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Doncasterlmc.co.uk

SUMMARY OF CHANGES TO QOF 2014/15 - ENGLAND
KEY
No change
Indicator
Business
Exception
14/15 QOF
NICE ID Indicator wording
Threshold
Threshold
timeframe
timeframe
timeframe
(months)
(months)
(months)
CLINICAL
Atrial Fibrilation (AF)
The contractor establishes and maintains a register of patients with atrial The percentage of patients with atrial fibrillation in whom stroke risk has been assessed using the CHADS2 risk stratification scoring system in the preceding 12 months (excluding those whose previous CHADS2 score is
greater than 1)
In those patients with atrial fibrillation in whom there is a record of a 2 score of 1 (latest in the preceding 12 months), the percentage of
patients who are currently treated with anti-coagulation drug therapy or anti-platelet therapyIn those patients with atrial fibrillation whose latest record of a CHADS2 score is greater than 1, the percentage of patients who are currently Secondary prevention of coronary heart disease (CHD)
The contractor establishes and maintains a register of patients with coronary heart diseaseThe percentage of patients with coronary heart disease in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or lessThe percentage of patients with coronary heart disease whose last measured total cholesterol (measured in the preceding 12 months) is 5 mmol/l or lessThe percentage of patients with coronary heart disease who have had 1 Aug to 31
influenza immunisation in the preceding 1 August 1 September to 31
1 Aug to 31 Mar
March The percentage of patients with coronary heart disease with a record in the preceding 12 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken
The percentage of patients with a history of myocardial infarction (on or
after 1 April 2011) currently treated with an ACE-I (or ARB if ACE-I
intolerant), aspirin or an alternative anti-platelet therapy, beta-blocker and Indicator
Business
Exception
14/15 QOF
NICE ID Indicator wording
Threshold
Threshold
timeframe
timeframe
timeframe
(months)
(months)
(months)
Heart failure (HF)
The contractor establishes and maintains a register of patients with heart failureThe percentage of patients with a diagnosis of heart failure (diagnosed on or after 1 April 2006) which has been confirmed by an echocardiogram or by specialist assessment 3 months before or 12 months after entering on to the registerIn those patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction, the percentage of patients who are currently treated with an ACE-I or ARBIn those patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction who are currently treated with an ACE-I or ARB, the percentage of patients who are additionally currently treated with a beta-blocker licensed for heart failure Hypertension (HYP)
The contractor establishes and maintains a register of patients with established hypertensionThe percentage of patients with hypertension in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90
The percentage of patients aged or under with hypertension in whom the last blood pressure reading (measured in the preceding 9 months) is 140/90 mmHg or lessThe percentage of patients with hypertension aged 16 or over and who have not attained the age of 75 in whom there is an assessment of physical activity, using GPPAQ, in the preceding 12 months The percentage of patients with hypertension aged 16 or over and who have not attained the age of 75 who score ‘less than active’ on GPPAQ in the preceding 12 months, who also have a record of a brief intervention in the preceding 12 months Peripheral arterial disease (PAD)
The contractor establishes and maintains a register of patients with The percentage of patients with peripheral arterial disease in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or lessThe percentage of patients with peripheral arterial disease in whom the last measured total cholesterol (measured in the preceding 12 months) is 5 mmol/l or lessThe percentage of patients with peripheral arterial disease with a record in the preceding 12 months that aspirin or an alternative anti-platelet is Indicator
Business
Exception
14/15 QOF
NICE ID Indicator wording
Threshold
Threshold
timeframe
timeframe
timeframe
(months)
(months)
(months)
Stroke and transient ischaemic attack (STIA)
The contractor establishes and maintains a register of patients with stroke or TIAThe percentage of patients with a stroke or TIA (diagnosed on or after 1 From 1 April
April 2008 2014) who have a record of a referral for further investigation
between 3 months before or 1 month after the date of the latest recorded timeframe change stroke or the first TIA
The percentage of patients with a history of stroke or TIA in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or lessThe percentage of patients with stroke or TIA who have a record of total The percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA whose last measured total cholesterol (measured in the The percentage of patients with stroke or TIA who have had influenza 1 Aug to 31
immunisation in the preceding 1 August 1 September to 31 March
1 Aug to 31 Mar
The percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is being taken Diabetes mellitus (DM)
The contractor establishes and maintains a register of all patients aged 17 or over with diabetes mellitus, which specifies the type of diabetes The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or lessThe percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) is The percentage of patients with diabetes, on the register, who have a record of an albumin:creatinine ratio test in the preceding 12 months The percentage of patients with diabetes, on the register, with a diagnosis of nephropathy (clinical proteinuria) or micro-albuminuria who are currently treated with ACE-I (or ARBs)The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 59 mmol/mol or less in the preceding 12 months The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 64 mmol/mol or less in the preceding 12 months The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 75 mmol/mol or less in the preceding 12 months Indicator
Business
Exception
14/15 QOF
NICE ID Indicator wording
Threshold
Threshold
timeframe
timeframe
timeframe
(months)
(months)
(months)
Diabetes mellitus (DM).cont.
The percentage of patients with diabetes, on the register, who have had 1 Aug to 31
influenza immunisation in the preceding 1 August September to 31
1 Aug to 31 Mar
MarchThe percentage of patients with diabetes, on the register, who have a record of retinal screening in the preceding 12 months The percentage of patients with diabetes, on the register, with a record of a foot examination and risk classification: 1) low risk (normal sensation, palpable pulses), 2) increased risk (neuropathy or absent pulses), 3) high risk (neuropathy or absent pulses plus deformity or skin changes in previous ulcer) or 4) ulcerated foot within the preceding 12 months The percentage of patients with diabetes, on the register, who have a record of a dietary review by a suitably competent professional in the preceding 12 monthsThe percentage of patients newly diagnosed with diabetes, on the register, in the preceding 1 April to 31 March who have a record of being referred to a structured education programme within 9 months after entry on to the diabetes register The percentage of male patients with diabetes, on the register, with a record of being asked about erectile dysfunction in the preceding 12 monthsThe percentage of male patients with diabetes, on the register, who have a record of erectile dysfunction with a record of advice and assessment of contributory factors and treatment options in the preceding 12 months Hypothyroidism (THY)
The contractor establishes and maintains a register of patients with hypothyroidism who are currently treated with levothyroxine The percentage of patients with hypothyroidism, on the register, with thyroid function tests recorded in the preceding 12 months Asthma (AST)
The contractor establishes and maintains a register of patients with asthma, excluding patients with asthma who have been prescribed no asthma-related drugs in the preceding 12 monthsThe percentage of patients aged 8 or over with asthma (diagnosed on or after 1 April 2006), on the register, with measures of variability or reversibility recorded between 3 months before and anytime after The percentage of patients with asthma, on the register, who have had an asthma review in the preceding 12 months that includes an assessment of asthma control using the 3 RCP questionsThe percentage of patients with asthma aged 14 or over and who have not attained the age of 20, on the register, in whom there is a record of smoking status in the preceding 12 months Indicator
Business
Exception
14/15 QOF
NICE ID Indicator wording
Threshold
Threshold
timeframe
timeframe
timeframe
(months)
(months)
(months)
Chronic obstructive pulmonary disease (COPD)
The contractor establishes and maintains a register of patients with COPDThe percentage of patients with COPD (diagnosed on or after 1 April 2011) in whom the diagnosis has been confirmed by post bronchodilator spirometry between 3 months before and 12 months after entering on to From 1 April 2011 COPDSPIR -3 3 (REG/DIAG) The percentage of patients with COPD who have had a review, undertaken by a healthcare professional, including an assessment of breathlessness using the Medical Research Council dyspnoea scale in the preceding 12 monthsThe percentage of patients with COPD with a record of FEV1 in the The percentage of patients with COPD and Medical Research Council dyspnoea grade ≥3 at any time in the preceding 12 months, with a record of oxygen saturation value within the preceding 12 months The percentage of patients with COPD who have had influenza 1 Aug to 31
immunisation in the preceding 1 August September to 31 March
1 Aug to 31 Mar
Dementia (DEM)
The contractor establishes and maintains a register of patients diagnosed The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months The percentage of patients with a new diagnosis of dementia recorded in the preceding 1 April to 31 March with a record of FBC, calcium, glucose, renal and liver function, thyroid function tests, serum vitamin B12 and folate levels recorded between 6 months before or after entering on to Depression (DEP)
The percentage of patients aged 18 or over with a new diagnosis of depression in the preceding 1 April to 31 March, who have had a bio- psychosocial assessment by the point of diagnosis. The completion of the assessment is to be recorded on the same day as the diagnosis is recordedThe percentage of patients aged 18 or over with a new diagnosis of depression in the preceding 1 April to 31 March, who have been reviewed not earlier than 10 2 days weeks after and not later than 35
8days weeks after the date of diagnosis
Indicator
Business
Exception
14/15 QOF
NICE ID Indicator wording
Threshold
Threshold
timeframe
timeframe
timeframe
(months)
(months)
(months)
Mental Health (MH)
The contractor establishes and maintains a register of patients with schizophrenia, bipolar affective disorder and other psychoses and other patients on lithium therapyThe percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive care plan documented in the record, (in the preceding 12 months) agreed between individuals, their family and/or carers as appropriateThe percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of blood pressure in the preceding 12 monthsThe percentage of patients aged 40 or over with schizophrenia, bipolar affective disorder and other psychoses who have a record of total cholesterol:hdl ratio in the preceding 12 monthsThe percentage of patients aged 40 or over with schizophrenia, bipolar affective disorder and other psychoses who have a record of blood glucose or HbA1c in the preceding 12 monthsThe percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of BMI in the preceding 12 monthsThe percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of alcohol consumption in the preceding 12 monthsThe percentage of women aged 25 or over and who have not attained the age of 65 with schizophrenia, bipolar affective disorder and other psychoses whose notes record that a cervical screening test has been The percentage of patients on lithium therapy with a record of serum creatinine and TSH in the preceding 9 months The percentage of patients on lithium therapy with a record of lithium levels in the therapeutic range in the preceding 4 months Cancer (CAN)
The contractor establishes and maintains a register of all cancer patients defined as a ‘register of patients with a diagnosis of cancer excluding non- melanotic skin cancers diagnosed on or after 1 April 2003’ The percentage of patients with cancer, diagnosed within the preceding
15 months, who have a patient review recorded as occurring within 3 6
months of the contractor receiving confirmation of the diagnosis Indicator
Business
Exception
14/15 QOF
NICE ID Indicator wording
Threshold
Threshold
timeframe
timeframe
timeframe
(months)
(months)
(months)
Chronic kidney disease (CKD)
The contractor establishes and maintains a register of patients aged 18 or over with CKD (US National Kidney Foundation: Stage 3 to 5 CKD) The percentage of patients on the CKD register in whom the last blood pressure reading (measured in the preceding 12 months) is 140/85 mmHg or lessThe percentage of patients on the CKD register with hypertension and proteinuria who are currently treated with an ACE-I or ARB The percentage of patients on the CKD register whose notes have a record of a urine albumin:creatinine ratio (or protein:creatinine ratio) test Epilepsy (EP)
The contractor establishes and maintains a register of patients aged 18 or over receiving drug treatment for epilepsy The percentage of patients aged 18 or over on drug treatment for epilepsy who have been seizure free for the last 12 months recorded in the preceding 12 monthsThe percentage of women aged 18 or over and who have not attained the age of 55 who are taking antiepileptic drugs who have a record of information and counselling about contraception, conception and pregnancy in the preceding 12 months Learning disability (LD)
The contractor establishes and maintains a register of patients aged 18 The percentage of patients on the learning disability register with Down’s Syndrome aged 18 or over who have a record of blood TSH in the preceding 12 months (excluding those who are on the thyroid disease Osteoporosis: secondary prevention of fragility fractures (OST)
The contractor establishes and maintains a register of patients: 1. Aged 50 or over and who have not attained the age of 75 with a record of a fragility fracture on or after 1 April 2012 and a diagnosis of osteoporosis confirmed on DXA scan, and 2. Aged 75 or over with a record of a fragility fracture on or after 1 April 2012The percentage of patients aged 50 or over and who have not attained the age of 75, with a fragility fracture on or after 1 April 2012, in whom osteoporosis is confirmed on DXA scan, who are currently treated with an The percentage of patients aged 75 or over with a diagnosis of
osteoporosis, with a fragility fracture on or after 1 April 20142, who are
currently treated with an appropriate bone-sparing agent Indicator
Business
Exception
14/15 QOF
NICE ID Indicator wording
Threshold
Threshold
timeframe
timeframe
timeframe
(months)
(months)
(months)
Rheumatoid arthritus (RA)
The contractor establishes and maintains a register of all patients aged The percentage of patients with rheumatoid arthritis, on the register, who have had a face-to-face review in the preceding 12 months The percentage of patients with rheumatoid arthritis aged 30 or over and who have not attained the age of 85 who have had a cardiovascular risk assessment using a CVD risk assessment tool adjusted for RA in the preceding 12 monthsThe percentage of patients aged 50 or over and who have not attained the age of 91 with rheumatoid arthritis who have had an assessment of fracture risk using a risk assessment tool adjusted for RA in the preceding 24 months Palliative care (PC)
The contractor establishes and maintains a register of all patients in need of palliative care/support irrespective of age The contractor has regular (at least 3 monthly) multidisciplinary case review meetings where all patients on the palliative care register are PUBLIC HEALTH
Indicator
Business
Exception
14/15 QOF
Indicator wording
Threshold
Threshold
timeframe
timeframe
timeframe
(months)
(months)
(months)
Cardiovascular disease - primary prevention (CVD-PP)
In those patients with a new diagnosis of hypertension aged 30 or over and who have not attained the age of 75, recorded between the preceding 1 April to 31 March (excluding those with pre-existing CHD, CVD-PP001 CVD-PP001
diabetes, stroke and/or TIA), who have a recorded CVD risk assessment score (using an assessment tool agreed with the NHS CB) of ≥20% in the preceding 12 months: the percentage who are currently treated with statins The percentage of patientsdiagnosed with hypertension (diagnosed after on or after 1 April 2009) who are given lifestyle advice in the preceding 12 months for: smoking cessation, safe alcohol consumption and healthy diet Blood pressure (BP)
The percentage of patients aged 40 45 or over who have a record of
Obesity (OB)
The contractor establishes and maintains a register of patients aged 16 or over with a BMI ≥30 in the preceding 12 months Indicator
Business
Exception
14/15 QOF
Indicator wording
Threshold
Threshold
timeframe
timeframe
timeframe
(months)
(months)
(months)
Smoking (SMOK)
The percentage of patients aged 15 or over whose notes record smoking The percentage of patients with any or any combination of the following conditions: CHD, PAD, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma, schizophrenia, bipolar affective disorder or other psychoses whose notes record smoking status in the preceding 12 The contractor supports patients who smoke in stopping smoking by a strategy which includes providing literature and offering appropriate therapyThe percentage of patients aged 15 or over who are recorded as current smokers who have a record of an offer of support and treatment within The percentage of patients with any or any combination of the following conditions: CHD, PAD, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma, schizophrenia, bipolar affective disorder or other psychoses who are recorded as current smokers who have a record of an offer of support and treatment within the preceding 12 months Cervical Screening (CS)
The contractor has a protocol that is in line with national guidance agreed with the NHSCB for the management of cervical screening, which includes staff training, management of patient call/recall, exception reporting and the regular monitoring of inadequate sample rates The percentage of women aged 25 or over and who have not attained the age of 65 whose notes record that a cervical screening test has been The contractor ensures there is a system for informing all women of the The contractor has a policy for auditing its cervical screening service, and performs an audit of inadequate cervical screening tests in relation to individual sample takers at least every 2 years Child Health Surveillance (CHS)
Child development checks are offered at intervals that are consistent with national guidelines and policy agreed with the NHS CB Maternity Services (MAT)
Antenatal care and screening are offered according to current local Contraception (CON)
The contractor establishes and maintains a register of women aged 54 or under who have been prescribed any method of contraception at least once in the last year, or other clinically appropriate interval e.g. last 5 years for an IUSThe percentage of women, on the register, prescribed an oral or patch contraceptive method in the preceding 12 months who have also received information from the contractor about long acting reversible methods of contraception in the preceding 12 months The percentage of women, on the register, prescribed emergency hormonal contraception one or more times in the preceding 12 months by the contractor who have received information from the contracator about long acting reversible methods of contraception at the time of or within 1 QUALITY AND PRODUCTIVITY
Indicator
Business
Exception
14/15 QOF
Indicator wording
Threshold
Threshold
timeframe
timeframe
timeframe
(months)
(months)
(months)
The contractor reviews data on secondary care outpatient referrals, for patients on the contractor's registered list, provided by the NHS CB The contractor participates in an external peer review with other contractors who are members of the same clinical commissioning group to compare its secondary care outpatient referral data with that of the other contractors. The contractor agrees with the group, areas for commissioning or service design improvementsThe contractor engages with the development of and follows 3 care pathways, agreed with the NHS CB, for improving the management of patients in the primary care setting (unless in individual cases they justify clinical reasons for not doing this) to avoid inappropriate outpatient referralsThe contractor reviews data on emergency admissions, for patients on the contractor's registered list, provided by the NHS CB The contractor participates in an external peer review with other contractors who are members of the same clinical commissioning group to compare its data on emergency admissions with that of the other contractors. The contractor agrees with the group, areas for commissioning or service design improvementsThe contractor engages with the development of and follows 3 care pathways, agreed with the NHS CB, (unless in individual cases they justify clinical reasons for not doing this) in the management and treatment of patients in aiming to avoid emergency admissionsThe contractor reviews data on accident and emergency attendances, for patients on the contractor's registered list, provided by the NHS CB. The review will include consideration of whether access to clinicians in the contractor's premises is appropriate, in light of the patterns on accident and emergency attendanceThe contractor participates in an external peer review with other contractors who are members of the same clinical commissioning group to compare its data on accident and emergency attendances with that of the other contractors. The contractor agrees an improvement plan with the group. The review should include, if appropriate, proposals for improvement to access arrangements in the contractors premises in order to reduce avoidable accident and emergency attendances and may also include proposals for commissioning or service design improvements.
The contractor implements the improvement plan that aims to reduce avoidable accident and emergency attendances.
PATIENT EXPERIENCE
Indicator
Business
Exception
14/15 QOF
Indicator wording
Threshold
Threshold
timeframe
timeframe
timeframe
(months)
(months)
(months)
The contractor ensures that the length of routine booked appointments with doctors in the surgery is not less than 10 minutes. If the contractor routinely admits extras patients during booked surgeries, then the average booked consultation length should allow for the average number of extras seen in a surgery session such that the length of the booked appointments is not less than 10 minutes. If the extras patients are seen at the end of surgery, then it is not necessary to make this adjustment. For contractors with only an open surgery system, the average face-to-face time spent by the GP with the patient is not less than 8 minutes. Contractors that routinely operate a mixed economy of booked and open surgeries should ensure that the length of the booked appointments is not less than 10 minutes and the length of the open surgery appointments is not less than 8 minutes

Source: http://www.doncasterlmc.co.uk/Summary%20of%20QOF%20changes%202014-15.pdf

Cpp153a 126.144

Clin. Psychol. Psychother. 5, 126±144 (1998)Michelle L. Van Etten1 and Steven Taylor2*1Department of Psychiatry, University of Michigan, USA2Department of Psychiatry, University of British Columbia, Vancouver, CanadaA meta-analysis was conducted on 61 treatment outcome trials for post-traumatic stress disorder (PTSD). Conditions included drug therapies(TCAs, carbamazepine, MAOIs, SSRIs, and

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