Practice manager Dr Jolande Bennekers provides insight into the Network DES indicators, also known as the Investment and Impact Fund Indicators (IIF).
This year, we have seen the introduction of many more indicators to the Investment and Impact Fund. These are quite ambitious to achieve and the sceptics amongst us will believe these were introduced to set primary care up to fail.
However, primary care has always risen to the challenge and achieved beyond expectation. As some targets were deemed unachievable, changes were made in October 2022. Some indicators were deferred until next year, others scrapped, and some adjusted.
Currently, there are three domains within the IIF:
- Prevention and Tackling Health Inequalities domain
- Providing High Quality Care domain
- A Sustainable NHS domain
Each area contains several indicators, and I will discuss these in this and subsequent articles. This piece focuses on the Prevention and Tackling Health Inequalities domain, which has the following areas within it:
- Vaccination and Immunisation (VI) area
- Tackling Health Inequalities (HI) area
- CVD prevention (CVD) area
The Vaccination and Immunisation (VI) area explained
This has three indicators: VI-01, VI-02, and VI-03.
VI-01 looks at the percentage of patients aged 65 or over who received a seasonal influenza vaccination between 1 September 2022 and 31 March 2023.
Low target: 80%; to achieve full points, you need to vaccinate at least 86%of your population in this group.
VI-02 focuses on the percentage of patients aged 18-64 years in a clinical risk group who received the seasonal influenza vaccination between 1 September 2022 and 31 March 2023.
Low target: 57%; to achieve full points: 90%.
VI-03 looks at the percentage of children aged 2 or 3 on 31 August 2022 who received a seasonal influenza vaccination between 1 September 2022 and 31 March 2023.
Low target: 45%; to achieve full points: 82%.
Achieving well on this indicator is possible, provided you invite patients and record all vaccinations appropriately. Don’t forget to decline patients who don’t wish to receive the vaccination. Tech tools like AccuRx may help in inviting, coding and declining patients, too.
Tackling Health Inequalities (HI) area explained
This has two indicators within it, HI-01and HI-02.
HI-01 concentrates on patients on the Learning Disability register aged 14 and over, who received an annual Learning Disability Health Check and have a completed Health Action Plan.
Low target: 60%; you only gain full points if you reach 80%.
HI-02 involves the percentage of registered patients whose ethnicity is recorded on their GP record.
Low target: 81%; to attain the full points, you need to reach at least 95%.
Although the first indicator may be difficult to achieve, involving your team or care coordinator may help in encouraging patients to attend their health checks.
The second indicator is easier, especially if you have a tool available, which allows you to send a questionnaire out to patients, receive the answer and save these coded directly into the patient’s notes.
CVD prevention (CVD) area explained
This area has 6 indicators: CVD-01, CVD-02, CVD-03, CVD-04, CVD-05, and CVD-06.
CVD-01 focuses on the percentage of patients with an elevated BP reading (≥ 140/90mmHg) aged 18 or over, who are not on the hypertension register, and received appropriate follow-up to confirm or exclude a diagnosis of hypertension.
Low target: 25%; to achieve fully, we need to reach at least 50%.
CVD-02 looks at the percentage of registered patients on the hypertension register, and the increase from the previous QOF year.
The lower increase target is a 0.4 percentage point increase, and to achieve full points, this should increase by 0.8 percentage points.
CVD-03 looks at the percentage of patients aged 25-84 inclusive, who have a CVD risk score (QRISK2 or 3) greater than 20%, who are on a statin.
The minimum achievement needed is 48%; for full points 58%.
CVD-04 focuses on the percentage of patients aged 29 and under, who have a cholesterol above 7.5, OR of those aged 30 and above, with a cholesterol above 9.0, who have been diagnosed with secondary hyperlipidaemia, clinically assessed for familial hypercholesterolaemia, referred for assessment familial hypercholesterolaemia, or genetically diagnosed with familial hypercholesterolaemia.
Lower target: 20%; you need 48%for full points.
CVD-05 involves the percentage of patients on the Atrial Fibrillation register with a CHA2DS2-VASc score of 2 or more (or 1 or more if not female), who were prescribed a direct-acting oral anticoagulant (DOAC), or, where this was declined or clinically unsuitable, a Vitamin K antagonist.
Lower target: 70%; but 95%needed for full points.
CVD-06 looks at the number of patients currently prescribed Edoxaban as the percentage of patients with AF and a CHA2DS2-VASc score of 2 or more (1 or more if male), and who are currently prescribed a DOAC.
Lower target: 25%; and 35% needed for full points.
These indicators may be a bit more difficult to achieve and may require the PCN to work together and put certain measures in place that involve the wider primary care team, including pharmacies.
A joint effort is vital
Remember, achievement is not dependent on the achievement of your individual practice but on the achievement of the entire PCN. If your practice performs well, but the PCN as a whole doesn’t, the income due to the PCN will be reduced, or even completely absent. Working together as a PCN on achieving the targets is therefore a must.
Good luck, it won’t be easy. But when has that ever stopped us?
Dr Jolande Bennekers is a retired GP who works as practice manager at Grimethorpe Surgery in Barnsley
