New Contract 2008-9 Guidelines

The new guidelines written to match the v12 business rules are now available to download from the INPS website.

The new guidelines to support the NGMS Contract 2008-9 are redesigned, with revised colours and updated to match the business rules v12. During the redesign we have appended a number of new management guidelines which will not only allow the practices to add the correct Read Codes needed to report to QMAS but will also assist in the day to management of patients with Chronic Disease within the QOF Domains.

We have also embedded some Macmillan Guidelines for the management of Cancer and Palliative Care patients.

We have tried to give a fresh new look to the guidelines and have changed the colours and added some additional guidelines where appropriate which will help with the overall management and administration of chronic diseases within the domains. The lines that relate specifically to QOF reports are marked with an asterisk to make it easier to identify them.

Once you’ve imported the new guidelines, you may wish to add them to your local guideline index; see here for instructions.

nGMS Contract 2008-9

Although the GP contract for 2008-9 has been running since 1st April 2008 the GP system suppliers have only recently received the Business Rules which allow us to write the queries required to extract the correct data and send it to QMAS for reporting.

The Business Rules v12 are now receiving attention at INPS so that audits and guidelines to match them can be produced.
However the new reporting audits cannot be released until they have been conformed to the CfH standards and the message tested with the new QMAS database to ensure that we have correctly interpreted these rules.
Conformance testing will commence the week of 13th October and we hope to have completed during that week, however QMAS will not be ready to accept the new messages until between 20th and 27th October after which we be ready to start the roll out of the audits.

In the meantime we have written a small temporary audit:

nGMS Contract 2008-9 Temporary Audits

    Interim Audits for Changes to Business Rules v12

These interim audits have been produced in order to allow practices to check their progress to date with the changes to this year’s nGMS Contract before the conformed reporting audits can be released. They can be downloaded from the INPS website under Client Zone - Downloads - Audits.  The audits highlight the significant changes between v11 and v12.
http://www.inps.co.uk/downloads/clinaudit/clinaudit.htm

Patients with no ethnicity recorded

Due to the requirements of QoF, a common query received on Helpline is how to construct a search for patients who have no ethnicity recorded.

The helpsheet below is a step-by-step guide to creating a search to look for these patients.

How to search for patients with no recorded ethnicity

QMAS “Switch Off” Reminder

A quick reminder that QMAS is currently in “switch off” mode; that is to say that although submissions are being accepted, it is not currently reporting on achievement for 2008/9 (and will not do so until the QMAS system has been updated).

More details here.

QOF changes for 2008-9

INPS have prepared a document detailing the changes in QOF for 2008-9. It can be downloaded here.

In order for INPS to write the clinical audits for Vision reporting, we require the set of detailed Business Rules from the DH and it is possible that these will not be available until June or July. The Business Rules contain the detailed Read Code deletions and additions and timeframes for reporting so it is impossible for us to give specific
guidance.

This document is based on the information we do have already and will at least give some indications where clinicians and practices will need to be aware of the changes.

QMAS 2008/9 Reporting

Due to the up-coming changes to the QOF framework for 2008/9, QMAS is now in “Switch Off”.

“Switch Off” refers to a state where QMAS will not report on achievement for 2008/09. This will be in place until the changes to the 2008/9 QOF framework are applied. From 1st April 2008, any clinical submission made to QMAS with a Report-Reference Date of 1st April 2009 will be rejected by QMAS, triggering an acknowledgment of 0021 “QMAS cannot accept submissions for the practice at this time. Please contact your QOF Lead or GPSS”.

The receipt of this Acknowledgement should NOT trigger an automatic resend to QMAS, as QMAS will continue to reject with codes 0021 until QMAS has been upgraded to reflect the changes announced by the Department of Health. Once upgraded, QMAS will once again be able to report on achievement for 2008/09 (”Switch On”).

Please note that “Switch Off” will not effect End of Year submissions for 2007/08.

For more information, please see this bulletin regarding the QOF changes for 2008/9.

Problems with QoF submission to CMWeb in Wales

Vision, in common with all other clinical suppliers, is experiencing problems with Welsh sites who have submitted their QoF reports to CMWeb. 

This is the result of CMWeb being upgraded at short notice from version 10 to version 11. As Vision practices are on v10, all QoF reports submitted on 1st February have not been updated to CMWeb (although users will not see any error in Vision). 

MSD will manually import any reports sent into CMWeb. This will automatically reprocess any reports which were sent on 1st Feb. At this stage, sites need take no action, other than to check CMWeb in the latter half of next week to ensure their reports have been successfully uploaded. 

Vision will be upgraded to v11 in DLM 251, which will be rolled out to sites very shortly.>

DLM 251 / Version 11 Business Rules

DLM 251 is now in the process of being rolled out to sites. This update only contains the latest audits for the version 11 business rules, hence there is no DLM User Guide on the INPS website.

The only changes in version 11 are as follows:

• In Hypertension, the code G24z1 has been removed from the heirarchy G24%-G2z..
• Hypertension is also included in the co-morbidity registers for Smoking and CKD.

Records 9

Records 9 states “For repeat medicines, an indicator for the drug can be identified in the records”. In the DES Reports spreadsheet released in DLM 237 INPS supplied a tool to help you determine how close you are to reaching your target. Part of this spreadsheet determines how many therapy items are linked to a problem and how many are not linked to a problem.

We have received a number of queries from practices stating that problem linkage is not the method they use. The Records 9 rule doesn’t state a particular method for recording this information - only that you have to be able to show that it’s been done. A few other methods are listed below…

• Therapy and reason for therapy recorded within the same consultation.
  
• Therapy and reason recorded on the same day.
  
• Freetext information recorded in the dosage box of the therapy item.
  
• Any other way you can think of as long as all staff are aware.
   

All these methods and problem linkage can be valid as long as you can adequately show there is a reason of some kind. Unfortunately, these other methods can be too bespoke to be able to do one search in Vision. For example, in freetext you could write “For backache” or “Asthma”, etc. As there are endless possibilities available it makes a generic search very hard. We can’t just check on there being a freetext entry at all as it might just contain the dosage information and nothing else.

In conclusion whilst we have provided a tool where possible to search for your figures, please do not feel that you are being forced to record the information this way. Any other method can be proved on a random sample of patients during your QoF Assement. If you are unsure then speak to your PCT QoF facilitator and they should be able to point you in the right direction.

Heart Failure (HT03) Help File

There is an error is the Help File relating to HF03 for the new (v10) audits. 

• In HF01 diagnosis is first ever.
• In HF02 there is an exception so diagnosis has to be after 01/04/2006.
• For HF03 the help file states diagnosis is since 01/04/2006, but this is incorrect - it should state ”first diagnosis ever”.

Please note that this error only affects the textual content of the Help File and the audit itself is correct.