Primary care, mental health and the GP contract

Primary care, mental health and the GP contract Dr Ceri Dornan, GPSI in Mental Health New GP contract Quality and outcomes framework: • Sets quality standards for care of clinical problems and practice organisation • ‘Points’ awarded for achieving standards • Part of practice income depends on points achieved • Includes mental health points PCT use of Quof • PCTs collect and review QUOF data • Use QuoF Payments to promote good practice • Audit QuoF data to input into public health • Scrutinise exception report Example of QuoF for chd • • • • • • • • • • • • • Summary of all Clinical Indicators Secondary Prevention in Coronary Heart Disease (CHD) Indicator Points Payment Stages Records CHD 1. The practice can produce a register of patients with coronary heart disease 6 Diagnosis and initial management CHD 2. The percentage of patients with newly diagnosed angina (diagnosed after 1 April 2003) who are referred for exercise testing and/or specialist assessment 7 25–90% 7 25-85% QOF and Mental Health MH8:The practice can produce a register of people with schizophrenia, bipolar affective disorder and other psychoses. Register is generated from a search of GP records for specific Read Codes so depends on codes having been entered. Most practices have created actively from other searches e.g. prescribing QOF and Mental Health MH9:The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses with a review recorded in the previous 15 months. In the review there should be evidence that the patient has been offered routine health promotion and prevention advice appropriate to their age, gender and health status. QOF and Mental Health MH6: The percentage of patients on the register who have a documented care plan documented in the records agreed between individuals, their family and/or carers as appropriate MH7: The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who do not attend the practice for their annual review who are identified and followed up by the practice team within 14 days of their non attendance QOF and Mental health Also points for: • Lithium monitoring • Measuring severity of depression • Screening for depression in people with ischaemic heart disease or diabetes • Dementia register and annual review Physical health review Why? • Reduced life expectancy of people with severe and enduring mental health problems Conditions of particular concern: lifestyle and drug treatment related • Ischaemic heart disease • Chronic obstructive pulmonary disease • Diabetes • Sexual health • Drug and alcohol use – HIV, hepatitis • General health promotion- cervical smears, breast screening, blood pressure, weight, diet and exercise, smoking People who miss out: • • • • Not registered with a GP Registered but do not attend Choose not to be reviewed Hospital inpatients Other problems • Detail of review not defined in QOF regulations • Some of those most at risk not seen • Reducing risk in those identified – what interventions work?