NOTES OF QUALITY & OUTCOMES WORKING GROUP
Friday 24th June 2005 10.00 – 12.00
Lower Conference Room, Morar, RSNH, Larbert
Anne Hawkins (Chair) John Browning
David Alexander Colin Hunter
Alison Blakely Stewart McDonald
Jackie Britton Jill Murie
Colin Brown Nicola Ring
Tony Callaghan Mairi Scott
Tom Clackson Jan Warner
1. Welcome/Introduction: AH welcomed those present to the meeting-
apologies were noted.
2. Note of Previous Meeting: The note of the meeting held on 29th April had
been previously circulated. This was accepted.
3. Matters arising:
Enhanced Services: JB indicated that discussions are ongoing with regard to
development of national datasets for enhanced services. It was noted that the
CHPs in Highland have developed a potentially robust system for gathering
data from service providers. FD briefly described the tool. JB indicated that
while the system in Highland was being developed at a financial cost an
alternative, less robust system was being discussed with GPASS. JB
agreed to keep the group advised of progress. Action JB
Patient Consent: This item was deferred as neither JT nor NH were present at
Scottish Enquiries Web Tool/ Newsletter: The first copy of the newsletter
had been circulated. JB sought comment from the Group. CB indicated he
thought this was a very useful tool – and provided good feedback/updates on
progress on work. The Group agreed colleagues should be encouraged to
input to the newsletter and that this should now be available through the
JB then updated the group on a recent meeting with colleagues to improve the
processing of enquiries and FAQs on nGMS. She indicated that Ian Cree, web
manager was now in discussion with colleagues at SHOW and the other parts
of the system involved (GPASS, NSS- ISD & PSD) to develop electronic links
across the websites. JF confirmed the actions which were taking place at NSS
to facilitate this. The Group will be kept advised of progress.
The discussion then moved to item 7 on the agenda – GPAQ Results 2004/05:
The Group noted the report which had been circulated from NHS Lothian.
SF outlined the process which Lothian had adopted. It was noted NHS Lothian
had robust public involvement support in each of the LHCCs/CHPs which had
given good support to practices. There was discussion about the differing
levels of support available across Scotland. CB enquired how NHS Boards
would follow up on the questionnaires – and the information available through
this tool. It was suggested that this would be discussed as part of the QOF
visits. CB also indicated it would be helpful to receive feedback from
practices about the information which was being collated. DA indicated that,
while he could not talk for all practices, the information to date seems to
validate what practices had known or perceived. It was suggested that in
addition to the information itself, PCOs should be reflecting on the quality of
reports produced from practices as part of the QOF visit. JR enquired about
the resources required for the process undertaken in Lothian and SF offered to
forward details to her.
The Group noted there are other tools available, which provide a different
level of information at practice/GP level.
CB reminded the Group of the NOP survey undertaken in 2004 and suggested
this too was a valuable source of information.
Benefits of QOF: This item was deferred until JT arrived.
Mental Health Disease Register: NH indicated there was nothing further to
report and suggested this item would be incorporated in the QOF review.
Publication of practice achievements 2004/05:
Following the publication of practices’ achievement data JF tabled a paper
summarising achievements, by NHS Board and also noting the requests for
information which have been received. JF indicated that the information on
NSS website will be updated in September and this would seek to include the
small number of practices which are currently in dispute. There was
discussion on the level of information available and TC indicated that this was
a point which had been raised the previous day at the QMAS users’ group. CB
indicated that it was very helpful to have such information readily accessible
to a wide audience. He referred the Group to the recent article in the Holyrood
Magazine. It was noted that the level of enquiries at individual practice level
had been lower than anticipated.
FD requested that if updated information is to be published NHS Boards are
advised of the timescale so that they, in turn, can advise practices. There was
also discussion on the publication of information during 2005/06. The Group
also noted that England have yet to publish their achievement data for
2004/05 and this may generate further enquiries for Scotland. NH suggested
that it was important to be mindful of the different % of 17c/GMS practices
across the 4 countries.
SF enquired whether it would be possible to report the information in
September at CHP level. JF indicated she would be pleased to do so, if NHS
Boards can identify the boundaries/practices within each CHP.
QMAS Users’ Group:
AK reported on the first meeting of the Group, which had taken place the
previous day. The main issues noted were:
The membership of the group would be extended to include a representative
from PCO management team;
The proposed remit of the Group had been accepted by its members – with
one of the key issues being to keep in touch with NpfIT. Issues which would
be taken forward from the meeting included:
(i) seek to build on the work developed in NHS Tayside to make more
accessible information available to support the QOF visits;
(ii) Training – different stakeholder groups identified;
(iii) Future development of QMAS – the QMAS users group agreed that
proposals from NpfIT ,and those received from Scotland should be
considered and agreed – or otherwise by the users group on behalf of
the Quality Group. One such proposal received is in respect of
The Quality Group noted the position. Feedback from future meetings will be
given to the Quality Group. Papers from the QMAS users group would be
available through the pay modernisation website.
Analysis of QOF by HERU
JB outlined the proposal which had been developed by HERU, University of
Aberdeen. The aim was to undertake an analysis of the QOF data in 3 different
health board areas with a view to understanding the impact of the QOF on
different parts of the system . JT indicated there was a desire to co-ordinate
national and local work and indicated that a meeting would be held later that
day at SEHD to scope out work being taken forward. JT indicated that England
has undertaken an analysis of the QOF which should be considered. The Group
noted that NHS bodies and other partners had requested QOF data to undertake
studies/research and there may be value in requesting access to their findings ,
rather than duplicating work. JF agreed to action this point ; and JT agreed to
write to NHS Boards and enquire if they are undertaking work locally.
4. Practice Visits:
Winter Group Report: As MW was not available, JT reminded the Group that
comments on the draft document had been received, including SGPC and RCN.
The comments had been noted and considered. JT indicated that prior to the
final document being issued sign off from SGPC would be required. DA
enquired about the position with regard to the reference to the Code of
Confidentiality. There was discussion on this and the timing of issuing the
DA also enquired about the meeting to be held with SGPC, RCN and others.
JT indicated that while it had been agreed such a meeting would be valuable,
this had not taken place.
JT agreed to: pursue the final document and arrange for this to be circulated;
clarify the position with regard to the Code of Confidentiality; arrange the
meeting with SGPC, RCN and others. Actions JT
CB indicated that nQIS have been requested to take an oversight of the QOF
process. SF indicated that an initial meeting has taken place and there is a
desire to draw others from the Service into this. He indicated that it was
anticipated the work would take the form of self assessment. The first meeting
of the Core Group will be held on 25th July and SF undertook to keep the
Quality Group advised. AH urged that careful consideration be given to the
need for visits. It was noted that nQIS has developed a methodology for
undertaking work however there may be concerns regarding capacity within the
System. Boards have responsibilities for the services provided and there is a
need for a balanced approach. Any concerns should be fed back
The Group noted the paper which had been tabled from RCGP providing an
updated position. The Group also noted that CB, JB and MW had met recently
with colleagues from RCGP to discuss issues which were being raised by NHS
Boards. CB indicated that the issues which had been discussed at that meeting
were in respect of the arrangements for the training, content, the increased costs
incurred by RCGP and an agreement on the need to strengthen accountability.
JT indicated that there had also been discussion at the recent meeting of nGMS
leads where comments had been raised with regard to the quality of the course;
delivery – content changing and a question raised in respect of is this what was
JB indicated that nGMS leads had been asked to consider the request from
RCGP for printing of additional reviewers manuals.
The Quality Group noted the comments. Those present from NHS Board areas
indicated that communication had improved in the recent weeks. AN indicated
that NHS Tayside is due to organise a local ½ session to deal with issues raised
regarding the content.
The Group noted the issue of the £50 cancellation fee and hoped that, as
communication has improved this should not be such an issue. The Group
sympathised with RCGP that, if costs have increased this needs to be addressed
–with the Service. JT indicated he had suggested to RCGP to include a
contingency cost at the outset. The Group agreed it would be appropriate to
seek more detail on the costings.
AH enquired whether the Quality Group had received a copy of the
specification for the work. JT indicated this had gone to nGMS leads. CB
suggested it would be helpful to remind people what was included/excluded
from the costs. It was agreed it would be helpful if RCGP could provide
information for the Group.
It was agreed that the sub-group which had met previously would meet, prior to
meetings of the Quality Group.
SF raised the point that as there is no formal accreditation at the end of the
course it is not possible to assess whether individuals are competent to
undertake the visits. DA indicated that with PA/QPA there had been external
observers. There was discussion on the issue of mentoring/provision of support.
It was suggested this was something which the nQIS Group could perhaps
consider, but not influence. CB indicated that Bill Taylor had been receptive to
feedback and this is a point which should be considered. AH enquired whether
it would be possible for NHS Boards to utilise other tools available to assess
competencies. DA suggested there was a value on building on the experiences
gained in the first year. It was also suggested that practice feedback would
assist in identifying any areas of concern.
JT reminded the Group that RCGP had undergone recent changes in personnel.
The Group agreed that, in addition to the sub-group, it is important to have
RCGP representation at the meetings of the Quality Group. It would also be
helpful to receive a proposal from RCGP on the way forward. JT agreed to
contact MS. Action JT
QOF/PV Visits: The perceived lack of clarity around the role of PV visits
was discussed. JR and FD indicated that, as far as they could tell, PSD perceive
the QOF visits and process to cover elements of PV, therefore these would be
excluded from the PV process itself. JT outlined the process to be undertaken
with regard to Annual Review; QOF visits; PV. TC agreed to take this issue
back and discuss within PSD. JT also agreed to speak with Lorna Jackson.
Actions TC/ JT
The meeting then returned to items noted earlier in the agenda:
Item 3 (iv) Benefits of QOF: JT indicated that he had received comments on
the paper circulated previously . This would be updated and recirculated. AH
indicated that this would assist Boards in respect of the Benefits Realisation
HDL. Action JT
Item 3(iii) Patient Consent: CB reminded the Group, as noted previously, the
Code of Confidentiality requires input from the lawyers. There is also a
requirement to issue Directions to enforce this. As timing is now becoming an
increasing pressure, there was discussion on the value of issuing in draft. CB
and JT agreed to liaise with David Notman on this. Action CB/JT
QOF Enquiries: NH updated the Group on the current position for dealing
with enquiries. She confirmed that clinical enquiries would be responded to by
Maintenance Group: NH indicated that this is the UK forum which deals with
QOF enquiries – the role will evolve after the Review into a different process.
UK Review/Subplenary: NH indicated that this Group had met recently, but she
had not received feedback yet. The next meeting will be held on 29th July. To
date, in excess of 530 submissions have been received. The Group is developing
a processing plan to deal with the submissions.
Date of Next Meeting: The next meeting will be held on THURSDAY 15TH
SEPTEMBER at 10.00, at RSNH Larbert . Dates for future meetings for the
remainder of the year would be arranged .