I appreciate that CCGs need more advice like my garden needs a good watering but along with the thousand and one demands raining down from on high, the Quality and Outcomes Framework seems likely to have a significant effect on some services this year.
I appreciate that CCGs need more advice like my garden needs a good watering but along with the thousand and one demands raining down from on high, the Quality and Outcomes Framework seems likely to have a significant effect on some services this year.
These demands are unlikely to come from the Quality and Productivity indicators. Now starting into their third year they seem to have failed to change anything very much. Originally set to be for one year only, with further years to be dependant on evidence of effectiveness, they have been renewed annually without any such evidence being published.
The more significant effects are likely to come from increasing demand for services which will need to be commissioned. The QOF already accounts for a significant proportion of all the laboratory tests requested and this seems set to continue. Radiology has been much less affected in the past but this year we can expect to see a significant rise in the number of patients having a DEXA osteoporosis test as screening calculations are mandated for all patients with rheumatoid arthritis.
Even that is likely to be small compared with the referral of every patient with a new diagnosis of diabetes to an educational class about how to manage their diabetes. This seems likely to be between two and five patients per thousand of a CCG's population. The QOF guidance from the Department of Health is quite explicit that where these services do not exist practices should be pressing their CCG to provide them.
The Department has postponed indicators requiring all patients with moderate to severe COPD or a new diagnosis of heart failure to be referred to a rehabilitation class. We should consider ourselves warned; these services will be mandatory from next April.
Slightly apart from the QOF will be the new Directed Enhanced Services. There is to be a screening programme for dementia (although we are calling it “case finding” in front of the bosses because it does meet the criteria officially to be screening). NICE is very clear that the diagnosis should be made by specialist services who can expect a large number of referrals.
Risk stratification will throw up patients with a high-calculated health risk. In some of these patients health services may not be aware of this already and extra community services will be required.
Additionally these groups of patients tend to be elderly. Some will be obese. By definition many will have problems walking due to shortness of breath or have failing memories. A large number will require transport arranged to ensure they can get to their classes or assessments.
Time is tight. These referrals must take place within the QOF year so if the services are only available from September they will have to work twice as hard before next April.
The availability of all of these services currently varies a great deal around the country. Even in those areas where they already exist demand is likely to soar over the next year, driven by the demands of the GP contract. These are a whole new set of must do services.
CCGs must be sure that they are not submerged by the flood.
About the author
Gavin Jamie is a full-time GP in Swindon with an interest in Health Informatics.
He has been a QOF assessor and runs the QOF Database website, publishing data and analysis from throughout the UK.
Related articles
