Clinical markers become tougher

Extensive revisions to the quality framework from April will mean GPs having to do more work for their points.

As well as seven new clinical domains and 17 new indicators, 17 existing indicators will be made substantially tougher and others will be worth fewer points.

Domains given the biggest overhaul include mental health, diabetes and COPD.

The total number of points allocated to mental health has dropped from 41 to 39, but GPs will be expected to do far more work to achieve these points.

The mental health register should now include all those with schizophrenia, bipolar disorder and other psychoses, but not those with long-term depression.

Points available for optimising lithium therapy have dropped from 11 to three, while nine have been allocated to creation and maintenance of a comprehensive care plan to be agreed with carers and reviewed yearly, and to active follow-up of DNAs.

On the diabetes register, GPs will now need to record the type of diabetes for all patients.

The guidance states that distinguishing type-1 and type-2 diabetes clinically may not always be easy in primary care, but adds that if in doubt, those under 30 or who require insulin within one year of diagnosis should be recorded with a type-1 code.

In addition, to receive five points for retinal screening, GPs must show that it has been carried out to the 'required standard'.

The number of points available for COPD treatment has dropped from 45 to 33, largely because of the removal of smoking cessation indicators into a dedicated smoking domain, worth 68 points.

COPD points will be awarded for recording FEV1 and checking inhaler technique on a yearly basis, rather than every two years.

Some of the changes have taken into account the criticism made of the original framework, such as not allowing individual patients to be recorded as having both asthma and COPD.

This has been changed so that patients with reversibility of 400ml or more on FEV1 who do not return to over 80 per cent predicted and who have a significant smoking history should from April be recorded on both registers.

It suggests that this will account for approximately 15 per cent of all COPD patients.

The subsection of the CHD domain previously devoted to patients with left ventricular dysfunction has been extended to include all heart failure patients, after criticism that half of all heart failure patients would have been excluded from treatment.


Total value £1.33 per patient:
- 40p for agreed plan.
- 44p for data accreditation.
- 27p for e-prescribing and up-to-date patient addresses.
- 22p for using Connecting for Health-approved IT system.

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