QoF changes October 2014
Date sent: Sunday 19 October 2014
Email sent by Wessex LMCs, on Sunday, 19 Oct 2014 to all GPs and Practice Managers
I was rather confused about the proposed changes to QoF that were recently announced. When I tried to explain this to a GP recently I discovered that I was unclear what action we needed to undertake in my practice.
I have therefore taken some time to read the published guidance and have summerised the details below.
Changes to QoF announced October 2014
The General Practitioners Committee (GPC) and NHS Employers (on behalf of NHS England) have now agreed changes to the Quality and Outcomes Framework (QOF) for 2015-16. These changes are:
- An adjustment to the QOF point value for 2015-16 taking account of population growth and relative changes in practice list size from 1 January 2014 to 1 January 2015.
- The threshold changes planned for 1 April 2015 have been deferred for one year to 1 April 2016.
- Retire three chronic kidney disease indicators - CKD002, CKD003 and CKD004 (26 points) while retaining the existing CKD register - CKD001 (renumbered CKD005) (6 points). Details at end of email.
- New CKD005 updated in line with the NICE recommendations to now read ‘The contractor establishes and maintains a register of patients aged 18 or over with CKD Stages 3 to 5’.
- Retire coronary heart disease indicator CHD006 (10 points) (see at end of email).
- Amend the atrial fibrillation indicator AF004 (renumbered AF007), retire AF005 and replace with new indicator (AF006) in line with NICE recommendations with added points to reflect the increased work load across the new indicators.
This rationalises the CKD indicator so that practices establishes a register and then is permitted to decide the appropriate management for each patient. This will release 26 points.
The removal of CHD006 will remove the requirement of GPs to ensure that patients post MI are taking aspirin, a Beta Blocker, a Statin and an ACE or ARB. As we all know this is an indicator that is more focused at hospital based care rather than the practice's. This releases a further 10 points.
The new wording of the atrial fibrillation indicators are:
New AF007: In those patients with atrial fibrillation with a record of a CHA2DS2-VASc score of 2 or more, the percentage of patients who are currently treated with anticoagulation drug therapy (warfarin or NOACs). (12 points)
New Indicator AF006 replaces the old indicator for calculating the CHADS2 score that was dropped this year. It's just the automatic scoring which, as with CHADS2 hopefully the IT will do for you, so. (12 points)
New Dementia indicators
There will be 24 points will be added to DEM002 (renumbered to DEM004) so that the new total is 39 points. The indicator wording will be amended to read as follows:
New DEM004: The percentage of patients diagnosed with dementia whose care plan has been reviewed in a face-to-face review in the preceding 12 months.
There will be changes of wording in respect of DEM003 (renumbered to DEM006):
New DEM006: The percentage of patients with a new diagnosis of dementia recorded in the preceding 1 April to 31 March with a record of FBC, calcium, glucose, renal and liver function, thyroid function tests, serum vitamin B12 and folate levels recorded between 12 months before or 6 months after entering on to the register.
Many patients with a dementia care plan could also benefit from a care plan for the case management to help prevent avoidable hospital admissions.
DEM 006 make far more sense - prviously you had to have undertaken the blood tests within a 6 month period prior to diagnosis. This occasionally led to unecessary blood tests because the patient was outside the timescale.
Summary of QoF indicators
Chronic Kidney Disease - QoF as of 1st April 2014
CKD001. The contractor establishes and maintains a register of patients aged 18 or over with CKD (US National Kidney Foundation: Stage 3 to 5 CKD)
CKD002. The percentage of patients on the CKD register in whom the last blood pressure reading (measured in the preceding 12 months) is 140/85 mmHg or less
|11||41 - 81%|
CKD003. The percentage of patients on the CKD register with hypertension and proteinuria who are currently treated with an ACE-I or ARB
|9||45 - 80%|
CKD004. The percentage of patients on the CKD registerwhose notes have a record of a urine albumin:creatinine ratio (or protein:creatinine ratio) test in the preceding 12 months
|6||45 - 80%|
Coronary Heart Disease
CHD006. The percentage of patients with a history of myocardial infarction (on or after 1 April 2011) currently treated with an ACE-I (or ARB if ACE-I intolerant), aspirin or an alternative anti-platelet therapy, beta-blocker and statin
NICE 2010 menu ID: NM07
AF001. The contractor establishes and maintains a register of patients with atrial fibrillation
On going management
AF005. In those patients with atrial fibrillation in whom thereis a record of a CHADS2 score of 1, the percentage of patientswho are currently treated with anti-coagulation drug therapyor anti-platelet therapy
Based on NICE 2011 menu ID: NM45
AF004. In those patients with atrial fibrillation whose latest record of a CHADS2 score is greater than 1, the percentageof patients who are currently treated with anti-coagulation therapy
Based on NICE 2011 menu ID: NM46
|6||40 - 70%|
Dr Nigel Watson
Churchill House, 122-124 Hursley Rd
Chandler's Ford, Eastleigh
Hants. SO53 1JB (Registered Office)