Dr David Coleman explores how nurses working in general practice can drive the response to this years ’ targets |
Reports of the death of the Quality and Outcomes Framework ( QOF ) in England have been greatly exaggerated — or at the very least they ’ ve proven to be premature . We ' re told next year will see a ‘ consultation on the future form and suitability of QOF ’, 1 but for now the beast is very much alive and as relevant as ever . General practice must make the best of the situation and adapt chronic disease management to hit those all-important targets while also achieving excellence for patients .
Many of you will have encountered post-pandemic challenges with chronic disease management : poor patient engagement ; worsening control of HbA1c , blood pressure and asthma symptoms ; and lower uptake of cancer screening . This article will suggest potential solutions and , while many practices will have attempted some of these already , I hope you find some helpful tips to make your QOF lives easier in 2023 / 24 .
Take another look at your recall systems
1Following the disruption of the pandemic period , many patients have fallen out of the habit of attending chronic disease reviews . This presents an opportunity to explore doing things differently with your administrative team . At our practice , we used the return of full-scale chronic disease management to trial a birthday month-based recall system – something the nursing and admin teams were keen to try . There were many positive aspects , and I think it will help distribute workload and make things easier for patients , although the experience taught us that the busy flu campaign period – especially with the addition of Covid-19 |
vaccination – makes things tricky over winter . Another factor is non-responders ; if you only invite a patient with a birthday in March , you won ’ t have time to reach out to non-attenders before the end of the QOF year . This year we are looking at a modified system where we invite April / May / June birthdays in April and May , aiming to get slightly ahead of the curve ; we ’ ll see how it goes .
Use digital solutions to lighten your workload
2Every primary care clinician is a precious resource . As there ’ s usually enough work to fill us all two or three times over , it ’ s vital to maximise clinical time for patients who need our skills the most . Using a variety of digital tools to support chronic disease processes allows us to deploy the nursing team efficiently and appropriately . Our integrated care board provides Accurx , although many other services perform similar functions . A good example is asthma management . Patients are sent an Asthma Control Test ( ACT ) questionnaire and a video demonstrating inhaler techniques . Responses are screened by the admin team , who determine the next steps using a flowchart that includes ‘ red flags ’ to reduce clinical risk . Patients scoring 20 or higher ( indicating good control ) are booked into a short slot with the nurse or nurse associate , who can conduct a brief telephone call or respond via SMS . A score of 19 or lower triggers a longer appointment with the nurse , in person or by phone , depending on the patient ’ s preference .
The mantra is nursing time is precious and should be proportionate to patient need . Help from members of the wider team allows nurses more time for complex cases .
|
GETTY |