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Quality and Outcomes Framework Assessor Training


  • pg 1
									   Quality and Outcomes
Framework Assessor Training
  Principles, Purposes and Process
       of Quality Review Visits
              Module K4
This presentation will cover:
   – principles of the annual review visit
   – the visit team and their skills
   – carrying out the visit
      • preparation
      • structure of the visit
      • outcomes
   – reviewing the review
   – other issues
QOF annual review - principles
• The annual review process is both summative and
  formative - both are equally important
• The purpose of the visit is:
   – to review achievement and give the PCT an assessment of
     likely achievement at 31 March
   – to confirm data collection and quality are accurate
   – to discuss the contractor’s aspiration for the following year
• Annual review process should be light touch
• Process needs to be sufficiently rigorous to satisfy
  audit requirements
QOF Domains - 1
Clinical domain
 - 76 indicators
 - 10 disease areas (coronary heart disease, stroke/
 transient ischaemic attack, cancer, hypothryroidism,
 diabetes, hypertension, mental health, asthma, chronic
 obstructive pulmonary disease and epilepsy)
 - 550 points
Organisational domain
 - 56 indicators
 - 5 areas (records, information, patient communication,
 education and training, practice management and
 medicines management)
 - 184 points
QOF Domains - 2
Patient experience domain
- 4 indicators
- 2 areas (patient survey and consultation length)
- 100 points

Additional services domain
- 10 indicators
- 4 areas (cervical screening, child health surveillance,
maternity services and contraceptive services)
- 36 points
Holistic care payments
Holistic QOF Points
- based on points scored in clinical domain
- 100 points
Quality practice payments
- based on points scored in organisational, patient experience
and additional services domains
- 30 points
Access bonus
- based on achievement of 24/48 hour access target
- 50 points
• PMS, APMS and PCTMS practices can agree local
  equivalent QOFs
• Local variations must have comparable frameworks
• Must be points based & add up to 1050
• Local QOF must be agreed by Director of Public
  Health or another suitable person
• Equally, should be similar reward for similar effort
  between national QOF and locally agreed variants
• All practices participating in a QOF should have a
  QOF assessment visit
The visit team
• PCT QOF lead
• Core visit team:
  – a PCT Management representative (normally QOF
  – a clinician (normally a GP)
  – a patient representative
  – others relevant to the issues to be discussed
    during the visit (e.g. data analyst)
• National training by MA (NatPaCT)
• QOF leads organise further local training
   – National materials provided to cascade locally
   – Local provision of training for K2 “understanding of local
     health community and PCT”
   – Need to ensure training is provided to all who require it
   – Support contractors via effective communication/training on
     QOF Assessment Process
• Importance of consistency - nationally and locally
Review team skills
• QOF lead skills
   –   Project Management
   –   Quality assurance of review process
   –   Communication
   –   Key competencies
• Core visit team skills
   – Should collectively cover all competencies (K1-K5
     and S1-S5)
   – Each individual member of the core visit team
     should also have at least K1, K3-K5, and S1
Preparation by the contractor
• Each contractor is asked to nominate a QOF lead to
  liaise over the visit
• 1 month before visit - contractor submits supporting
   – latest QMAS achievement report
   – information on non-clinical domains, as set out in the New
     GMS Contract Supplementary Documents
• The information submitted:
   – must cover all areas for which the contractor intends to
     submit an achievement claim
   – should include levels of exception reporting
Preparation by the PCT - 1
• Over the next few months
   – PCT establishes mechanisms to quality assure review
     process and ensure consistency of visits
   – set of local principles and strategy should be shared with
     contractors and PCT staff
   – Ensure all assessors attend national training or currently
     hold transferable competencies
• By end of July
   – PCT QOF lead agrees visit schedule and process of review
     with contractors, scheduling visits between Oct and Jan and
     giving contractors at least 2 months’ notice
Preparation by the PCT - 2
• 3-4 weeks before visit - review team
   – analyses information provided by contractor
   – considers other relevant information
   – identifies issues to follow up
• 2 weeks before visit - QOF lead
   – discusses agenda with contractor, if possible resolving
     issues ahead of visit
• 1 week before visit - QOF lead
   – finalises agenda and if possible agrees with the contractor
Carrying out the visit
• The visit should avoid disruption to the contractor
   – PCTs and contractors should seek to minimise necessity for
     practices to close
   – where a practice has to close, alternative arrangement for
     patients to be seen should be sought
• It is suggested the visit be divided into:
   – verification and inspection of current achievement
   – discussion of aspiration and future development
Verification and inspection
• The team should:
   – review and verify achievement on a selection of indicators:
       • cover all domains for which the contractor intends to submit an
         achievement claim
       • also choose some indicators at random
       • preferably cover all sub-domains (depth of coverage will
         depend on the circumstances)
   – spot check accuracy and exception reporting levels
   – request remedial plan if there are data quality issues
   – identify areas for further analysis, discuss solutions and agree
     timetable for post-visit report
• The team should:
   – discuss the contractor’s future plans within QOF, include
     next year’s aspiration
   – involve other people, if appropriate, normally with agreement
     of contractor (e.g. practice staff, possibly relevant external
     people such as a clinical governance lead)
   – consider learning, support and development needs in
     seeking to achieve higher quality
   – make arrangements to follow up as appropriate
Outcomes of the visit
• Written report
   –   details of how assessment was done
   –   main findings and conclusions
   –   action points agreed
   –   assessment of likely aspiration
• The report should:
   – be shared in draft with contractor within 2 weeks of visit for
   – be quality assured
   – be cleared by PCT Chief Executive and copied to Board and
     PEC Chairs
   – be finalised within 4 weeks of visit
Reviewing the review
• PCT local review of process with contractors
  and LMC
• SHA oversight
• National review events in Feb 2005
  – share learning
  – involve both review teams and contractors
Further issues
•   Suspected fraud
•   Confidentiality - code of practice
•   Dispute resolution - local protocol
•   Frequency of visits in future years
Further information…
• Further detail on the annual review process is set out
  in the guidance and technical annexes at the DH
  Primary Care Contracting website
• DH Primary Care Contracting website:
• DH/MA (NatPaCT) Primary Care Contracting

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