Alternative QOFing Dr Peter Smith OBE Vice Chair, NAPC

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Alternative QOFingDr Peter Smith
OBEVice Chair, NAPC
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The Really Ugly Duckling
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• Well, as it turned out, he was just a really ugly
  duckling. And he grew up to be a really ugly
  duck.
• The End

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Really Ugly Duck or Swan?
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Alt.QOF Interest
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Formats
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STANLEY KUBRICKS
Drs.R.Strangelove or How I learned to stop
worrying and love the QOF
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Filmed on location in Darlington

• Small PCT
• Population 114,000
• Mainly middle class
• Few areas of deprivation
• 11 GP practices
• 9 within 2.5 miles of city centre
• 2 rural

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The Cast..

• All GPs are PMS practices
• 9 early adopters in 2001
• 2 in 2003
• Strong Clinical Governance Lead
• High profile involvement from PCT executives
• Exceptional open dialogue with each GP/practice
• La-La Land by comparison!

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Scene 1- Before GMS

• Local PMS monitoring document foisted by the
  (then) Health Authority
• No input from clinicians
• Heavily criticised
• Did not match NSF targets
• Few patient outcomes measured
• Number crunching exercise

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PMS Monitoring

• Clinical Governance team decision to design
  meaningful local QOF
• Each practice nominated Lead GP for each NSF
  disease area
• Working Groups established around each disease
  area
• developed patient outcome indicators reflecting
  NSF and evidence-based practice

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Arrival of nGMS

• General consensus to adopt the nGMS QOF -
  consistency in national payment structures
• Determination to keep 4 local priority areas
  alive- Teenage Pregnancy- Sexual Health-
  Substance misuse- Older People

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Where did the points come from?

• Finance dept identified each strand of existing
  PMS budget to ensure no duplication with new QOF
• Achieving national access target was already
  addressed in PMS Growth money (amounting to 1M
  across Darlington)
• Access was attracting 50 points in new QOF

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Where did the points go?

• Therefore, the 50 Access points were
  distributed across our four local priority areas

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Teenage Sexual HealthAddition of six new
indicators
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Sexual Health ServicesAddition of two new
indicators
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Drug Substance MisuseAddition of four new
indicators
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Older PeopleAddition of three new indicators
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Non-clinical domain Contraceptive
ServicesAddition of eight new indicators
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Pistols at Dawn

• High profile GP took umbrage
• 164 points had already been deducted from PMS
  practices
• Losing 50 more - double whammy
• PCT were cheating
• Quickly established a following with colleagues

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The Cavalry Arrives

• Director of primary care out on practice visit
  for face-to-face meetings
• Advice from PEC Chair and GP Clinical Governance
  Lead
• Resulted in
• 50 Access points being returned to QOF in 2005

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But all was not lost.
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All quiet on the front?

• High profile GP satisfied
• Clinical Governance Lead GP persuaded all to
  continue with local priority indicators for the
  sake of good practice
• And to do that without points incentive
• all GPs agreed !

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We are on a roll !

• Persuaded Clinical Lead GPs to enhance national
  QOF and look at primary prevention
• Disease areas identified and actions agreed

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This will be written into the 2005 local QOF
within PMS, and NOT pointed!!
The Finale
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Quality Measures

• General
• http//www.qualitymeasures.ahrq.gov/
• Mental Health
• http//www.cqaimh.org/quality.html
• www.oecd.org/els/health/technicalpapers
• OECD HEALTH TECHNICAL PAPERS NO. 16
• SELECTING INDICATORS FOR THE QUALITY OF HEALTH
  PROMOTION, PREVENTION AND
• PRIMARY CARE AT THE HEALTH SYSTEMS LEVEL IN OECD
  COUNTRIES