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Time to network
3Primary care networks ( PCNs ) are now relatively mature structures with a significant workforce of staff recruited via the Additional Roles Reimbursement Scheme ( ARRS ). Many PCN teams will support practices with chronic disease management , so are you making the most of the opportunity to share the load with your local network team ? Our excellent PCN pharmacist assists with atrial fibrillation and heart failure annual reviews at our practice . Those were the areas identified when we looked at where a pharmacist could be most effective , alongside COPD . They are centred around medication , and the help frees our nursing team to focus on other areas . Similarly , physician associates and nurse associates have skillsets that can offer valuable support . For example , our nurse associate conducts a range of reviews with housebound patients .
A smart approach for diabetes
4Five years ago , we approached diabetes management with a one-size-fits-all method . It was effective , but incredibly time consuming . Unfortunately , time is something we never seem to have enough of in primary care — and our diabetes register is continually growing . We needed to get smarter about using our resources , and the PARM tool 2 ( a collaborative project between NHS Devon and pharma company Lilly ) has proven to be a useful tool in our armoury .
PARM stands for ProActive Diabetes Register Management , and is essentially a tool to identify patients who may benefit from medicines optimisation to improve HbA1c control as part of the QOF targets . It accounts for frailty and sorts patients based on the medications they are currently taking . Similar tools are coming online , and if you ' re uncomfortable with the pharma link-up , you could create a series of searches and filters to identify patients who might benefit from a certain intervention . However , PARM is an effective tool to highlight areas of focus for your diabetes population .
Childhood vaccination changes
5This has been a subject of controversy in the world of QOF over the past two years . The upper and lower thresholds for the VI001 , VI002 and VI003 domains were so challenging that many practices lost thousands of pounds , with those in areas of deprivation most affected . It has been consistently argued that this reinforced health inequalities but thankfully , there has been some movement and the new thresholds should see fewer practices left out of pocket .
An important new NHS England provision is that ‘ children vaccinated overseas in accordance with the UK national schedule can be coded as a success for the purposes of QOF achievement ’. 3 If you work in an area of high immigration , this could have a transformative impact on achievement for these indicators , so a thorough vaccination history is imperative .
No room for rheumatoid arthritis ?
6RA002 , the indicator for face-to-face reviews of patients with rheumatoid arthritis ( RA ), has been retired this year , so it is no longer a contractual requirement . It would be prudent to discuss at a practice level how you plan to proceed . RA patients may well be expecting an invite to review their condition so it will be important to communicate your practice ' s decision .
References 1 NHS Confederation . GP Contract changes 2023 / 24 : what you need to know . 2023 . tinyurl . com / GPcontract-2324 2 PARM Diabetes . parmdiabetes . co . uk 3 BMA . Quality and outcomes framework . Updated April 2023 . tinyurl . com / BMA-QOFguide 4 Aveyard P et al . Screening and brief intervention for obesity in primary care : a parallel , two-arm , randomised trial . Lancet 2016 ; 388:2492-500 . tinyurl . com / aveyard-obesity 5 NHSE . Weight Management Enhanced Service 2023 / 24 . tinyurl . com / NHSEweight 6 JBS3 Board . Joint British Societies ’ consensus recommendations for the prevention of cardiovascular disease . Heart 2014 ; 100 : ii1-ii67 . tinyurl . com / JBS-CVD
Dr David Coleman is a GP partner and co-clinical director at Doncaster South PCN , South Yorkshire
Options are to continue to do the reviews for all patients , offer a brief telephone review as a halfway house , or to inform patients that the reviews will no longer be happening routinely but to contact the surgery if they develop new symptoms or concerns .
Act on weight readings
7How many patients step onto the scales as part of their chronic disease review ? It ’ s a significant number . I work in an area of deprivation , with some of the highest obesity rates in the UK . A sizeable proportion of the adult patients I see are overweight or obese , yet I don ’ t feel I discuss weight-management options or make referrals anywhere near enough . It can be a taboo subject and a tricky one to broach , but as I discussed in a previous article , there is strong evidence that a brief intervention from a clinician can be effective . 4 There is also the under-publicised Weight Management Enhanced Service5 ; find out if your practice should sign up and what the local options are .
Take a look at lipids
8Cholesterol control and lipid management is a new focal point in the 2023 / 24 QOF year . Practices will have their own workflows for lipid management , with duties distributed between medical , nursing and pharmacy teams . There are 30 points available collectively for the new CHOL001 and CHOL002 indicators , which focus on prescription of a statin or equivalent and control ( non-HDL cholesterol lower than 2.5 mmol / L or LDL < 1.8 mmol / L ). The control aspect is new , and these may be figures your practice hasn ’ t used before . They are drawn from the Joint British Societies ' recommendations . 6
It would be advisable to conduct a practice-wide clinical meeting looking at lipid management to ensure everyone is on the same page and aware of the pathways and responsibilities . This is a big indicator and rightly so , as lipid control remains crucial in terms of primary and secondary prevention .
Cervical screening – consider extended access
9Cervical screening applies to women and transgender men with a cervix aged between 25 to 64 . These are people of working age , which can mean access is challenging during normal surgery hours . Consider using PCN extended-access arrangements to widen access opportunities to those who struggle to get time away from work . This reduces a barrier to access and can improve screening rates .
Workforce wellbeing – make it more than a tickbox exercise year sees the introduction of a quality improvement indicator on workforce 10This
wellbeing . This could wind up being a time-consuming tickbox exercise , but there is an opportunity to make it more meaningful . Your practice will be evaluating your wellbeing as part of the primary care workforce so think about what you ’ d like to see change – be it more flexible working options , improved communication within the practice or better training for new staff members – and provide honest and constructive feedback . Nursing teams have a fantastic oversight of how a practice functions and GP partners and managers should value and respect your opinions .