Changes to the QOF for 2009/10 see a small mention for alcohol

The General Medical Services (GMS) contract is the UK-wide contract between general practices and primary care organisations to deliver primary care services to their local communities. Within GMS, the Quality and Outcomes Framework (QOF) sets out a range of national standards based on the best available research evidence. The standards are divided into four domains:

• clinical standards linked to the care of patients suffering from chronic diseases
• organisational standards relating to records and information, communicating with patients, education and training, medicines management and clinical and practice management
• additional services, covering cervical screening, child health surveillance, maternity services and contraceptive services
• patient experience, based on patient surveys and length of consultations

A set of indicators has been developed for each domain to describe different aspects of performance. Practices are free to choose the domains that they want to focus on. QOF is a mechanism for delivering substantial financial rewards for high-quality care.

NHS Employers and the General Practitioners Committee have agreed changes to the GMS contract for 2009/10. The changes will give a fairer distribution of resources across practices, and will ensure that the contract rewards those practices that continue to develop services to meet local patient needs. The changes include reallocating 72 QOF points - these are being reallocated to seven new clinical areas. One of these, cardiovascular disease in people diagnosed with high blood pressure, awards points for giving advice on safe alcohol consumption. Details here.

This follows news of a new Directed Enhanced Service (DES) for alcohol that pays out £2.33 for each newly registered patient screened by their GP.   We are hearing mixed reports of the DES - some colleagues say £2.33 is too small a payment, others say it is acceptable. 

Comments

[Malcolm Thomas]

The alcohol DES certainly isnt worthwhile if GPs are planning to perform screening and brief intervention to the quality level needed to obtain the outcomes seen in clinical trials.

We train large numbers of doctors and other clinical staff in brief intervnetions using the Newcaslte version of the WHO Strucutured Brief Intervention sheet.

In our opinion, you need 4 minutes to do a full AUDIT (this will be done by Health Care Assistants in most practices). You need to allocate 3 minutes per brief intervention, needed in 30% of adult patients. Probably more if the doctor doing the intervention did not run the initial questionnaire.

And you should budget for 10 mins of GP time per brief intervention if there is a new appointment just for this.

So my guess is the practices who DO sign up for the DES can only make this work by cutting corners to keep it as a worthwile rate of pay.

Most LES agreements that we have seen have been in the £5-£7 per patient screened category - and these use a shortened version of AUDIT (normally FAST)

If asked, I recommend that GPs do not take up the DES because they will have to choose either to do it well (hence unprofitably) or do it poorly (hence unprofessionally)

MT