Maximising your QOF income: Dementia

GP Dr Gavin Jamie looks at how practices can attain maximum points within the dementia area of QOF’s clinical domain

Summary – indicators and value

• Indicators: 2
• Points: 19
• Prevalence: 0.75% (this is an estimate based on latest available QOF data and current trends)
• Estimated value per patient: £57

Background

Dementia has been part of the QOF for a decade and prevalence has roughly doubled in that time. Payments have more than halved recently too, making these points less attractive than they have been in the past. Almost all of the points are concentrated on a single annual review indicator.

DEM001: Maintain patient register (5 points)

To help keep an accurate register:

• Bear in mind patients with dementia may be taking medicines that are not used for any other conditions; search for cholinesterase inhibitor prescriptions to find any patients without a diagnosis code.
• It is also worth following up with patients who have been referred to the memory clinic, to ensure that their outcomes have been recorded.

DEM004 : Annual face-to-face review (14 points)

Points are awarded if 35% to 70% of patients with dementia have a face-to-face annual care plan review. This should be fairly comprehensive and will involve discussion of the patient’s wishes, as well as the details of their carer, if they have one.

Some pointers:

• There should be a physical health check as part of the review. Symptoms of physical illness or pain may be masked by dementia and problems should be looked out for.
• Mental health symptoms can also be hidden by dementia. Depression is common and specific symptoms should be identified, if present.
• The guidance contains quite a lot about the effects of the disease on the physical and mental health of the carer, where the patient has one. Again this might take some investigation. Behavioural issues related to dementia are likely to affect both the patient and their carer, although the carer may feel they should not complain. The carer may not be a patient of the practice but any issues can be communicated, with the carer’s permission, to their own GP.
• The review does not need to be completed in one go and it may be that information is gathered and a plan developed over the course of the year. As with the rest of QOF, this does not necessarily need to be done by a GP so you can delegate to one or more members of the primary care team.
• Many patients are housebound so will require a visit. Others may be in nursing homes. Depending on local arrangements with nursing homes the review could take place either in the surgery or the home. Again this may be a review that is developed over more than one visit. In these cases, there will not need to be a review of the role of the carer, other than to make sure that the patient’s needs are adequately met by the home.
• There are codes for exception reporting (now termed ‘personalised care adjustment’) if the patient declines the care plan or care plan review.

Removed in 2019/20:

There is no longer an indicator requiring newly diagnosed patients to have a battery of blood tests at the time of diagnosis. This was removed due to the small numbers of patients making the indicator unreliable. The blood tests themselves remain the recommended practice.

Dr Gavin Jamie is a GP partner in Swindon and runs the QOF Database website

Further reading/resources

NHS England – Quality and Outcomes Framework guidance for 2023/24. Published 30 March 2023.