GP Dr Gavin Jamie looks at how practices can attain maximum points within the cancer area of QOF’s clinical domain
Summary points and value
- Indicators: 3
- Points: 13
- Prevalence: 3.4% (this is an estimate based on latest available QOF data and current trends)
- £/patient on the register (estimated): £8.50
*Prevalence is an estimate based on latest available QOF data and current trends. For further explanation read more details here.
The cancer register includes all patients diagnosed since 1 April 2003. The size of the register has tended to grow at a steady rate every year since the start of the QOF. This dilutes the payment for every new patient added.
Cancer reviews were shaken up recently, with a new indicator for review within three months of diagnosis, and amendments to the timeframe and requirements for the cancer care review indicator.
There are now effectively two review indicators. The first review must be within three months of the cancer diagnosis and should offer information about the support available from primary care.
The second review should be within a year of the diagnosis (previously six months) and use a structured template. This carries the same six points as the pre-2021 indicator, but the template is a new aspect.
Indicator CAN001: Maintain register of patients with cancer since 2003 (5 points)
Patients will go onto the register after a diagnosis of malignant disease. There is no code for removal.
The register will include patients who have had a diagnosis of malignant disease. The codes that are recognised are pretty comprehensive and include squamous cell carcinoma but not basal cell carcinoma. These codes are all within the ‘disorder’ section of SNOMED codes rather than ‘morphological abnormality’.
The majority of patients are likely to receive their definitive diagnosis in secondary care and there should be a system to enter this into the patient records when letters or messages arrive. The diagnosis is sometimes refined over time and it is important that multiple diagnoses are not entered for the same tumour, as this will trigger the need for multiple reviews under the following indicators.
Indicator CAN005: Review care and offer support to patients within three months of diagnosis (2 points)
There is no requirement for this to be a face-to-face review or to be carried out by a GP. This can often be a busy time for patients, so flexibility in approach may be appreciated. All patients diagnosed after the 1 April 2021 will be included in this indicator and there are two points for getting to 90% of patients.
It would probably be most effective to contact patients as soon as is feasible after the diagnosis has been received by the practice. This may be after an out patient appointment or following discharge from hospital.
The practice could adopt a policy of the usual doctor phoning a patient when a new diagnosis of cancer is received. It is often much appreciated by the patient, and an opportunity for the doctor to do a care review (guidance specifically states that this can be done over the phone). If contact is not possible, flag it in notes so it can be done opportunistically.
Indicator CAN004: Review within 12 months of diagnosis using structured template (6 points)
It is nearly impossible to produce a single template that covers everything from terminal ovarian cancer to a squamous carcinoma excision, but Macmillan Cancer Support has had a go and this is the template that should be used.
You can download the template here. It is already available on practice computer systems.
This will only apply to patients who have their latest diagnosis from January 2021, so will apply to some patients diagnosed before the start of the QOF year. Note that this date is different to the first review indicator above.
Check for any other patients who can be added to the register by searching every month or two for those diagnosed with cancer within the previous ten months who have not had a review, and offering them the review.
The usual exception reporting (now termed ‘personalised care adjustment’) will apply for unsuitability or informed dissent.
The exception reporting code will need to be entered in the QOF year after the patient’s diagnosis as this will be when the 12 month period for review expires.
Dr Gavin Jamie is a GP in Swindon and runs the QOF database
- NHS England – Quality and Outcomes Framework guidance for 2023/24. Published 30 March 2023.