antiepileptic
drugs who have a record of information and
counselling about contraception, conception and
pregnancy in the preceding 12 months
Learning Disability (LD)
• Wording & age range change
• LD001 now LD003
• The contractor establishes and maintains a
register of patients aged 18 or over with
learning disabilities
• Retirement
• LD002 Down’s syndrome TSH
Osteoporosis: Secondary Prevention of
Fragility Fractures (OST)
• Wording & timeframe change
• OST003 now OST004
• The percentage of patients aged 75 or over
with a diagnosis of osteoporosis, with a
fragility fracture on or after 1 April 2014 2,
who are currently treated with an appropriate
bone-sparing agent
Rheumatoid Arthritis (RA)
• Retired Indicators
• RA003 – CVD Risk assessment
• RA004 – Fracture risk assessment
Palliative Care (PC)
• No changes
Public Health
Domain
Changes
Cardiovascular Disease – Primary
Prevention (CVD-PP)_
• Retirement
• CVD-PP002
• The percentage of patientsdiagnosed with
hypertension (diagnosed after on or after 1
April 2009) who are given lifestyle advice in
the preceding 12 months for: smoking
cessation, safe alcohol consumption and
healthy diet
Blood Pressure (BP)
• Wording & age range change
• BP001 now BP002
• The percentage of patients aged 40 45 or over
who have a record of blood pressure in the
preceding 5 years
Obesity (OB)
• No changes
Smoking (SMOK)
• Retirement
• SMOK001 The percentage of patients aged 15
or over whose notes record smoking status in
the preceding 24 months
Cervical Screening (CS)
• Retirement
• CS003 The contractor ensures there is a
system for informing all women of the results
of cervical screening tests
Child Health Surveillance (CHS)
• Only indicator retired
• CHS003 Child development checks are offered
at intervals that are consistent with national
guidelines and policy agreed with the NHS CB
Maternity Services (MAT)
• Only indicator retirement
• MAT001 Antenatal care and screening are
offered according to current local guidelines
agreed with the NHS CB
Contraception (CON)
• Retired
• CON002 The percentage of women, on the
register, prescribed an oral or patch
contraceptive method in the preceding 12
months who have also received information
from the contractor about long acting
reversible methods of contraception in the
preceding 12 months
Quality & Productivity
& Patient Experience
Domains
Changes
Quality & Productivity (QP)
• All indicators retired
Patient Experience (PE)
• Retired
• PE001 10 minute appointments
Questions
Contact Details
[email protected]
www.lincslmc.co.uk
01522 576659
Disclaimer
Although Lincolnshire Local Medical Committee Limited has gone to great lengths to ensure that all information contained in this presentation is
accurate at the time of publication, inaccuracies & typographical errors may occur. Lincolnshire Local Medical Committee Limited does not warrant
or guarantee the accuracy or completeness of the information provided in this presentation. We can accept no responsibility or liability, which may
arise from the use of information published in this presentation. Under no circumstances will Lincolnshire Local Medical Committee Limited be liable
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