Practice manager Dr Jolande Bennekers provides insight into the Network DES indicators, also known as the Investment and Impact Fund Indicators (IIF)
A quick reminder, there are three domains within the IIF:
- Prevention and Tackling Health Inequalities
- Providing High Quality Care
- A Sustainable NHS
In other articles, I discussed the Prevention and Tackling Health Inequalities domain and part one of the Providing High Quality Care domain.
In this article, I will discuss the second part of the Providing High Quality Care domain and, finally, the Sustainable NHS domain.
The Providing High Quality Care contains the following areas:
- Personalised Care (PC) area
- Access (ACC) area
- Enhanced health in care homes (EHCH) area
- Anticipatory Care (AC) area
- Cancer (CAN) area
- Structured medication reviews and medicines optimisation (SMR) area
This article discusses the last three.
The Anticipatory Care (AC) area explained
This area has one indicator, AC-02. It looks at the standardised number or emergency admissions of specified ambulatory care sensitive conditions per registered patient.
To achieve on this indicator, we need to reduce this by 0.001.
Ambulatory care sensitive conditions are defined as those where effective community care and case management can help prevent the need for hospital admission. PCNs are rewarded for reducing the rate of all emergency admissions for care home residents and emergency admissions for a subset of ambulatory care sensitive conditions. These are:
- COPD
- Diabetes complications
- Convulsions and Epilepsy
- Asthma
- Congestive Heart Failure
- Hypertension
- Influenza and Pneumonia
- Ear, Nose and Throat infections
- Pyelonephritis
- Cellulitis
The Cancer (CAN) area explained
This has one indicator, CAN-01. It focuses on the percentage of lower gastrointestinal fast-track cancer referrals accompanied by a faecal immunochemical test (FIT) result, recorded either within 20 days before the referral or 14 days after the referral.
The lower achievement target is 40%. To gain full points, it is 80%.
Achievement of this indicator relies heavily on patients returning the FIT kit in a timely fashion and the availability of appointments. There may be a delayed return of the FIT test, or difficulty in establishing contact following a positive result.
The Structured medication reviews and medicines optimisation (SMR) area explained
This area contains 11 indicators, SMR-01A, B, C and D; SMR-02A, B, C and D; SMR-03, RESP-01 and RESP-02.
SMR-01A the percentage of patients at risk of harm because of medication errors who received a structured medication review.
SMR-01B the percentage of patients with severe frailty who had a structured medication review.
SMR-01C the percentage of patients on potentially addictive medication who received a structured medication review.
SMR-01D the percentage of permanent care home residents aged 18 or over who received a structured medication review.
For SMR-01 A-D the low achievement target is 44%. To gain full points, the target is 62%.
SMR-02A the percentage of patients 18 or over prescribed both an NSAID and an oral anticoagulant in the last 3 months of the previous financial year, who in the 3 months to the reporting period end date either no longer were prescribed an NSAID or also were prescribed a gastroprotective.
Low target is 85% and to achieve full points is 90%.
SMR-02B percentage of patients 65 or over on an NSAID and no oral anticoagulant in the last 3 months of the previous financial year, who in the 3 months to the reporting end date either no longer were prescribed an NSAID or also received a gastroprotective.
Low target: 85%, 90% for full points.
SMR-02C percentage of patients 18 or over on both anticoagulant and anti-platelet in the last 3 years of previous financial year, who in the 3 months to reporting end date either no longer were prescribed an anti-platelet, or also received gastroprotection.
The low target is 75% and to achieve full points, it’s 90%.
SMR-02D percentage of patients 18 or over prescribed aspirin and another anti-platelet in the last 3 months of the previous financial year, who in the 3 months to the reporting end date either no longer were on aspirin and/or no longer on anti-platelet, or also receive gastroprotection.
Low target is 75% and it’s 90%for full points.
SMR-03 percentage of patients on a direct-acting oral anticoagulant (DOAC), who received a renal function test and had their weight and Creatinine Clearance Rate recorded along with a recording the DOAC dose was either changed or confirmed.
The low target is 50% and to achieve full points, it’s 75%.
RESP-01 percentage of patients on the asthma register who received three or more inhaled corticosteroid prescription over the previous 12 months.
The low target is 71% and to achieve full points, it’s 90%.
RESP-02 percentage of patients on the asthma registered who received 6 or more Short Acting Beta-2 Agonist (SABA) inhaler prescriptions over the last 12 months.
To achieve the lower target, we need 25% or less and to get full points, it’s 15% or less.
The third domain, A Sustainable NHS, has one area – the Environmental sustainability (ES) area.
There are two indicators.
ES-01 looks at the Metered Dose Inhalers (MDI) prescriptions as a percentage of all non-salbutamol inhaler prescriptions issued to patients 12 or over.
To achieve the lower target, it’s a maximum of 44%, or for full points, it’s 35% or less.
ES-02 looks at the mean carbon emissions per salbutamol inhaler prescribed.
This should be less than 22.1 kg CO2e, or for full points 18.0 kg CO2e or less.
When it comes to these Network DES indicators, some are easy to achieve, while others are laborious. The indicators in the Structured Medication Review area are particularly time and labour intensive. Achievement of these depends on how much capacity we have.
Good luck!
Read more blogs from Dr Bennekers on QOF and the IIF
Guide to the IIF Indicators: Prevention and Tackling Health Inequalities
Guide to the IIF Indicators: Providing High Quality Care (Part one)
