QOF project on Dementia March 2015

2 QOF indicators

1)Care plan review face-to-face within 12 months.

2)Patients who are newly diagnosed with dementia should have FBC, calcium, glucose, renal and liver function, vitamin B12 and folate recorded between 12 months before or 6 months after entering onto register.

Aims of project

I concentrated on indicator (1)

To be able to review dementia care plans for all those who are on the dementia register:-

  • Face to face
  • In a timely manner in order to avoid a rushed approach towards the end of the QOF year.
  • To devise a system which would work year on year as opposed to just this year
  • To be able to complete advance care plans for all dementia patients where possible which is part of the DES (Direct Enhanced Services)

Methods

A system one search for all patients with dementia was conducted and this revealed a total of 80 patients. From these 80 patients, 66 (83 %) had a dementia review recorded in the last twelve months. Another search was then conducted in order to find out the dates on which the dementia reviews had occurred. This showed a mixture of telephone vs face to face reviews. In addition it revealed the majority of the reviews took place between the months of October and March (66%), where patients had been contacted by a named doctor who carried out the review having identified that the review was overdue. This was in comparison to only 34% of reviews being carried out between April and September.

I devised a standard letter to send out to patients detailing that their dementia review is now due requesting that they book an appointment. The letter also detailed the option of asking for a home visit if the patient is housebound. Nursing home patients were booked in to see a doctor on a visit for their dementia review by the administrative staff.

A recall was added to each patient’s notes. The admin staff worked down the list of 80 patients and ensured that recalls were created for 8 patients every month from April onwards which meant that all the reviews would be complete by the end of the month of January for the subsequent year. Every month a search would be conducted by one of the named receptionists and those who are due a dementia review would be identified and would be sent the above letter. Nursing home patients would be booked in for visits as above.

I then printed out the advanced care planning booklet and discussed this in the practice meeting so all doctors were aware of how to ask the patient to fill this booklet out. The patient was then required to bring back one page which summarised their wishes for end of life care, details of next of kin, lasting power of attorney etc. This would then be scanned onto the patient’s records as Advance Care Plan in communications and letters so it would be easy to find. I then photocopied a few copies of the booklet and ensured that each doctor had 2 copies of these booklets in their rooms.

Re-audit

I re-audited this in may 2015 and 12 patients (15%) had already had their face to face dementia review in comparison to 3 patients (3%) last year within this time frame. (see graph below)This has shown a clear improvement in terms of review taking place in an appropriate and timely manner.

Plan for future

I have worked with one of the other GPs during this project as she was the practice lead for Dementia QOF and therefore I have handed over the responsibility to review this project to herself. The idea would be to re-run the dementia search againearly next yearand to re-populate the recalls as appropriate, depending on the change in patient numbers which is likely to change with new diagnoses, death, moving practices etc.