Recent changes in the GMS contract for 2010-11 have led to some practices losing potential income under the Quality and Outcomes Framework. At its inception, adjusted disease prevalence factor gave some protection to practices with low disease prevalence by utilising a square root formula in its calculation. The revised payment system saw the removal of the square root formula for 2009/10 and the subsequent removal of the 5% cut-off arrangements for 2010/11.
The recent re-allocation of points has also led to a reduction in potential income for the clinical domains of the QOF. It is therefore even more important that practice disease registers are accurate and up to date.
The table below explains how the difference in prevalence affects the value of a point. The difference made by the lower number of points available can also be clearly seen.
Based on national prevalence of CHD of 3.4%
QOF point value 09/10
Max Domain Income **
QOF point Value 10/11
Max Domain Income *
* 76 points available in total for this domain for year 2010/11 ** 87 points available in 2009/10 Note: This example assumes the practice has an average list size of 5891
Oberoi Consulting has worked with many practices to support disease register validation since the inception of the GMS contract. The evidence to date illustrates that there are often inaccuracies in data which then impacts on prevalence, patient care and QOF income.
Data Quality Manual
This contains detailed searches for each chronic disease area, together with instructions on what data to extract and the current and correct Read codes that should be added to the patient's medical record once a diagnosis has been verified by a clinician.
As well as searches to identify potential patients for the registers, there are also searches to identify patients who should be reviewed and possibly be removed from the register.
The full validation can be run in-house by practice staff working through each of the sections in the manual.
The cost of the manual is £100 + VAT at the current rate.
For those practices that may not have the time or expertise within their team to run the searches, an Oberoi Regional Account Manager will visit the surgery and run the searches using the practice clinical computer system. These searches can also be re-run at a later date if required.
In addition, the Regional Account Manager will use a software tool to calculate the resultant changes in potential income. This information assists the practice in working through their workload in priority order.
This service can either be paid for on a daily rate basis or delivered free of charge with a 30% commission charge on the revised income achieved.
Disease Prevalence & QOF Income Calculator
The Oberoi Prevalence Calculator can be used by the Practice to create a snapshot of their current prevalence by simply adding in the practice population and the current disease register numbers.
The calculator will automatically create a graph (such as shown below), showing the practice prevalence against the latest UK national average.
The Summary page of the calculator (example shown below) will show how the current prevalence is reflected in potential income. By changing the number of patients on the various disease registers the practice can easily see how changes will effect income.
By concentrating on those areas with most potential for growth (ie. those areas where the practice prevalence is significantly lower than the UK national average prevalence), the practice are able to work through the disease areas in priority order.
The cost of the calculator is £50 + VAT at the current rate.