Down at the doctor’sBy Gordon Blackwell, The National Health Intelligence Service

THE POINTS SCORED by GP practices as part of the 2005 Quality and Outcomes Framework (QOF) have been determined and the payments made. The total available to a practice in a year is 1050 points, However, PMS practices have 168.39 points deducted, so the maximum they can score is 881.61. Within the Framework, there are five ‘domains’: • clinical – 550 points (52% of the total) • organisational standards – 184 points (18%) • patient experience – 100 points (10%) • additional services – 36 points (3%) • holistic care, quality practice and access – 180 points (17%). Points and patients In each domain, ‘indicators’ are used to measure the practice’s performance. In the clinical domain there are 76 indicators, which measure aspects of: • the structure of care – e.g. is there a disease register in place? • the care process – e.g. is the indicator being measured and an appropriate intervention being made? For what percentage of the relevant population? • the outcome – e.g. how well is the condition being controlled? For what percentage of the population? For Yes/No indicators such as “Is there a disease register in place?” the practice receives the allocated number of points or none at all. For indicators that depend on measuring a percentage (for example, of patients with diabetes whose cholesterol counts in the previous 15 months have been recorded), there will be minimum and maximum thresholds with a scale of points allocation between them. The rules for transforming points into pounds need not concern us here. Note, however, that the monetary value of a point depends on the prevalence of a condition in the practice relative to the national norm. All this is important information for medical sales professionals, because it gives them: • market intelligence at practice level • an opportunity to help practices increase their incomes • a chance to boost sales by increasing the number of diagnosed patients. Knowing the score The table on page 33 shows what could be typical results from a range of practices, including three PMS practices. The first line shows the domain totals and the scores in the green line give the maxima. You will notice that six practices have achieved 97% or more, and one has achieved the maximum score. The last three practices could clearly do with a deal of help; but since raising another 1% means more cash in the bank next year, and because the rules will become progressively more severe, even those practices in the high nineties should be open to discussion – provided you can make an impact. Eight of the practices have dropped clinical points, and a look at the second section of the table tells you where. It directs you to the therapy areas where it could be in your interest to get in quickly and see where you can help. The remaining sections of the table show the results for the other domains. For reps looking for things to discuss with GPs, there is plenty of ammunition here. So you need to: 1. Understand the detail of the Quality and Outcomes Framework. To do this, you can go to the guidance issued by the DoH and the various interpretations; but subscribers to the National Health Intelligence Service at www.nhis.info will clearly have a head start in acquiring sufficient knowledge. 2. Decide how you can benefit the practice. This may be by increasing the numbers on a disease register, helping the practice to carry out a diagnostic or therapeutic process, or giving them some help with their systems. Such action could increase the number of points scored or raise the points’ value, or both. 3. Obtain the QOF data for your practices, so you can see where help is needed. Data day The data started to appear in mid-April. PCTs are making these data available in a range of formats. Some PCTs are claiming (under Section 22 of the Freedom of Information Act) that since the information will be published in some form later, whether on their website, in hard copy or via some centralised system, they do not have to make it public now. So getting the information involves a lot of effort. For DIY addicts, the process in England involves contacting all the PCTs and fighting the system until the data appear – but the data from one PCT could be an inch-thick wad of paper delivered though the post, or four e-mailed spreadsheets for each practice. The National Health Intelligence Service was geared up for the advent of this information; in April, it started actively collecting the data and translating it into the format shown on page 33. It intends to publish disease-specific reports covering the PCTs that have provided data, and details of the costs of the treatment advertisement on page 36. If you need more details, email qof@nhis.info or ring  0870 241 4402  0870 241 4402 . There is a wealth of data within the scoring system that may be useful for drilling down to disease-specific questions. But for pharmaceutical company use, the format shown in the table will be sufficient to pinpoint areas for action. Companies that have access to such data will be able to work with practices to help them raise their incomes, to build constructive partnerships and to sell more product. It is a win-win situation, but the timescale is short-term – and if your competitors get there first, you will have missed a unique opportunity. The NHIS could help you. Otherwise, start contacting the PCTs and wait while the competition forges ahead.