Case Study

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Improving Quality and Maximising Resources in 10 London Practices

   The background

The Organisation is a London based primary care organisation providing GP services at 12 locations across several PCTs. They wanted to develop a systematic approach to quality improvement, and ensure all practices were providing a high standard of safe and effective patient care. In addition, with increasing pressure on resources, they recognised the need to ensure that practices maximised available income to provide high quality patient care.

  The challenge

The practices are located over a wide geographic area, spanning several PCTs in London and utilise a number of different clinical systems. Preliminary clinical audits identified unexplained variations in the quality of patient care, lower than expected prevalence rates, patients with unmet clinical needs and consequent reduced Quality and Outcomes Framework (QoF) income. Not all practices appeared to be delivering enhanced services.

The solution

QMS Practice Focus software was installed in 10 practices in the group and this provided practices with an easy to use quality improvement tool and aggregated data from all practices in the Organisation for performance monitoring.

QMS provided an ‘on site’ consultancy service at all practice sites to review practice performance and business systems.  This included:

  • Identifying patients who may be missing from disease registers.
  • Comparing practice registers with expected prevalence to identify potential income opportunities.
  • Analysing DES data to look at achievement compared with best practice.
  • Highlighting areas of missed income in DES’s.
  • Identifying children with incomplete childhood immunisations records.
  • Identifying missed opportunities in patients eligible for a health check under the national programme.

The consultant’s visit culminated in a presentation to the practice clinical team and a written report highlighting areas for possible improvement.

The outcomes

Across the 10 practices QMS identified potential increases in prevalence in the following areas:

  • 9% increase in Asthma register
 value £2,600.00
  • 10% increase in COPD register
 value £1,800.00
  • 9% increase in Mental Health register
 value £5,400.00
  • 4% increase in CHD register
 value £1,400.00
  • 3%  increase in Diabetes register
 value £2,200.00
  • 44% increase in Heart Failure register
 value £4,500.00

Increases were also identified in Hypothyroidism, Stroke, epilepsy and cancer.

£1,500 of additional income was identified from patients coded for all parameters of the National Health Check programme but not coded correctly, and a further £13,000 in patients with an incomplete health check. 

At all practices, QMS were able to identify potential additional income that exceeded the cost of the software and review. Potential increases in income varied from practice to practice with the minimum identified in excess of £1,500 (NB list size of just 300 at time of review) and the maximum in excess of £13,000.

QMS were able to identify over £30,000 in potential additional income across the Organisation if practices simply added patients with known conditions to the appropriate disease registers, in the six top areas at each practice.

QMS were able to identify potential additional DES income of over £25,000 across the Organisation if patients’ records had been correctly coded under DES rules.  For example at one practice, 90% of new patients were screened for alcohol use, using the FAST tool, but as a result of inadequate coding, this work did not qualify for payment.

Summary

The QMS model, using on site consultants supported by QMS Practice Focus software proved effective at identifying quality improvements and demonstrating significant additional income for practices. The potential to increase practice income far outweighed the cost of the review.

  • The average additional income from data quality issues £3,000 - £4,000
  • The average additional income from DES £1,500 - £3,000

Client Comments

The Practice Reviews really are going to form a major part of our development programme over the next year as this issue about prevalence is both a health inequality issue (if patients are not included in disease registers, they end up not being included in the recall systems and structured care programmes) and a cost issue (under-claiming on the prevalence component of QOF scores)”

Dr M.A. (London)