QOF Quality & Productivity Indicators Dr Steve Jenkins & Chris Valchero

1. QOF Quality & Productivity IndicatorsDr Steve Jenkins & Chris Valchero 11th July 2012

2. QOF Q&P indicators • Congratulations!- Most practices achieved maximum QP 6-11 points available in Yr 1 • Year 2 • Building on successes from year 1 and some amendments based on our learning • Trafford CCG continue to facilitate process • Overseen by NHS Greater Manchester Cluster • Some National revisions to Q&P indicators • Removal of Prescribing Indicators QP1 – 5 • Same Outpatient and Unscheduled Admission Indicators QP 6 – 11 but new areas • Addition of A&E Indicators QP 12 – 14

4. QP 6 – 8GP outpatient referrals • Dyspepsia • Trafford rate of gastroscopies relatively high compared to other PCTs (Atlas of Variation) • Continue with Dyspepsia • Aiming to localise pathway following feedback / discussions from External Peer Review • Childhood Eczema • Dermatology - one of highest outpatient specialties • Availability of Community Children’s Nursing Teams to support patients with known diagnoses of eczema • Developed localised pathway from Trafford Dermatology Guidance • Rhinitis • ENT – another of highest outpatient specialities • Consultant advised an area of common inappropriate referral • Localised pathway developed by multidisciplinary team

8. QP 6 What do we need to do? • Practice Internal Review of outpatient referrals • If no referrals – consider in-house management • Speciality data available within Actuate by mid July • Clinical system search (referral / in-house ) or get secretary to keep record for specific diagnoses • Compare variance against Map of Medicines Pathways for each area • Document outcome of Internal Review meeting on QP6 template • QP 6 template now more specific and one template for all 3 areas • Submit to CCG by 28 Sept 2012

9. QP 7 What do we need to do? • QP 6 template must be submitted before External Peer Review Meeting • TCCG to facilitate a specific QOF Q&P External Peer Review Meeting – Oct 12 (date tba) • Practice GP representative to attend • Practice feedback will inform further localisation of pathways • Outcomes / completed QP 7 template submitted to TCCG shortly after meeting

12. QP 9 – 11Unscheduled Admissions • COPD • Local best practice Trafford guidelines based on NICE guidance • Continue high emergency admissions for respiratory conditions • Build on work undertaken last year • Asthma • Trafford PCT ranks high for asthma admissions • 14th highest diagnosis for which patients admitted in Trafford • Evidence structured primary care improves symptom control • TIA • Evidence timely management of TIA reduces stroke risk (NICE 2008) • Greater Manchester Cardiac and Stroke Network assessment pathway with referral to TIA clinics • Assessment via ABCD2 tool – training DVD & in info pack

15. Key priorities for implementation (NICE 2008) • Rapid recognition of symptoms and diagnosis • People who have had a suspected TIA who are at high risk of stroke (that is, with an ABCD2 score of 4 or above) should have: • aspirin (300 mg daily) started immediately • specialist assessment and investigation within 24 hours of onset of symptoms

16. QP 9What do we need to do? • Practice Internal Review of unscheduled admissions • If no unscheduled admissions, consider in-house mgt • Data available within Actuate by mid July (incl diagnoses) • Keep copies of discharge letters / clinical system search • Proforma for practices to undertake and document review for each area • Document outcome of Internal Review meeting on QP9 template • QP 9 template now more specific & one template for all areas • Attach 3 “patient anonymised” proforma to QP 9 template • Submit to CCG by 28 Sept 2012 • External Peer Review (QP 10) as per outpatients process

17. QP 12- 14Accident & Emergency

18. QP 12 What do we need to do? • Practice Internal Review of top 10 A&E attendances • Over 65s • Under 15s • Frequent Flyers • Quarter 4 patient level data available within Actuate by mid July (as report) • Document on proforma - consider day / time / reason for attendance / management in house • ? Discharge info for UHSM attendances • QP12 – one template for all 3 areas with attached proforma • Submit to CCG by 28 Sept 2012 for use at External Peer Review Meeting

19. QP 13-14 What do we need to do? • QP 13 • Agree Improvement Plan • Proposals for improved access • Arrangements in practice • Service re-design via CCG • Submit QP 13 template to CCG shortly after External Peer review Meeting • QP 14 • Implement Practice Improvement Plan • Aim to reduce avoidable A&E emergency attendances • Quarterly A&E reports will be updated on Actuate (Qtr 1 & 2 data available) • Produce report of action take on QP 14 • Submit QP 14 template to CCG by end Feb 2013

20. Contacts • TCCG Actuate & QOF Q&P Lead • Sarah.gunshon@trafford.nhs.uk • 0161 873 9515 • TCCG Map of Medicine • Matthew.preece@trafford.nhs.uk • 0161 873 9511 • QOF Lead • Gail.sampson@trafford.nhs.uk

21. What Next? • Pathways are being finalised • Complete packs available 3rd week in July • Data available on Actuate 3rd week in July • Practice secretary keep log of referrals • Keep log of unscheduled admission discharges • Re-familiarise with Actuate…. • ANY QUESTIONS?

22. Process • Target is to review management plans for minimum of 3 high risk COPD patients per 2000 registered list • Review last year’s emergency admissions (in pack) • If needed, review those with more than 3 exacerbations requiring antibiotics • Ensure optimum management • Review use of management plans, rescue therapies (advice, deferred script for steroids and abx) & referral to pulmonary rehab (if appropriate) • Documents in pack – more available from TCC • Review data and complete audit proforma, discuss at internal review in practice and return by mid Nov to TCC