Maintaining Quality and Outcomes Framework (QOF) performance during the colder months is a major challenge for GP practices. With increased patient demand and seasonal illnesses on the rise, completion of this work during some of the busiest periods can get extremely tough.
But as services begin to contemplate the end of yet another QOF cycle, you may be looking for ways to accelerate achievement and lock in attainment before next spring.
From Suvera experience, there are some practical strategies you can implement to ensure you continue to meet targets, while maintaining delivery of high-quality routine patient care during the autumn and winter months.
Here we provide some top tips.
It’s essential to have a clearly defined model in place for call and recall of patients with regards to chronic disease management. This can provide a structured basis from which to plan workforce related to QOF.
Whether it’s by risk, month-of-birth or condition specific, different systems will all have their advantages and disadvantages relative to your register and available resource as you approach peak season.
For example, while birth month examples point to benefits such as more even distribution of workload, they also highlight potential pitfalls during the tricky autumn and winter periods. For example, when a larger portion of a register falls at the same time when the increased demand of flu season strikes.
This is where being ahead of the curve and prioritising by risk can be beneficial. Particularly for conditions like asthma, COPD, diabetes, and hypertension as we know these can all worsen during this time.
GP practices and PCNs Suvera has worked with have successfully implemented proactive recall systems to review high-risk patient groups ahead of time, and been primed for success with QOF achievement. This can ensure appropriate patients have the support they need before winter begins, while also helping to avoid the end-of-year rush.
For more on approaches and models you can implement click here
23/24 QOF made cholesterol and lipid management a key area of focus. This year saw updates to secondary prevention targets from LDL ≤1.8 mmol/L to LDL ≤2.0 mmol/L (or if LDL not recorded non-HDL of ≤2.6 mmol/L).
While these higher thresholds are beneficial, ensuring you have a strategy in place to meet these targets is vital.
The colder months can impact cholesterol levels with individuals becoming less active and more prone to indulge in unhealthy food. Certainly, studies show cholesterol levels of individuals tested during winter were 8% higher than summer.
Consider a practice-wide review of how lipid management is conducted across our team ahead of this time. Practice clinical meetings can be a great forum to get everyone on the same page with regards to lipid targets, and optimise pathways and associated responsibilities.
Find out more about how to optimise your approach with our CVD masterclass.
On the subject of getting the people on the same page – collaboration is all- important. From GPs to pharmacists through to nurses and administrative staff, everyone has a role to play in achieving QOF during peak season.
For example, following the example of lipid targets, admin teams can search for patients not treated to goal. Practice-based pharmacists can conduct structured medication reviews, and also play a role in managing cardiovascular health. While practice nurses can take a lead in chronic disease monitoring.
It might mean conversations with the team to see if there’s any areas they’d like to upskill in relation to QOF and creating development opportunities for them to do so. Then, it’s a case of ensuring specialists within the team are assigned the right tasks so everyone is working to ‘the top of their license’.
Optimal use of your available skills mix can free up GP capacity and reduce waiting times, which with anticipated demand spikes in routine appointments during autumn and winter can go a long way.
Those spikes can also be lessened with a good forward plan of communication with patients. For example, SMS messaging, while commonplace now in many practices can have a big impact.
Clear, accessible communication can keep patients informed of seasonal clinics and signpost to services and information for routine issues that may not require a GP appointment. This can create time for QOF work.
It can also keep chronic disease registers informed of planned care appointments, increase engagement and provide resources to support self-management. While questionnaires can collect health information and enable remote monitoring.
Make use of all the channels you have at your disposal too. Taking asthma as an example, for AST007, an asthma control test can be sent to patients through SMS systems that support such questionnaires. Blood pressure or blood sugar readings can be taken via digital platforms, helping to maintain QOF work for hypertension and diabetes. And video consultations for asthma reviews or COPD exacerbation management can help fulfil QOF indicators remotely.
Identifying patients missing from clinical registers is an area where practices can also make some potential quick wins at this time. This can often be due to missed codes, and interrogating available data to identify such cases can help pinpoint any gaps in care delivery.
This can be done by running searches on practice clinical systems. You can also identify which condition registers will provide the highest yield to target. For example, here at Suvera we compare prevalence with local and regional average to help focus efforts. From that foundation, we run bespoke searches to identify errors.
This helps to refine recall strategy, and we coordinate overlap in patients with multiple comorbidities to ensure individuals are invited once in a holistic appointment, maximising clinical outcome with fewer appointments.
For a demo of our prevalence coding service, contact our team
Finally, if demand becomes overwhelming in spite of best laid plans, draw on your available support.
Analysing QOF areas where you are particularly struggling can be a first step to identifying help you need.
You may be able to collaborate with your PCN pharmacists if needing extra resource while care coordinators can also take some of the administrative weight during peak times. Nurse associates can review patients at home too.
Other sources of support are also available.
Hera at Suvera, we offer a complete chronic disease management service for QOF.
From call and recall to diagnostics and data coding, Suvera makes complex care simple. It’s less administration, time and cost for you. Results include:
To lock in your QOF achievement, contact partnerships@suvera.co.uk
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