Transcript Changes to the GMS Contract Presentation 6th June 2013

Glasgow LMC & NHS GG&C
GMS Contract Meeting
6th June 2013
LMC CENTENARY YEAR
1913 - 2013
Glasgow LMC Limited
7.00 pm
Agenda
Welcome and Introductions
Dr Michael Haughney - Chairman, LMC
7.05 pm
Scottish Patient Safety Programme

Climate Survey
Dr Paul Ryan - Clinical Director, Glasgow City CHP (NE Sector)

Trigger Tool
Rachel Bruce – Lead Clinical Pharmacist, Interface Pharmacist
7.30 pm
Anticipatory Care Planning

Why?

What?

How?

When?
Dr John Nugent – Clinical Director, Glasgow City CHP (NW Sector)
7.50 pm
QoF Clinical Domain
Dr John Ip – Medical Secretary, Glasgow LMC
8.10 pm
Questions – Panel Discussion
8.30 pm
Dr Paul Ryan, Rachel Bruce, Dr John Nugent, Dr John Ip,
Contracts Manager
Close
Glasgow LMC Limited
Tom Clackson GMS
Scottish Patient Safety Programme
-Safety Climate Survey
Dr Paul Ryan, Clinical Director, NE Sector Glasgow City CHP
6th June 2013
National Objectives
•To reduce the number of events which cause avoidable harm
to people from healthcare delivered in any primary care
setting.
•All NHS territorial boards and 95% of primary care clinical
teams will be developing their safety culture and achieving
reliability in 3 high-risk areas by 2016.
Work streams
Interventions relating to
1.Safer Medicines
•Safe and reliable prescribing, monitoring and
administration of high alert medications (e.g. DMARDs,
warfarin, insulin, lithium
•Reducing high risk prescribing – data / alerts
•Medication reconciliation
2.Safe and reliable
patient care across the
interface and at home.
•Management of test results
•Communication at point of referral
•Handling written communication
3.Leadership and Safety
Culture
•Promoting a culture of safety and learning using Trigger
Tool, Safety Climate Survey, safety walk rounds
•Promoting organisational learning from Significant Event
Analysis (SEA)
•Building capacity and capability to support the programme
•Ensuring patients become partners in making care safer.
Guidance Patient Safety Indicators
Indicator
PS 1
PS 2
The practice conducts two case note reviews, using a validated
tool, to detect patient safety incidents, meets to discuss the
results, and shares a reflective report on actions and themes
that arise from this with the Health Board
The practice conducts a safety climate survey with all staff,
clinical and non-clinical, using a validated tool, meets to discuss
the results, and shares a reflective report on actions that arise
from this with the Health Board
Points
6
5
Adverse Event Causation
Technical
Factors
(30-20%)
Accident
Causation
(70-80%)
Human
Factors
=
Safety
Culture
+
Operator
Behaviour
What is Safety Culture?
Why is a strong Safety Culture Important?
A strong safety culture essential to safe reliable care
in any workplace
Francis Report and Culture
• There was an atmosphere of fear of adverse repercussions
• There was a lack of openness
• It did not listen sufficiently to its patients and staff or correct
deficiencies highlighted
• Above all it failed to tackle an insidious negative culture
involving tolerance of poor standards
How does the SafeQuest Safety Climate Survey
work in practice?
Safety Climate Survey
•
•
•
•
•
On line
Practice centred
Measurement
Diagnosis
Catalyst for change
5 key factors:
• Teamwork
• Workload
• Communication
• Leadership
• Safety systems and learning
Not the Safety Climate Survey!
Distribute- who to?
• We recommend that all practice staff and anyone involved in or
considered part of the practice team complete the survey. However, it
remains the discretion of individual practices to decide who they invite to
participate.
“Weren’t as good as we thought we were”
“Mismatch between what the clinical and
non clinical staff thought”
“Prompted some very open discussion”
Positive Change
Increased frequency of staff meetings.
At least one doctor to attend staff meeting.
2 way communication over a variety of issues.
Newsletter/minutes after each meeting.
Quarterly meeting involving whole practice.
Reflection Sheet
• What positive aspects of your team’s safety culture were highlighted in
the report and your discussions?
• What aspects of your safety culture do you as a team feel you could
improve?
• What steps will you take to improve these aspects of your safety
culture?
• What else might you change to improve your safety culture?
• Would you like any support or guidance to make changes in your
practice? If so, what would be useful?
Climate Survey
http://www.healthcareimprovementscotland.org/safetyclimate.aspx
http://gpsafetyclimate.com
Knowledge Page
http://www.knowledge.scot.nhs.uk
Medicine
Safety & Improvement in General Medical
Practice
Trigger Review of Clinical Records
“The Trigger Tool”
Dr Rachel Bruce
Lead Clinical Pharmacist – Interface Prescribing
Presenting on behalf on NES!
Quality Education for a Healthier Scotland
Content and Purpose of Session
Medicine
Content
• What is the Trigger Tool?
• Trigger Review Documentation
• What do you need to do?
Purpose
• To describe the Trigger Review concept and provide brief overview in applying
the method
• Signpost you to the experts!
Learning outcomes
• Understand the principle of the Trigger Review Method
• Know where to access the relevant support/documentation
Quality Education for a Healthier Scotland
Why?
Medicine
Quality Education for a Healthier Scotland
Context
Medicine
• Patient Safety
• The trigger review process forms part of the Scottish
Patient Safety Programme in Primary Care
• Incorporated into the 2013/14 GMS contract: “patient
safety” indicators
• PS1 (Quality Improvement) = “trigger tool” review
• 6 points
Quality Education for a Healthier Scotland
Medicine
The “Trigger Tool”
Quality Education for a Healthier Scotland
What is the Trigger Tool?
Medicine
 A simple checklist for a number of selected clinical “triggers”
 The trigger tool facilitates a rapid structured, focused review of a selected
sample of clinical records in the practice
 Using these “triggers” can potentially identify previously undetected patient
safety incidents
Quality Education for a Healthier Scotland
Safety Incidents in GP – Feedback Sources e.g.
Ombudsman Reports
Incident Reporting
Patients
Medicine
Colleagues
Self-report
Complaints
Clinical Records
SEA
Pharmacist
Quality Education for a Healthier Scotland
What is a trigger review of clinical records?
Medicine
•
•
Trigger review is simply a method of audit that involves the systematic evaluation of
a small batch of patient records by a clinician (GP or Practice Nurse)
A ‘Trigger’ is a pre-defined prompt or sign in the record that MAY indicate that a
patient safety incident has occurred – roughly defined as any incident, however
minor, where a patient was harmed, may have been (i.e. a near miss), or could be
in future (i.e. a latent risk)
•
Detected Trigger(s): a signal for the reviewer to undertake a more in-depth review
of the record to determine if evidence of a safety incident exists
•
For example, an INR>5.0 (a trigger) was detected by a clinical reviewer - further
review of the record found evidence of the patient having suffered a bleed and
being admitted to a local hospital (a patient safety incident)
•
If a safety incident is uncovered, the reviewer makes a professional judgement on
whether it was avoidable or not, how severe it was and if it originated in primary
care or elsewhere
•
This grading helps to pinpoint incidents where learning and improvement are a
greater priority - may be necessary if multiple incidents are detected
Quality Education for a Healthier Scotland
What are the “Triggers” in Clinical Records?
‘‘Triggers’’ are defined as easily identifiable flags, occurrences or prompts in
patient records that alert reviewers to actual or potential safety incidents
(undetected)
Sections in GP Records
Triggers
Clinical encounters
(documented consultations)
≥3 consultations in 7 consecutive days
Medication-related
(acute and chronic prescribing)
Repeat medication item stopped
Clinical read codes
High, medium, low, allergies
New ‘high’ priority or allergy read code
Correspondence Section
Secondary care, other providers
OOH / A&E attendance / Hospital admission
Investigations
Requests and results
eGFR reduce <5, Hb < 10.0, INR > 5.0
Quality Education for a Healthier Scotland
Medicine
Detecting Patient Safety Incidents in GP
Clinical Records: Proof of Principle
• Two GPs reviewed 500 randomly selected electronic patient
records (100 x 5 Scottish GP practices): 12-month period.
• Clinical triggers developed and tested help to pinpoint safety
incidents
• 9.5% of records contained evidence of unintentional harm to
patients
• 60+% were judged to be preventable
• Most cases low to moderate severity, all severe cases
originated in secondary care
• Scope for safety-related learning and improvement (in the
same way as SEA or Audit)
Quality Education for a Healthier Scotland
Medicine
PS1 Indicator: Quality Improvement
1.1. Aim: to identify and reduce patient safety incidents
within practices
1.2. Background: use of rapid structured case note
review using a trigger tool in high risk patient groups
can identify patient safety incidents and near misses
which practice teams can learn from and so reduce
the risk of future patients from being harmed
Quality Education for a Healthier Scotland
Medicine
When and What do we need to do?
Medicine
1.3 Using the NES primary care Trigger Tool each practice will complete a
structured case note review twice in 2013/14, at least three months
apart
Review to be conducted on 25 patients each time (x 2) from the
recommended risk groups:
•
Patients on DMARD therapy
•
Patients with diagnosis of Left Ventricular Systolic Dysfunction
•
Patients on Warfarin therapy
•
Patients with a higher SPARRA score e.g over 40
•
Recent admissions with COPD Care home residents
•
Patients on chronic District nursing caseload
•
Patients aged 75 years on 6 or more medications
Quality Education for a Healthier Scotland
How do we do it - The trigger tool process
Medicine
STEP 1: Planning and preparation
STEP 2: Review a random sample of records
STEP 3: Reflection and further action
Quality Education for a Healthier Scotland
Medicine
Quality Education for a Healthier Scotland
Medicine
Quality Education for a Healthier Scotland
Step 1: Plan
Medicine
- Decide on patient group e.g. patients on warfarin
- Run search and randomly select 25 patients
- Decide if you want to add an optional trigger e.g
acute Rx of a NSAID
- Agree the time frame to look for triggers. This should
ideally be a 3 calendar month period with a preceding
month’s gap from the current date (for example in
Sep 2012 I looked at May, June and July 2012 time
frame)
- Identify who will undertake the trigger tool review
Quality Education for a Healthier Scotland
Step 2: Review. How to Undertake a Trigger
Review
Medicine
When examining a record, the reviewer looks to answer the following 5 questions:
1. Can triggers be detected?
• If yes, the reviewer examines the relevant section of the record in more detail to
determine if the patient came to any harm.
• If no, move onto the next record - average review time is 2 to 3 minutes
2. Did harm occur?
• If yes, move onto the next question on the proforma sheet.
• If none is detected, move onto the next record.
After 20 minutes if unable to decide if harm occurred you ignore the record and
move on.
3. What was the severity of harm detected?
• The reviewer should rate the severity of every incidence detected
4. Was the detected harm incident preventable?
• The reviewer should determine whether the detected incident was preventable based on a combination of evidence found and professional judgement.
5. Where did the harm incident originate?
• The circumstances leading to the incident may have originated in primary or
secondary care, or a combination of both.
Quality Education for a Healthier Scotland
Medicine
Quality Education for a Healthier Scotland
Step 3: Reflect
Reflection can be at different levels and is the most important part
of the trigger review process
 Patient level: acknowledge, apologise, audit, consider
interventions to prevent recurrence
 Practitioner level: identify any PDP/CPD needs, complete TT
process, submit for appraisal
 Practice level: share, reflect, discuss findings, prioritise any
incidents and possible interventions, compare findings to
previous reviews
 Interface: should any incidents be reported through local or
national systems
The indicator requires practices meet to discuss the results, and share a
reflective report on actions and themes that arise from this with the
Health Board.
Quality Education for a Healthier Scotland
Medicine
Medicine
Repeat the process (steps 1-3) on your chosen patient
group (25 different patients) after a minimum time
period of 3 months has elapsed
Quality Education for a Healthier Scotland
Examples of improvements made during
trigger review:
Medicine
1. Nephrotoxic medication discontinued.
2. Drug dosage (warfarin) adjusted.
3. Referral letter to secondary care done (x3).
4. Allergy or adverse reaction code updates.
5. Medication reviews done.
6. Medication adjustments made.
7. Initiated follow up appointment for patients requiring review.
8. Cardiotoxic drug discontinued.
9. Updated notes with investigation.
10. Follow up blood test arranged.
Quality Education for a Healthier Scotland
To Summarise…..
Medicine
• Quick and Structured
• Clinical triggers help you to navigate your records quickly
• Looking for evidence of (undetected) safety incidents/latent risks
• Reflection, learning and improvements made following the trigger
review is the key part of the process - help you direct safetyrelated learning and improvement
• Links with SEA and Quality Improvement
• Evidence for QOF, Appraisal and GPST etc.
• Tested with large groups of GPs, Practice Nurses and GP
Trainees
Quality Education for a Healthier Scotland
…and finally
Medicine
•
The focus is patient safety incidents and not error. Ask yourself: ‘Would I have
wanted this to happen to me or my family?’
•
Only review the specific period in the record (3-months).
•
Choose full calendar months to facilitate the review.
•
The maximum time spent on reviewing any record should be twenty minutes. The
objective is to detect ‘obvious’ problems, rather than every single episode.
•
Most records do not contain triggers or evidence of incidents – these only take a
few minutes to review
•
If there is reasonable doubt whether a safety incident occurred, the incident should
not be recorded.
•
Use the team to assist in searching (admin) for and reviewing (nurse) records
Quality Education for a Healthier Scotland
Resources
Medicine
ONLINE RESOURCES:
http://www.healthcareimprovementscotland.org/our_work/patient_safety/sp
sp_primary_care_resources/trigger_tool.aspx
http://www.nes.scot.nhs.uk/education-and-training/by-themeinitiative/patient-safety-and-clinical-skills/tools-and-techniques/safetyand-improvement-in-primary-care.aspx#Trigger%20Tool
TRAINING: Glasgow City CHP RCGP Quality Improvement Training – 13th
June 2013. Hampden Park
THE EXPERTS!
Dr Carl de Wet: [email protected]
Dr John McKay: [email protected]
Dr Paul Bowie:
[email protected]
Quality Education for a Healthier Scotland
Anticipatory Care Planning
6th June
John Nugent
Clinical Director
51
Guidance to date
• Document 4: December/January
• ACP ‘Summary Guidance…’ April/May
• Scottish QOF Guidance May
52
Document 4
• Improving Care for Patients at High Risk of
Emergency Admission
• ‘…appropriate ACP can improve the quality of
care, reduce the risk of medication harm and
either (or both) the number of future
admissions and lengths of stay…’
• ‘As poly-pharmacy can significantly increase
the risks (of admission/harm)…it has been
agreed as appropriate to include’
53
Document 4
• Support to practices;
• ACPs uploaded/accessed/utilised (added to?)
• Support Community Nursing Teams (members of
the primary care team) to participate in
developing ACPs and attending MDTs
• Prescribing support…to participate in polypharmacy reviews
• Data on bed days utilisation
• Local development support
54
‘Summary Guidance’
• Improving the quality of care;
• ‘Anticipatory care planning encourages people
to adopt a ‘thinking ahead’ approach and to
have greater control and choice by planning
for what their preferred support and care
interventions would be in the event of a
future flare-up or deterioration in their
condition, or a carer crisis.’
55
Summary Guidance
• Identifying patients for ACP and Poly-pharmacy
Reviews
• Using a SPARRA risk threshold of between 20% and
60% will generate a cohort of around 5% of patients in
the practice to fulfil the QP006 indicator
• Working down from an ‘upper ceiling’ of those with a
60% risk score will enable the practice to improve
outcomes for people most likely to benefit from an
Anticipatory Care Plan and a poly-pharmacy review.
• This will complement other local ACP initiatives that
target cohorts with greater than 60% SPARRA risk
56
Summary guidance
• Patients < 60% SPARRA risk more likely to be
engaged with the practice team than active on
the community nursing caseload i.e. mobile
• Interventions < 60% represent earlier
intervention likely to reduce escalation of
dependency and to optimise adherence to
medicines.
57
Summary Guidance
• Scope to apply clinical judgement to what constitutes
'at risk of emergency admission' ; may be patients who
would benefit from an ACP but do not have a risk score
within the risk thresholds specified
• The Key Information Summary (KIS); tool by which
practices create and share (with consent) ACPs
• Summary of medical history/patient wishes, replaces
paper based faxing between GPs and OOH
• More generic version of the electronic Palliative Care
Summary (ePCS).
58
Summary Guidance
• Current ePCS patient information will transfer
automatically to KIS but needs checked once KIS is
switched on (ePCS patients that transfer
automatically to KIS will not count as part of the
cohort required for QP006 and QP007)
• NHS24, SAS, A&E, OOH and Acute Admission Areas
already have access to KIS
• Access in other acute areas/departments depends
on Board PMS systems and clinical portal
developments
• Flow chart included
59
Poly-pharmacy
• 50% drugs not taken as prescribed
• 5-17% admissions due to adverse reactions
• If on multiple medications more side effects
• Potential harm of drug may outweigh benefit
QOF QP; QP004(S), 7 points
• QP004(S). The contractor meets internally to
review data on emergency admissions, for
patients on the contractor's registered list,
provided by the NHS Board and the learning
from at least 25 per cent of the Anticipatory
Care Plans (ACPs) completed for QP007(S)
• Template for reporting will be agreed
nationally
61
QOF QP; QP005(S), 17 points
• QP005(S). The contractor participates in an
external peer review with either a group of
local practices, or practices from within the
board area, to compare its data on emergency
admissions and to share the learning from at
least 25 per cent of the Anticipatory Care
Plans (ACPs) completed for QP007(S), and
proposes areas for internal practice
improvement and service design
improvements for the NHS Board.
62
QOF QP; QP006(S), 5 points
• QP006(S). The contractor produces a list of 5
per cent of patients in the practice, who are
predicted to be at significant risk of
emergency admission or unscheduled care.
This list can be produced using a risk profiling
tool accessible to practices e.g. SPARRA, or
where this is not available/required (by local
agreement), alternative arrangements can be
agreed between the NHS Board and LMC.
63
•
QOF
QP;
QP007(S),
30
points
QP007(S). The contractor identifies a minimum of 15
per cent (in 2014/15, 30 per cent) of those patients
from the list produced in indicator QP006(S) who
would most benefit from an Anticipatory Care Plan (the
ACP must include a poly-pharmacy review), be shared
with the local out of hours service and has an
appropriate review date. The frequency of each
patient’s review should be determined in the light of
their clinical and care needs. The contractor will be
responsible for ensuring that an appropriate system is
in place for monitoring and reviewing the patients
identified in this cohort.
64
QOF QP; QP008(S), 10 points
• QP008(S). The contractor holds at least 4
meetings during the year to review the needs
of the relevant patients in the practice ACP
cohort, to agree any required changes in the
patient management and to share learning/
identify learning needs. These meetings
should be open to multi-disciplinary
professionals who support the practice’s
patients
65
•
QOF
QP;
QP009(S),
10
points
QP009(S). The contractor produces and submits a
report to the Board before 15 March 2014 on internal
practice and wider NHS Board system changes that
may benefit patients with Anticipatory Care Plans
(ACPs). The report should include Significant Events
Reviews (SERs) on 1/1000, to a maximum of 3 patients
per practice, of patients with ACPs from the cohort in
QP007(S), who were admitted during the QOF year,
after their ACP had been created. If less than the
required number of patients with ACPs were admitted
during the QOF year then the practice should write
SERs of the care of an equivalent number of these
patients who remained in the community.
66
Summary
• Patient centred care; closer to home, reduced
harm
• Carers; communication, support
• Practices; supports review, professionally
satisfying, reduces ‘chaos’ (use)
• Boards; reduced admissions/lengths of stay
• Improves interface working
• Not about keeping anyone out of hospital who
needs hospital
67
Issues - now
•
•
•
•
•
•
•
SPARRA; ‘push not pull’
Review and decide who would most benefit
See in surgery/home
KIS; EMIS now, VISION 2 weeks
MDTs; membership, review
Poly-pharmacy review; overlap with LES
‘Face-to-face’
68
Poly-pharmacy; overlap with LES
• Practices should generally only make one claim for payment
for a poly-pharmacy medication review, per patient, during
2013/14
• Exceptional cases may arise when an ACP/PP should be
developed after a Poly-pharmacy LES review has occurred or
vice versa
• Payment can only be claimed on behalf of the same patient
for a Poly-pharmacy LES and a ACP poly-pharmacy medication
review during 2013/14 if;
a. there are 2 distinct reviews recorded in the patient’s record
b. there is clear clinical justification to demonstrate the need for
a repeat review for the same patient during the lifetime of the
2013/14 Poly-pharmacy LES
Clinical Justification
• The clinical justification would include a change in a patient`s
clinical status due to one or more of the following occurring;
1. Hospital admission at least 1 month after the first polypharmacy review (ACP/PP or PP LES) had taken place
2. New clinical diagnosis
3. Deterioration in existing clinical condition requiring 3 or more
either changes to drug or drug dose (oral or parenteral
medication only)
4. Patient needing to go onto the palliative care register
Issues - later
• Role of DN/PN/Pharmacy support?
• Learning?
• Board support?
71
Information held on KIS
• Significant Diagnoses and PMH
• Prognosis
• Medication and allergies
• Current Care Needs
• Help at home (e.g. Social Services / Care Packages)
• Legal Issues (e.g. AWIA, Power of Attorney)
• Preferred Place Care
• End of Life Care wishes
• DNA-CPR information
• Free-text Anticipatory Care Plan
Example of a KIS which has been
developed over a period of time?
Summary of main
issues
Summary of main
issues
Plan of action in event
of a deterioration
Summary of main
issues
Plan of action in event
of a deterioration
Medication that can be
used as PRN
Summary of main
issues
Plan of action in event
of a deterioration
Medication that can be
used as PRN
Details of other
professionals involved
in care
Summary of main
issues
Plan of action in event
of a deterioration
Medication that can be
used as PRN
Details of other
professionals involved
in care
Contact details of
family member
Information available on KIS
QOF Clinical Domain
2013/14
Dr John Ip
Glasgow LMC
QOF Changes
•
•
•
•
•
New Domain- Rheumatoid Arthritis
New Clinical Indicators
Increases in thresholds
All 15 month targets now 12 months
Numbering changes
Glasgow LMC
New Work
•
•
•
•
•
•
Rheumatoid Arthritis domain
4 indicators- 18 points
Register (1 point)
Review (5 points)
CVD Risk (7 points)
Fracture Risk (5 points)
Glasgow LMC
New Clinical Indicators
• DM dietician review, referral to
Structure learning programme
• DM- ED screening, advice &
treatment
• COPD- O2 sat for Grade 3 and above
• Depression- BPS assessment for
new patients, 10-35 day review after
diagnosis
Glasgow LMC
New Clinical Indicators
• CVD-PP SCOT-PASQ for patients
with HT diagnosed after 1 April 2009
• Smoking- transfer from Information 5
Glasgow LMC
Atrial Fibrillation
AF001
5
Register. No change from AF1
AF002
10
AF003
6
AF004
6
CHADS2 Score. 15 to 12 months
(AF5)
Score 1 on anti-coag or anti-platelet.
15 to 12 months (AF6)
Score >1 on anti-coag or antiplatelet. No change from AF7
Glasgow LMC
Secondary Prevention of CHD
CHD001
4
Register. No change from CHD1
CHD002(S) 17 BP <150/90. 15 to 12 months and
threshold 40-75% to 50-85% (CHD6)
CHD003(S) 17 Chol <5. 15 to 12 months and
threshold 40-75% to 50-85% (CHD8)
CHD004(S) 7 Flu. No change from CHD12
CHD005(S) 7
Aspirin, anti-platelet, anti-coag.15 to
12 months (CHD9)
CHD006(S) 10 MI- ACE, aspirin, BB, statin. No
change from CHD14
Glasgow LMC
Heart Failure
HF001
4
HF002
6
HF003
HF004
Register. No change from HF1
Echo. Specifies 3mth prior to 12 mth
after entering register (HF2)
10 LVSD- ACE or ARB. 45-80% to 5085% (HF3)
9 LVSD- BB. 40-65% to 50-75%
Glasgow LMC
Hypertension
HYP001
6
Register. No change from BP1
HYP002
55 150/90 or less (9 months). No
change from BP5
BP4 gone- record of BP last 9
months. 8 points
Glasgow LMC
Peripheral Arterial Disease
PAD001
2
Register. No change from PAD1
PAD002
2
BP <150/90. 15 to 12 months (PAD3)
PAD003
3
Chol <5. 15 to 12 months (PAD4)
PAD004
2
Aspirin or alternative. 15 to 12
months (PAD2)
Glasgow LMC
Stroke and TIA
STIA001
2
Register. No change from Stroke1
STIA002(S)
2
STIA003(S)
5
Record of referral 3 months before to 1
month after entering latest recording.
45-80% to 50-90% (Stroke13)
BP<150/90. 15 to 12 months (Stroke6)
STIA004
2
Chol reading. 15 to 12 months (Stroke7)
STIA005
5
Chol <5. 15 to 12 months (Stroke8)
STIA006(S)
2
Flu. 45-85% to 50-90% (Stroke10)
STIA007(S)
4
Anti-platelet. No change from Stroke12
Glasgow LMC
Diabetes Mellitus
DM001
6
Register. No change from DM32
DM002(S)
8
BP <150/90. 15 to 12 months (DM30)
DM003(S)
10 BP <140/80. 15 to 12 months (DM31)
DM004
6
Chol <5. 15 to 12 months (DM17)
DM005
3
DM006(S)
3
Change from microalbuminuria test
to albumin:creatinine ratio test. 15
to 12 months (DM13)
Nephropathy or micro-alb- ACE. 4585% to 50-90% (DM15)
Glasgow LMC
Diabetes Mellitus
DM007(S)
17 HBA1c < 59. 15 to 12 months (DM26)
DM008(S)
8
DM009(S)
10 HBA1c <75. 15 to 12 months (DM28)
DM10(S)
3
Flu. 45-85% to 50-90% (DM18)
DM11
5
DM12
4
Retinal Screening. 15 to 12 months
(DM21)
Foot exam & risk classification. 15
to 12 months (DM29)
HBA1c <64. 15 to 12 months (DM27)
Glasgow LMC
Diabetes Mellitus
DM13
3
NEW- Annual Dietician review (all)
DM14
DM15
11 NEW- Referral to Structured Learning
Programme (new
4 NEW- Erectile Dysfunction Screening
DM16
6
NEW- ED Advice and Treatment
Glasgow LMC
Hypothyroidism
THY001
1
Register. No change from Thyroid1
THY002
6
TFTs. 15 to 12 months (Thyroid2)
Glasgow LMC
Asthma
AST001
4
AST002
15 Variability or reversibility testing of
3 months before or anytime after
diagnosis (Asthma8)
20 Asthma Review in past 12 months.
No change from Asthma9
6 Smoking status 14-20 years. 15 to
12 months (Asthma10)
AST003
AST004
Register. No change from Asthma1
Glasgow LMC
COPD
COPD001
3 Register. No change from COPD14
COPD002
5 Spirometry between 3 mths before
and 12 mths after entering register
(COPD15)
COPD003
9 Annual Review 15 to 12 months
(COPD13)
COPD004(S) 7 FEV1. 15 to 12 months. 40-75% to
50-85% (COPD10)
COPD005
5 NEW- Grade 3 and above O2 Sats in
past 12 months
COPD006(S) 5 Flu. 45-85% to 50-90% (COPD8)
Glasgow LMC
Dementia
DEM001
5
DEM002
15 Face to face review. 15 to 12 months
(DEM2)
6 New diagnosis blood tests. No
change from DEM4
DEM003
Register. No change from DEM1
Glasgow LMC
Depression
DEP001
DEP002
21 NEW- Bio-Psychosocial
Assessment at Diagnosis
10 NEW- Review of patient between 10
days and 35 days after diagnosis
Glasgow LMC
Mental Health
MH001
4
MH002
6
MH003
4
MH004
5
MH005
5
Register. Includes other patients on
Li therapy (MH8)
Care Plan. 15 to 12 months. 30-55%
to 40-90%
BP reading. 15 to 12 months (MH13)
Chol:HDL ratio. 15 to 12 months
(MH19)
Blood Glu or HBA1c. 15 to 12
months (MH20)
Glasgow LMC
Mental Health
MH006
4
BMI reading.15 to 12 months (MH12)
MH007
4
Alcohol. 15 to 12 months (MH11)
MH008(S)
5
MH009
1
MH010
2
Cervical Screening. No change from
MH16
Lithium- creatinine and TFT in past
9 months. No change from MH17
Lithium therapeutic range 4 months.
No change from MH18
Glasgow LMC
Cancer
CAN001
5
Register. No change from Cancer1
CAN002
5
Change of time period of cancer
diagnosis within preceding 15
months from 18 months. Patient
review recorded within 3 months
instead of 6 months. (Cancer3)
Glasgow LMC
Chronic Kidney Disease
CKD001
6
Register. No change from CKD1
CKD002(S) 11 BP <140/85. 15 to 12 months (CKD3)
CKD003
9
CKD004
6
Proteinuria on ACE or ARB. No
change from CKD5
Urine Alb:creat ratio. 15 to 12
months (CKD6)
CKD2 (4 points) gone. Record of BP
Glasgow LMC
Epilepsy
EP001
1
EP002
6
EP003
3
Register (over 18). No change from
Epilepsy1
Seizure Free. 15 to 12 months
(Epilepsy8)
Contraceptive, conception &
pregnancy advice. 15 to 12 months
(Epilepsy9)
Glasgow LMC
Learning Disability
LD001
4
Register. No change from LD1
LD002
2
Down’s & TSH level. 15 to 12
months (LD2)
Glasgow LMC
Osteoporosis
OST001
3
Register. No change from OST1
OST002
3
OST003
3
50-75yrs, fragility # confirmed on
DXA treated with bone sparing
agent. No change from OS2
75 and over, fragility fracture treated
with bone sparing agent. No change
from OST3
Glasgow LMC
NEW- Rheumatoid Arthritis
RA001
1
RA002
5
RA003
7
RA004
5
Maintains Register Of Patients 16
years and over with RA
Face to Face Review in the past 12
months
Aged 30 to 85 having a CVD Risk
Assessment with tool adjusted for
RA (ASSIGN +DM) in preceding 12
months
Aged 50 TO 91 having a Fracture
Risk Assessment with tool adjusted
for RA (FRAX) in preceding 24
months
Glasgow LMC
Palliative Care
PC001
3
Register. No change from PC3
PC002
3
3 monthly MDT case review
meetings. No change from PC2
Glasgow LMC
CVD Primary Prevention
CVD-PP001
CVDPP002(S)
CVDPP003(S)
10 Similar to PP1 but payment is for
putting new HT patients who have
had CVD risk assessment on Statins
if risk is over 20%, Points increase to
10 from 8. Threshold increased from
40-75% to 40-90%
5 Lifestyle Advice for HT patients
diagnosed after 1 April 2009. 15 to 12
months (PP2)
5 NEW- PATIENTS GIVEN LIFESTYLE
ADVICE IN CVD-PP002 HAVE SCOTPASQ DONE
Glasgow LMC
Glasgow LMC
Obesity
OB001
8
Register 16 years and over with BMI
>30. 15 to 12 months (PC3)
Glasgow LMC
Smoking
SMOK001
SMOK002
SMOK003
SMOK004
11 Change from 27 to 24 months for
recording smoking status (Smoking7)
25 Chronic disease & Smoking status
recorded.15 to 12 months (Smoking5)
2 NEW- PRACTICE HAS STOPPING
SMOKING LITERATURE AND OFFERS
APPROPRIATE THERAPY
(same as Information 5 indicator)
12 Change from 27 to 24 months for
smokers to have an offer of support
and treatment (Smoking8)
Glasgow LMC
Cervical Screening
CS001(S)
CS002(S)
CS003
CS004
7
Practice Protocol. No change from
CS7
11 20-60yrs smear in past 5 years. 4580%. No change from CS1
2 System for informing results. No
change from CS5
2 Auditing policy & 2 yearly inadequate
smear audit. No change from CS6
Glasgow LMC
Child Health Surveillance
CHS001(S)
6
Offer child devlopment checks. No
change from CHS1
Glasgow LMC
Maternity Services
MAT001(S)
6
Antenatal care and screening
offered. No change from MAT1
Glasgow LMC
Contraception
CON001
4
CON002
3
CON003
3
Register. Specifies age group as aged
54 or under (SH1)
LARC advice. 15 to 12 months (SH2)
Emergency contraception & LARC
advice. No change from SH3
Glasgow LMC
Patient Experience
PE001(S)
33 Length of consultation 10mins.
Same as PE1
Glasgow LMC
NEW Quality Improvement
QI001(S)
6
QI002(S)
5
NEW- 2 CASE NOTE REVIEWS
USING A VALIDATED TOOL, MEETS
TO DISCUSS AND SHARE REPORT
WITH BOARD
NEW- SAFETY CLIMATE SURVEY,
MEETS TO DISCUSS AND SHARE
REPORT WITH BOARD
Glasgow LMC
Medicines Management
MM001(S)
MM002(S)
MM003(S)
4
Similar to Medicines6- meet prescribing
advisor and agree 3 actions. Previously
it was “up to 3 actions”.
9 Similar to Medicines10 (4 points) Meet
with prescribing advisor and agree 3
actions and provide evidence of
change. Now includes doing an audit.
10 Similar with Medicines11 (7 points) Med
review recorded for patients on 4 or
more meds. 15 to 12 months.
Glasgow LMC
Public Health
BP001
15 Similar to Records11 (10 points)
BP recorded in preceding 5 years.
Age group now 40 and over
(previously 45 and over)
Threshold now 40-80% (previously
target was 65%)
Glasgow LMC
What has Happened to the
Organisational Domain?
Glasgow LMC
Organisational Domain
•
•
•
•
•
•
77 transferred to Core Funding
37 moved to Clinical QOF indicators
15 moved to Public Health domain
2 moved to Smoking
23 moved to Medicines Management
0.5 moved to QOF QP
Glasgow LMC
New Records Standard
The practice has an effective system
for maintaining safe clinical records
for patients, including
communication with OOH services
and a minimum clinical summary
level of 80%.
Proposed subsections/Global sum %:
• information sharing with OOH (0.125%),
• drug indication and allergies (0.375%),
• clinical summaries (0.5%).
Glasgow LMC
New Education Standard
The practice has an effective system for
Continuous Professional Development
for nurses, annual appraisal for nurses
and non-clinical staff and completes a
minimum of 3 SEAs annually.
Proposed subsections/Global sum %:
• Life support training (0.25%),
• Complaints and SEA (0.25%),
• CPD for nurses, appraisal for nurses and practice staff (0.25%).
Glasgow LMC
New Management Standard
The practice has an effective system
for handling repeat medicine
requests within 48 hours (2 working
days) and staff employment policies.
Proposed subsections/Global sum %:
• Written procedures and employment policies
accessible by staff (0.25%),
• Repeat prescription availability timescales of 48
hours (0.25%).
Glasgow LMC
Questions?
Glasgow LMC