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Guide to the IIF Indicators: Providing High Quality Care (Part one)

11 January 2023

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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 that 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. Remember, these indicators are not only dependent on the achievement of your practice but rely on the achievement of the entire PCN. Even if your practice performs well, but the PCN as a whole doesn’t, you may not receive full payment for the work done. Working together as a PCN is therefore a must.

In a separate article, I discussed the Prevention and Tackling Health Inequalities domain. In this article, the Providing High Quality Care domain will receive attention.

The Providing High Quality Care domain contains the following areas:

  • Personalised Care (PC)
  • Access (ACC)
  • Enhanced health in care homes (EHCH)
  • Anticipatory Care (AC)
  • Cancer (CAN)
  • Structured medication reviews and medicines optimisation (SMR)

This is quite a large area so I will tackle three areas in this article and the remaining three areas in a separate piece.

The Personalised Care (PC) area explained

This has one indicator, PC-01.

It looks at the percentage of registered patients who have been referred to a social prescribing service.

The lower achievement lies at 0.8%: to achieve full points: 1.2%.

To meet this target, run searches of frequent attenders and assess their records for signs the patient might benefit from social prescribing. Follow this up with contact with the patient and an offer of referral. You may already have searches set up for this locally. Alternatively, tools like Ardens may help.

The Access (ACC) area explained

This area currently has two indicators remaining, ACC-07 and ACC-09.

ACC-07 relates to the number of pre-referral specialised advice requests (also known as Advice and Guidance) across 12 specialties identified for accelerated delivery per outpatient first attendance.

The minimum achievement for this indicator is set at 0.066; to achieve full PCNs must reach 0.19.

The specialties identified are:

  • Cardiology
  • Dermatology
  • Ear, Nose & Throat (ENT)
  • Endocrinology
  • Gastroenterology
  • Gynaecology
  • Haematology
  • Neurology
  • Paediatrics
  • Respiratory
  • Rheumatology
  • Urology

ACC-09 looks at the number of referrals to the community pharmacist consultation service per registered patient.

PCNs need to reach a single threshold of 0.034 to achieve this indicator.

Both indicators may be difficult to achieve. Advice and Guidance isn’t always appropriate and may delay an appropriate referral. Also, patients may decline referral to the pharmacist if there are still doctor’s appointments available.

ACC-02– online consultation submissions received by the PCN per registered patient– has been deferred to 2023, as has ACC-08the percentage of patients whose time from booking to appointment was two weeks or less.

ACC-05– making use of the Patient Survey to identify patient groups experiencing inequalities in access to their practice, and developing, publishing and implementing a plan to improve this – has been retired.

Enhanced Health in Care Homes (EHCH) area explained

This area has three indicators: EHCH-01, EHCH-02, and EHCH-04.

EHCH-01 is the number of patients aged 18 or over recorded as living in a care home as a percentage of the care home beds aligned to the PCN and eligible to receive the Network Contract DES EHCH service.

The minimum achievement on this indicator is 30%: to achieve full points: 85%.

EHCH-02 looks at the percentage of care home residents over 17, who have a Personalised Care and Support Plan agreed or reviewed.

To achieve this indicator, we need a minimum of 80%: to achieve full points: 98%.

EHCH-04 focuses on the mean number of patient contacts as part of the weekly care home round per care home resident aged 18 or over.

The minimum achievement is 6: to achieve full points: 8.

EHCH-06 ­– standardised number of emergencies on or after 1 October per care home resident aged 18 or over – has been deferred till 2023/24.

EHCH-03 –the percentage of care home patients who have had a Structure Medication Review – has been renamed as SMR-01D and will be discussed in a later next article.

Certain areas of the IIF are easier to achieve than others, and it is challenging to achieve fully on all. However, there are tools around to help us and if we work together as a team, and as a PCN, meeting the targets should be possible.

Like in other years, our goalposts have changed midway through the year, with some indicators being deferred, dropped, or targets being adjusted. These deferrals mean that the next year will be even more challenging than the current one.

As ever, good luck!

Dr Jolande Bennekers is a retired GP who works as practice manager at Grimethorpe Surgery in Barnsley