Transcript QOF Changes 2014/15

QOF Changes 2015/16
Kate Pilton
Development Manager
Introduction
• As part of the 2015/16 GMS contract changes,
NHS Employers and the General Practitioners
Committee (GPC) of the BMA agreed a
number of changes to QOF effective from
1 April 2015
• The threshold changes planned for 1 April
2015 have been deferred for one year to
1 April 2016
Introduction
• Changes to Clinical Domain
– Atrial Fibrillation
– Coronary Heart Disease
– Dementia
– Chronic Kidney Disease
• Changes to Public Health Domain
– Obesity
QOF Point Value/List Size
• An adjustment to the value of a 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 national average list size as of 1 January
2015 is 7,233 and the value of a QOF point for
2015/16 will be £160.12
QOF Point Value/List Size
• QOF Point Value
• 2015/16
• 2014/15
£160.12
£156.92
• England Average List size
•
•
•
•
2015/16
2014/15
2013/14
2004/13
7233
7052
6911
5891
List Size & Prevalence
• List size measured on the first day of each
quarter
• Clinical indicators
• National Prevalence Day, 31 March
List Size & Prevalence
Practice List Size/National Average List Size
X
Practice Disease Prevalence/National Average Disease Prevalence
X
£160.12 = £’s per point
Prevalence
• www.gpcontract.co.uk
• S1 Prevalence
Guidance
Click here to download guidance
Summary of Changes
Click here to
download
summary
Business Rule Sets
• V31
• http://www.hscic.gov.uk/qofbrv31
Clinical Domain
Changes
Atrial Fibrillation (AF)
• Retired
– AF005 In those patients with atrial fibrillation in
whom there is a record of a CHADS2 score of the
percentage of patients who are currently treated
with anti-coagulation drug therapy or antiplatelet
therapy
– Was 6 points
Atrial Fibrillation (AF)
• New indicator
– AF006 The percentage of patients with atrial
fibrillation in whom stroke risk has been assessed
using the CHA2DS2-VASc score risk stratification
scoring system in the preceding 12 months
(excluding those patients with a previous CHADS2
or CHA2DS2-VASc score of 2 or more)
– 12 points
– Thresholds 40-90
Atrial Fibrillation (AF)
• The scoring system recommended is
CHA2DS2-VASc, which is validated and gives a
score that allows a better stratification of low-risk
patients than the CHADS2 score
• There is a clinical benefit in using a stroke risk
score to identify patients at risk
• The review of cohort studies found that there
may be a slight benefit of CHA2DS2-VASc over the
other scores considered (CHADS2, ACCP and the
ACC/AHA/ESC)
Atrial Fibrillation (AF)
• Replacement
– AF004 In those patients with atrial fibrillation whose latest
record of a CHADS2 score is greater than 1, the percentage
of patients who are currently treated with anti-coagulation
therapy
– 6 points
• Replaced with
– 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
– 12 points
– Thresholds remain the same 40-70
Secondary Prevention of
Coronary Heart Disease (CHD)
• Retirement
– 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
– Was 10 points
Dementia (DEM)
• Wording & points change
– DEM002 now 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
– Was 15 points now 39 points
– Thresholds remain the same 35-70
Dementia (DEM)
• Wording & timeframe change
– DEM003 now DEM005
– 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 6 months before or 6 months after
entering on to the register
Dementia (DEM)
• Where a patient does not already have a care
plan or an advanced care plan in place, it is
expected that the practice will develop a care
plan
• The face-to-face care plan or advanced care
plan review focuses on support needs of the
patient and their carer
Dementia (DEM)
• In particular the review should address the
following key issues:
– An appropriate physical, mental health and social
review for the patient
– A record of the patients’ wishes for the future
– Communication and co-ordination arrangements
with secondary care (if applicable)
Dementia (DEM)
• Identification of the patients’ carer(s); and
1.
2.
3.
4.
Obtain appropriate permissions to authorise the practice to
speak directly to the nominated carer(s) and provide details
of support services available to the patient and their family, if
applicable, the carer’s needs for information commensurate
with the stage of the illness and his or her and the patient’s
health and social care needs
As appropriate, the carer should be included in the care plan
or advanced care plan discussions
If applicable, the impact of caring on the care-giver
Offer the carer a health check to address any physical and
mental health impacts, including signposting to any other
relevant services to support their health and wellbeing
Chronic Kidney Disease (CKD)
• Wording change
– CKD001 now CKD005
– The contractor establishes and maintains a
register of patients aged 18 or over with CKD (US
National Kidney Foundation) with classification of
categories G3a to G5 (previously stage 3 to 5)
Chronic Kidney Disease (CKD)
• The NICE guideline on CKD recommends that CKD should
be classified using a combination of GFR and ACR
categories
• The 2014/15 indicator CKD001 recommended classification
using the US National Kidney Foundation classification
system
• The classification system for CKD was included in the scope
for the guideline update and as a result of this work, the
staging system was replaced with a system that classifies
GFR and ACR by categories
• This was to systematically take into account proteinuria
when considering GFR
• So the terminology within the guideline recommendations
now refers to categories rather than stages
Chronic Kidney Disease (CKD)
• Retired
– 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 points)
– CKD003 The percentage of patients on the CKD
register with hypertension and proteinuria who are
currently treated with an ACE-I or ARB (9 points)
– CKD004 The percentage of patients on the CKD
register whose notes have a record of a urine
albumin:creatinine ratio (or protein:creatinine ratio)
test in the preceding 12 months (6 points)
Public Health
Domain
Changes
Obesity (OB)
• Wording change
• OB001 now OB002
– The contractor establishes and maintains a
register of patients aged 18 16 years or over with
a BMI ≥30 in the preceding 12 months
– 8 points (no change)
Questions
Contact Details
[email protected]
www.lincslmc.co.uk
01522 576659
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