By Paul Midgley, The Healthcare Partnership
Following his article in February’s Pf, Paul Midgley reviews the changes to the QOF elements of the GPs’ GMS contract, building on the improvements in Chronic Disease Management since the launch of QOF in 2004. Paul outlines how you can help practices to achieve their business objectives to score high QOF points against the range of new chronic diseases targeted in the revised scheme.
In December, agreement was reached between the BMA and NHS Employers to develop the national GMS contract, following completion of the first part of a two-stage review. These changes will take effect from 1 April 2006. Negotiations for stage two have now started, following publication of the Government’s White Paper in England Our health, our care, our say: a new direction for community services at the end of January (for implementation from April 2007).
The article in February’s Pf (‘Opportunity knocks’) looked at the wider changes to the GMS contract, including enhanced services. This article focuses specifically on the QOF elements and their role in improving the quality of disease management for patients with 19 specified long-term conditions.
Overview of the amended QOF
The Quality and Outcomes Framework, part of the new GMS contract introduced in April 2004, has encouraged practices to improve the care of patients with certain long-term conditions by introducing financial incentives for systematic follow-up of patients on 10 disease registers. The changes coming into force in April 2006 will build on this work, focusing on the existing disease areas and eight new ones to extend the benefit of improved care to new patient groups. The key aim of the new QOF is to incentivise improvements in care for a wider range of patients with long-term conditions, based on sound, current clinical evidence.
In brief, QOF 2006 has:
Recycled 138 points by allocating them to new clinical areas. Points have been taken from the existing ‘holistic care’ bonus and certain ‘organisational’ indicators, as well as by reducing the number of points for some disease registers and removing the ‘quality practice payment’ altogether.
Strengthened some existing indicators with an additional 28 points.
Raised qualifying thresholds to 40% before points can be earned.
Raised the majority of maximum achievement areas in existing indicators to 70–90% in line with the average national achievement in last year’s QOF.
Repackaged smoking indicators from various subsets within different disease categories into one smoking category.
Replaced the CHD subset for ‘left ventricular dysfunction’ with a ‘secondary prevention of CHD’ indicator set.
Taken 50 points from ‘access’, with the cash value being added to the Access Directed Enhanced Service (QOF is now worth 1000 points in total).
The QOF changes in more detail
Eight new areas – totalling 138 points – are being introduced within the three broad areas of mental health, end of life care and cardiovascular disease, as follows: Depression 33 points, Dementia 20 points, Mental Health (new) 9 points, Learning Disability 4 points, Palliative Care 6 points, Atrial Fibrillation 30 points, Chronic Kidney Disease 27 points and Obesity Disease Register 8 points.
The full set of disease areas targeted is as follows:
Note that QOF points have not changed in value. For an average-sized practice with average disease prevalence, one point still has a value of £125. So a full QOF points achievement is worth £125,000 in addition to the practice’s other sources of income – clearly something that most practices will strive for.
Medication use and treating to target (24% of all points)
244.5 points in the new QOF are directly linked to the use of various classes of medication to treat patients to target in a number of different disease areas. 195 of these points are aimed at patients with cardiovascular diseases.
If your product falls into one of these categories, then your detail is sure to be QOF-focused – and no doubt, subject to favourable formulary status, your sales will do very nicely with the QOF incentives in place. Since April 2004, sales of QOF-related drugs have contributed to an annual increase in the national medicines bill by 15%, up from around 10–12% in previous years.
An increasing focus for you will be supplementary and extended prescribers such as practice nurses, specialist nurses, community matrons, pharmacists and allied health professionals. GPs will increasingly delegate QOF work to non- GP prescribers, along with other services moving into primary care as Practicebased Commissioning speeds up service redesign to reduce hospital costs.
It is important that marketing departments and senior sales management recognise the importance of these non-GP prescribers (or influencers), and encourage the tailoring of activity and sales messages to these groups as well as GPs where a product is used for treating long-term conditions (such as those listed above).
Services to practices (411 points)
Nearly half of all points are achieved by the practice carrying out investigations or activities that may not traditionally have been seen as ‘core general practice’. As a result, pharma companies have an opportunity to provide added value services to practices in helping them to achieve some of these points.
Have a look at the table below. Perhaps your company has in-house resources that they can offer to key practices to help them achieve certain QOF targets? Or perhaps you can draft in nurse advisors to provide other services, or outside consultancies to help with business/action planning or training (e.g. CPR or SEA)? Or perhaps, via your hospital specialist representative colleagues, you can ensure better access to specialised secondary care tests, even helping to move these out into the community (in line with PbC)?
When you can prove that your visit is truly on the practice’s agenda, this raises the prospect of your becoming a genuine business partner who can provide products and services that are business-critical to your key practices, while significantly improving access and sales for yourself.
You can obtain a reference copy of the full Quality and Outcomes Framework document and a full list of the GMS 2006 revisions, explaining the full rationale behind each QOF indicator, from The Healthcare Partnership (see below).
Where are practices now?
Consider for a moment the unprecedented range of challenges facing general practices in 2006:
new Directed Enhanced Services
new PCT/SHA boundaries
revalidation of GPs
Practice-based Commissioning planning (PbC)
cluster working in PbC
the White Paper Our health, our care, our say . . .
Imagine what it must be like to be a practice manager at this time, trying to ensure that all these changes are implemented while the day-to-day business of seeing patients continues unabated. Key skills that practices need for coping include:
All of this means more meetings! You will already have noticed (and sponsored) a number of meetings focused on Practice-based Commissioning, especially where practices are forming into clusters. Practices will need to hold in-house meetings:
to plan for PbC (95 pence per patient for writing a business plan)
to plan how they will respond to patient survey feedback (50 points)
to plan how they will address the new QOF disease areas listed above (138 points)
to review significant events (10 points)
to train staff on CPR (7 points).
How can you help?
So how will you support your key practices in 2006? Will you be the sort of person they see as a drain on their precious time, adding no value and focused on delivering ‘key messages’ – or will you add value to their business, making time spent with you worthwhile? If all you are doing is providing a detail on your product, even if it is in a key QOF area, you may be viewed as a ‘time vampire’. However, if you are able to identify what needs the practice has in terms of service developments and meetings, and you can offer to help with these (through sponsorship, speaker finding and/or facilitation), then you will be working on their agenda and will be seen as part of the solution, rather than as another problem.
Successful representatives in 2006 will be sensitive to GPs’ and practices’ busy schedules and aware of the issues arising from the major changes they face. Using in-house Protected Learning Time where possible, successful representatives will maximise the learning time available to include the whole wider practice team (where possible) – especially GPs, practice nurses, supplementary prescribers and practice management – in order to streamline decision-making.
In your territory business plan, identify which changes in the local Health Economy will benefit your products and prioritise these in terms of educational support. If your product is not in a relevant QOF disease area, look out for opportunities to piggy-back meetings being organised by others to discuss these changes, as there will be a great many meetings around these topics in 2006
The Healthcare Partnership provides speakers for meetings, and facilitation for practice training, on all the above topics. Our key support services for practices are PbC business planning, implementing the new QOF and Practice Development Planning.
Contact us on
0870 2413506 0870 2413506 or firstname.lastname@example.org for details of sponsorship opportunities and our full range of services, plus copies of the new GMS and QOF documentation.