Transcript Scottish GMS 2013

Scottish GMS 2013
Time frame changes
Moving from 15 months to 12 months
so everyone seen between April
and March
 Moving from 27 months to 24 months

Basically reduce everything by 3 months
Retirements/combinations
CHD treated with a beta blocker*
 CKD who have BP recorded *
 Diabetes – record of neuropathy testing*
 Diabetes – BMI recorded
 Diabetes – egfr recorded
 Epilepsy – seizure frequency recorded
 BP – recorded in the last 9 months*

Doesn’t mean you don’t have to do it – just now combined with other indicators
Hypertension

Combination

In last 9 months with recording of >150/90

Remember CVD lifestyle!
Diabetes

New diabetics referred for structured
education within 9 months of diagnosis.

Dietary review by suitably competent
professional – probably PN or GP

Those with nephropathy or microalbuminurea who are treated with ACE/A2 –
threshold increased to 90%
Diabetes cont:

% asked about erectile dysfunction

% offer advice, assessment of
contributory faction and treatment option

ACR test not microalbumin
(but will still need to check for protein)
COPD

MRC scales of >3 in the last 12 months
who have had oxygen saturation
recorded
Think about coding now!
Stroke

% of those with non-haemorrhagic or a
history of TIA who have had cholesterol
under 5mmo/l

% on aspirin or anti-coagulant

Remember OTC medicines !
Public Health

% aged over 40 (from 45) with BP
recorded in the last 5 years.

Start calling now – think about he 40-45 year
olds who now come into this!

Is there anything on clinical letters that you can
take
CVD

Those between 30-74 who have CVD
risk assessment >20 who are treated
with a statin
8 week opportunity window removed

Now 12 months!
SCOT-PASQ questionnaire
Cancer

Initial review changed from 6 months to
3 months

3 monthly reviews – fits in with ACP
Depression
% new diagnosis of depression who
have had a bio-psychosocial assessment
at the point of diagnosis
 % reviewed within 10-35 days of
diagnosis
 Withdrawal of the 2 questions for
diabetes/CHD – although some still asking as good
practice.

Bio-psychosocial example
Mental Health

% with a comprehensive care plan
documented and discussed with patient;
family and carers as appropriate.

If seeing CPN or Psychiatry/Psychology
services and have a care plan this can be
used as the care plan.
Rheumatoid Arthritis

% of those between 30-84 who have had
CVD risk assessment

% of those between 50-90 who have a
recorded fracture risk assessment

% of those who have a face to face annual
review
(no indication of only those diagnosed after 2013- so start cleaning register)
Patient Safety Programme

Global trigger tool

Case note review 25 sets on notes twice in
QOF year
Looking over last 3 months
 20 minutes per record – on average
 10 triggers?




eg. > 3 consultation in last 7 days
eg. OOH/A&E attendance
eg. Repeat medication discontinued
Patient Safety

Safety Climate survey
How many? – 1
 Review results
 Create action plan
 Make changes

http://www.healthcareimprovementscotland.org/our_work/patient_safety/
spsp_primary_care_resources/safety_climate_survey.aspx
Organisational Domain

77 points removed from QOF to core
funding
MPIG/OOH no change however aspiration
payment will reduce by £10.5k for average
practice
 Allocation based on achievement in last 3
years
 Creating Organisational Standards as part
of post-verification review

Removals
60% / 70% and 80% clinical summaries
 Summary within 8 weeks
 Backup and data validation of electronic
records
 Calibration of instruments
 Less that 4 repeat medications reviewed

Others
Moving
BP aged 40+ to public health
Retain
- 4+ medications to be reviewed
- Meet with prescribing advisor to agree actions
- Actions with evidence of change
- Patient experience
Records – Organisational Standard
Information sharing with OOH
Recorded Drug interactions
Up to date Clinical summaries
Education – Organisational
Standard
Life support training
SEA and complaint reviews
CPR and PLP for nurses
Appraisals for nurses and practice staff
Management – Organisational
Standard
Written employment procedures
Repeat prescriptions available with 48
hours
Included now in Statutory

Information and child protection

Carer identification and support
ACP

Practice meets internally to review emergency admissions
and externally to compare data

Identify 5% of patients who would benefit from ACP –
shared with OOH and polypharmacy done. (265 patients –
average sized practice)

Of that 5% - 15% who should have ACP (40 patients average sized practice)

Hold at least 4 MDT meetings per year to review needs of
patients on 5% list

Written SEAs on at least 3 patients who have been
admitted after ACP created from above and reports to
Board – use docman to read code from template
Information from colleagues

Most QOF and PV visits seem to be
focussing on the content of reviews!

Make sure content is documented!
So what’s in a review?
CVD –FACE TO FACE!!

-

-






Bloods lipids, fasting cholesterol, U&E,
TSH
Cholesterol treat and forget
BP
Smoking
alcohol
BMI
Assign score
SCOT PASQ questions**
STROKE






Stroke
referral 3 months before and 1 month after
diagnosis
BP
Statin but not if haemorrhagic stroke.
Cholesterol for all
non-haemorrhagic/TIA target of > under
5mmol
Dementia
face to face consultation
 physical and mental health review
 carer needs assessed/ impact of caring
and also assess the stage of dementia
and how much information you can give
to carer and maintain confidentiality.
 Communications and co-ordination with
secondary care

Depression








symptoms
Social support
alternative treatment options
follow up any external referrals
suicidal thoughts
encourage continuation of medication
side effects and efficiency of meds
must be face to face with GP or nurse
practitioner.
Mental Health

Remission can be used if in last 5 years the patients had had no
medication, no mental health input or no admittance for a mental
health condition - then you can exclude.

promote smoking, diet and exercise
health check
social needs and support
patient expectations on social aspects
co-ordination arrangement with support services
summary of service received
employment
awareness of early signs of relapse
patient preferred course of action if relapse happens inc
medication.








Cancer
Review recommended from Marie Curie support
document could include:

physical effects (weight loss, problems with appetite,
tiredness)
 emotional (future, relationships)
 family matters (being able to talk to others)
 job/money worries
 treatment issues (side effects etc)
 practical issues (housework, equipment)
 spirituality
Osteoporosis
lifestyle and nutritional assessment
 weight bearing exercise
 smoking
 alcohol
 T score

RA


assign
depression
 bp
 side effects of drugs
 smoking
 Bloods - crp/esr/pv
 effect on life/employment etc
 Possible MDT/referral
 History of fractures
 Oral glucocoticords
 history of falls
Thank you for listening
[email protected]