General Medical Services (GMS)/Personal 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 [phone]
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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(No Transcript)
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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