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Most general practice teams are likely to be anticipating another difficult winter , playing catch-up on QOF indicators while simultaneously attempting to deliver vaccination campaigns . The intensity in general practice is now such that we no longer seem to get seasonal lulls over summer , which makes preparing for winter all the more testing . New QOF indicators , another Covid-19 booster programme , flu vaccinations and all the other winter challenges lie ahead . To make matters worse , many practice teams will be facing these with strained capacity due to workforce gaps .
While I can ’ t conjure up additional staff ( I ’ m not the health secretary , after all ), I do have some tips for optimising your approach and making the best use of the wider practice and PCN teams .
Covid-19 / flu vaccination campaigns
1Among the big general practice headlines this summer was the announced reduction of the item-of-service ( IoS ) payment for Covid vaccination administration to £ 7.54 , and now the changed schedule for administering these . 3 There was widespread debate about whether it would even be possible to deliver the service specification at that level of payment , although thankfully the government has come to its senses and increased the payment again . While it now appears deliverable , it will still pay to be as efficient as possible . There will be lots of other challenges this winter , so teams can ’ t afford to focus solely on Covid and flu . Maximising co-administration of the two vaccines wherever possible is essential . Some PCNs may have some Covid support monies available that could support workforce costs ; another option is to use extendedaccess capacity for vaccination , effectively killing two birds with one stone . PCN ARRS staff can be deployed to deliver housebound vaccinations at scale as part of roving teams . This will make sure vulnerable patients receive their vaccinations without impacting nursing capacity at practice level .
A team approach to lipid management
2Many practices are still grappling with the changes to QOF guidance this year , and we ’ ve found the new lipid indicators to be particularly demanding . If your team is smaller than you ’ d ideally like , you ’ re probably playing a game of catch-up by this point in the year . Just as practice workforces differ , so do practice approaches to lipid management , with doctors , |
References 1 NICE . CG181 . Cardiovascular disease : risk assessment and reduction , including lipid modification . 2023 . nice . org . uk / cg181 2 NHSE . Quality and Outcomes Framework guidance for 2023 / 24 : lipid management . tinyurl . com / QOF-lipids 3 Colivicchi A . 25 % cut to Covid vaccine IoS ‘ threat to patient safety ’, BMA warns . tinyurl . com / Covid-IOS 4 NHSE . Investment and Impact Fund . tinyurl . com / NHSE-IIF 5 NHS Digital Weight Management Programme . tinyurl . com / NHSD-weight |
pharmacists , nurses , nurse associates and administrative staff all potentially performing key roles . However , a collaborative team approach that includes patients will serve you best . A practice should consider suboptimal lipid results to be everyone ’ s business .
While NICE 1 advises reduction of non-HDL cholesterol by > 40 % from baseline with statin therapy , QOF indicators 2 have adopted the Joint British Societies ’ JBS3 consensus recommendation – a non-HDL cholesterol target of < 2.5mmol / L ( LDL-C < 1.8mmol / L ).
If there is uncertainty about this target , a clinical meeting with all teams represented would be a good starting point . Admin teams can be briefed to search for patients who are not treated to target . It may also be beneficial to change the language of statin prescribing . Rather than discuss each dose change , practices could pitch statin dosing as a variable concept , adjusted based on results ( like warfarin and INR , for example ). This could reduce the need for hundreds of time-consuming discussions . SMS messaging can be used to keep patients informed , although if we make the target clear they can monitor their own progress via the NHS app . In this way we can empower patients to take control of their own lipid management as much as possible .
Can extended-access services help ?
3Appointments with all members of the practice team will be at a premium this winter , so it makes sense to tap into all available support . PCN extended access looks different in every locality , but there is usually a significant nurse , nurse associate and healthcare assistant component . Locally , our extended access capacity is often underused . Our approach is to analyse which work we might struggle to deliver in house and consider reviews that don ’ t necessarily |
ALAMY |