Practice manager Dr Jolande Bennekers explains how to create a robust recall system to support QOF performance.
Although a robust recall system will make your life easier, setting it up will take time. But don’t let that put you off. I will walk you through how to create the system step-by-step. And I’ll share how to use tools that make the process as simple as possible.
The first decision is what criteria you’ll use for the system. In our surgery, we decided on a birthday month recall system.
This means that all recalls for a patient (cervical smears excluded) are due in their birthday month. That’s simple enough, though we opted to avoid any recalls in January, February, and March. That’s because we use these months to mop up any reviews that have not yet taken place despite invitations sent. So, patients whose birthdays fall in the first three months of the year are added to April, May, and June.
To set up this system, you need to know two things:
- which patients have a condition requiring a review (patients on the QOF register and who have a few other conditions)
- when their birthday falls.
When I first set up this system for our practice, I went through the notes of each patient born in a particular month, one by one. I checked for clinical conditions requiring recall and added the recall dates. This was an onerous and time-consuming task.
Although the preparatory work took a lot of time, we hoped the system would lead to a ‘one-stop shop’ in which all reviews could take place at the same time wherever possible.
So, how do you go about it?
A step-by-step guide
I started by setting up searches. As the clinical system already had disease register searches for QOF, I used those. All patients who fell under any QOF categories (including cervical smears) were part of this search.
Next were the sub-searches for patients by birthday month. For each month, we had to trawl the list one by one to add the recalls.
After that, I set up searches to find any outstanding recalls per month. We could then begin to invite the first patients using the recall system.
Getting to this stage took about a year in total.
Tools to help
At this point, our CCG commissioned Ardens. Other similar tools provide you with the support to streamline and improve recall systems. The project might have been much easier had this tool been introduced before we began creating our new system.
For example, Ardens makes it simple to run birthday month recall searches for all QOF domains (multi-morbidity and single conditions). It also includes sub-searches for patients to invite by text, email, or post. This makes life a lot easier! The clinician performing the review simply adds the next recall to the birthday month. And that avoids doing all the grunt work described in the previous section.
Once the system is set up, it’s time to start recalling the patients.
Recall the patients
To do that, you run the search and send the invitation, coding the invitations that go out. Run the searches regularly and invite patients a second or third time if a review hasn’t taken place. Searches are included for this in Ardens too. Don’t forget tools like AccuRx, which allow batch texting of patients using the searches provided.
If patients still haven’t attended for a review after a third invitation, you need to consider exclusion reporting (now called personalised care adjustments).
Before doing so, it is advisable to send the patient a strong letter to stress the importance of regular reviews. You could also consider adapting your second or third invitation letter to include this. That way, the standard letters would remind patients why a review is important for their health.
- A robust recall system requires accurate note-keeping and precision when adding the appropriate recall dates. This can take a considerable time if you set it up from scratch.
- You may need the input of a clinical person to determine which conditions require a recall date.
- Once the recall dates are in place, regular searches for the recalls are essential. This helps keep you on top of sending appropriate invitations, reminder letters, or letters to stress the importance of regular reviews.
- Appropriate exclusion reporting also needs to be done regularly.
- Tech tools can really help simplify this work. Consider discussing this with your PCN or ICB, since they may commission the tool for your local practices.
Dr Jolande Bennekers is a retired GP who works as practice manager at Grimethorpe Surgery in Barnsley
Read other articles on QOF by Dr Jolande Bennekers – how to hit QOF targets with a deadline and how to monitor achievements throughout the year.