General Medical Services GMSPersonal Medical Services PMS Contracts - PowerPoint PPT Presentation
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Title: General Medical Services GMSPersonal Medical Services PMS Contracts
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General Medical Services (GMS)/Personal Medical
Services (PMS) Contracts Quality and Outcomes
Framework (QOF) Marion Pullen Head of the Primary
Care Contractor Business Unit Tel 0121 712
8315 Email marion.pullen_at_solihull-ct.nhs.uk
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Introduction
- Context GMS/PMS Contracts and QOF
- Outcome of QOF Review Process
- Application of QOF data
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GMS/PMS Contracts
- GMS
- National Contract
- Less Flexible
- Minimum Practice Income Guarantee (MPIG)
- No growth funding
- PMS
- Local Contract
- Flexible to address specific need
- No MPIG - but included in contract base line
- Growth funding additional services
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What is QOF?
- Introduced in 2004 as part of the nGMS contract
- Major source of new funding
- Clinical, organisational and patient focus
- Evidence based
- Rewards practices for delivering quality and
health improvement - QMAS is the IT system that will calculate
achievement
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QOF
- 4m per annum for Solihull Care Trust
- 25m per annum total GMS/PMS spend for Solihull
- 050/1000 points at approx 124 per point
- 20 increase in income for Practices
- And
- 1.6bn nationally
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QOF 06/07 Value for Money
- Increased emphasis on clinical indicators
- No increase in s per point
- No inflation
- Increase in level of target
- Efficiency gains
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QOF Domains (1)
- Clinical
- 19 domains (8 introduced this year)
- Asthma, diabetes, Chronic Heart Disease
- Palliative Care, Obesity, Mental Health
- Organisational
- Information for patients, records, education and
training - Patient Experience
- Length of consultation and patient surveys
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QOF Domains (2)
- Holistic Care
- Quality payment
- Access
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QOF 2006/07 Principles
Formative QOF
Full
GMS/PMS Contract Monitoring Summative
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QOF Monitoring Approach
- Year 1 Process was prescriptive
- Team of Solihull Care Trust Manager, GP and Lay
Assessor - Year 2 onwards
- Flexibility of approach
- Solihull Care Trust continued to visit all
practices and use Manager, GP and Lay Assessor
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End of Year Process
- Pre Payment Verification
- Practice
- Care Trust
- 5 Random Check
- Pan Birmingham process
- Performance monitoring
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Results from QOF 2005/06
- 5 Random Check
- Adopted a Pan Birmingham and the Black Country
approach - 2 Solihull practices reviewed
- No significant issues identified
- Organisational issues identified in 1 practice
- Annual Report to the Solihull Care Trust Audit
Committee
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Application of QOF Data
- Commissioning
- Quality Assurance/Governance
- Performance Management
- Service Redesign
- Epidemiology
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Current Points Calculation
Two types of indicators Yes / No
Numerator/Denominator
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Example DM7
- DM 7. The percentage of patients with diabetes in
whom the last HbA1C is 10 or less in last 15
months - 11 points available
- Min Threshold 25
- Max Threshold 85
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No Financial Incentive above max threshold
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Distribution of QOF Scores
QOF Without thresholds
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Solihull ward map
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Solihull map with practice locations
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Results from QOF 2005/06
- 1 practice with maximum 1050 points
- 5 practices with 1049
- 29 with gt 1000 points
- Average score 1037
- Solihull PCT was the highest scoring PCT in the
West Midlands Strategic Health Authority
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The National Picture
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QOF Points 2005/06 by GP Practice
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QOF indicator CHD6 - 2005/06
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QOF indicator MH2 - 2005/06
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Prevalence Map Diabetes Mellitus
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QOF and Contract Monitoring
- Robust and rigorous
- Integrated
- Priority for the Care Trust
- Value for money
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