Practice manager Dr Jolande Bennekers advises on tools to measure QOF performance throughout the year
When we want to achieve QOF and not miss out on those time-sensitive indicators, it’s important to monitor our activity throughout the year. Only if we track our progress, can we adjust the course and improve performance. Monitoring performance also helps to identify the jobs we still need to focus on. In this article, I will discuss how we can monitor our progress for maximum achievement.
The simplest way to monitor achievements is to use the QOF tools built into our clinical systems. For EMIS, these are in the reporting section. There are four different tabs: ‘How am I driving?’, ‘1 month’, ‘3 month’, and ‘End-of-Year’. SystmOne also uses similar tabs, housed within the reporting section.
Although the first three tabs are useful (How am I driving, 1 month, and 3 month), I focus mainly on the End-of-Year one since this shows how far we are from our end target on the 31 March. As our end-of-year achievement is what we wish to perfect, that is what I look at from the start.
EMIS also helps to show how well we’re doing by showing the percentages achieved as red, blue or black depending on whether we have reached our lower (blue) or higher targets (black), or not yet achieved them (red). SystmOne also colour codes in this way but uses different colours.
The clinical system’s QOF section provides an overview, but it does not actually show the number of patients needed per indicator to reach the higher target.
It is also important to remember that some indicators will only record achievement from October onwards and will show zero before then. These indicators are:
AF007 – The percentage of patients with AF and a CHA2DS2-VASc score of ≥ 2 on anticoagulation.
DM022 – The percentage of patients with diabetes ≥ 40, without CVD or moderate/severe frailty taking a statin.
DM023 – The percentage of patients with diabetes and CVD (excluding haemorrhagic stroke) on a statin.
DM006 – The percentage of patients with diabetes with nephropathy or micro-albuminuria receiving an ACE-I (or ARBs).
HF003 – The percentage of patients with HF because of LVSD currently taking an ACE-I or ARB.
HF004 – The percentage of patients with HF who receive an ACE-I or ARB and a beta- blocker licensed for heart failure.
Measuring whether you are close to hitting targets
As mentioned, the QOF tools within your clinical system are a good start. Still, it’s vital to be able to identify the number of patients you need accomplish the high targets, as this helps to focus the practice’s efforts in the right areas. For example, knowing you only require another two patients to reach the high target provides an opportunity to invite enough ‘missing’ patients for a review (in Emis you find these under the header ‘excluded’). It’s best to invite a few more than you need to increase the chances of success. Numbers will be different for different indicators. So, you may need another 20 patients to achieve full points in one indicator but 45 may be required for another. Working your way through the lists of missing patients, inviting them for their reviews, and chasing them up if they don’t attend will help to achieve QOF targets.
While I worked as a GP, I used a calculator to work out the numbers of missing patients. However, this was rather cumbersome and a waste of precious time.
Later, as practice manager, I developed a spreadsheet where the calculations were automatic – all I need to do is fill in the numbers provided by the clinical system and it shows us how far we are from achieving the full points on any indicator.
Using automatic formatting within a spreadsheet highlighted the areas that need most attention, so I find it useful and still use this method now.
Explore what external services can help
We now have more tools available to add to our arsenal and make life easier for us.
Last year, our PCN and CCG procured Ardens for us. This package contains several searches to make life easier, and it improves the monitoring capability for QOF. Ardens also allows us to easily identify the work required to achieve our QOF targets.
A recall system based on birthday month helps to identify patients who still need to receive a first, second or third invitation, or those who we might need to consider for exception reporting (now called personalised care adjustments). For their clinical safety, it is important to stress the importance of regular reviews to patients before (or at the time of) exception reporting.
Ardens contains templates for chronic disease management, including multi-morbidity templates tailored to the patient’s needs. Templates for administrative purposes are also available that can help to streamline practice processes even further.
Of course. there are other tools delivering similar services and it is well worth looking into them, and negotiating with your PCN or ICS to fund this investment.
In summary, ensure you keep track of your achievements throughout the year and use all tools available to you. This will allow you to more easily adjust your efforts as you go, in a bid to gain full QOF points at the end of the fiscal year.
* Use the QOF reporting section in your clinical system.
* Use a spreadsheet to determine how many more patients you need to hit the higher targets. If you want to have some help with setting one up, you can download one here. Just add your own numbers. You can find instructions on how to use the spreadsheet here.
* Explore what other external services there are you can invest in, such as Ardens. Negotiate with your PCN/ICS to provide funding for these.
Dr Jolande Bennekers is a retired GP who works as practice manager at Grimethorpe Surgery in Barnsley