Contract Specification: LES - Enhanced CHD Care (GGC) 2012-11 Final

28/03/2012

LES - Enhanced CHD Care 2012-13

Contract Mechanism and Specification

Introduction

1. All practices are expected to provide essential and those additional services they are contracted to provide to all their patients. This enhanced service specification outlines the more specialised services to be provided. The specification of this service is designed to cover the enhanced aspects of clinical care of the patient, all of which are beyond scope of essential services. No part of the specification by commission, omission or implication defines or redefines essential or additional services.

This specification deals with Primary Care Services to patients with CHD and enhances the services provided by general practices achieving the quality indicator points in this area.

Background

2. CHD is a leading cause of death and morbidity in Glasgow. It is associated with high levels of risk factors and increasing levels of deprivation. Secondary prevention can substantially reduce the risk of subsequent myocardial infarction and progression of the disease once it is diagnosed. The quality indicators in nGMS will ensure that some aspects of secondary prevention are systematically addressed. However nGMS is limited and does not, for example, address the important factors of diet, exercise and alcohol. The SIGN guideline on secondary prevention underlines the importance of a holistic approach to secondary prevention including rehabilitation. Greater Glasgow has provided services to support smoking cessation, improving eating habits, getting more active and weight management. The LES will ensure a systematic approach, not only to the medical model of secondary prevention, but also to the other risk factors which can contribute around half the potential risk reduction. In addition, depression limits an individual’s ability to change health related behaviours and increases mortality risk. This LES addresses that issue and does not mandate the pursuit of health related behaviour change until the issue of depression has been addressed.

CHD data entered on the LES screens are extracted from Practice clinical systems and held on behalf of Practices on the NHSGG&C “LES Server” at GartnavelRoyalHospital. Only two members of the IT Department Software Development Team have unrestricted access to these data. These data are used for Contract monitoring, payment and support purposes. Should NHS or any other staff wish access to these data, permission must be sought for access to anonymised data. Permission is required from the Data Quality Group, a sub-group of the Enhanced Services & QOF Workgroup, which has LMC representation. Access to data will not be given without due reason and will never be given to unanonymised patient data.

Scope of this scheme

3. This scheme is for the provision of general medical services and the enhanced services set out at paragraph 5 to CHD patients.

Aims

4. To ensure that:

(i) CHD patients have equal access to an enhanced level of service from practices

designed to ensure that their health needs in relation to CHD are effectively tackled

(ii) Practice staff are provided with the knowledge, training and resources to enable them to deal effectively with an enhanced level of CHD care

(iii) a patient pathway is used to ensure patients are managed in a seamless way across primary and secondary care, without duplication of services

(iv)cardiac rehabilitation services including phase 3 and support for changing individual behaviours is offered at each step change in their disease and available to patients asthey need and want them (the menu based approach recommended in the SIGN guideline).

(v)patients have depression addressed

Service outline

5. This national enhanced service will fund:

(i)provision of an Annual Review of Patients with CHD – those who have, or have had angina, MI, CABG, angioplasty, including those who also have heart failure

(ii)provision of a review between 4-6 weeks of hospital discharge for any relevant diagnosis (MI, chest pain due to CHD, angioplasty, CABG, decompensated heart failure) unless attending cardiac rehabilitation; and within 4-6 weeks of a new diagnosis of CHD at an OP or rapid access chest pain clinic; and within 6 months of a discharge from a phase 3 cardiac rehabilitation programme.

(iii)Completion of the review items which are not included in the Quality and Outcomes Framework of the New GMS Contract (as agreed between LMC and GGHNHSB) and recording using the agreed method.

(iv)ensure appropriate referral for CHD patients or those with complications as per the agreed referral documents (as agreed between LMC and Heart MCN).

(v)aim for blood pressure target as agreed in local guideline. This is currently <140 and <85 (80 for diabetic patients).

(vi)allow electronic extraction of the data as required for verification/audit purposes.

Accreditation

6. Those doctors who satisfy at appraisal and revalidation that they have such continuing medical experience, training and competence as is necessary to enable them to contract for the enhanced service shall be deemed professionally qualified to do so.

First Level Registered Nurses are accountable for their own practice and must keep abreast of all new developments relating to their clinical practice. Therefore those nurses delivering the LES must have completed the one day CHD and half day health Improvement training courses run by NHSGG&C. Those who participate in delivering this LES as part of their clinical remit must be strongly encouraged to attend, on an annual basis, update training provided by NHSGG&C.

Costs

7.In 2012/13 each practice contracted to provide this service will receive an annual payment of £22per patient with CHD(paid quarterly in arrears) for whom the appropriate LES work has been carried out and recorded on the appropriate computer screens. For payment purposes, the full payment recording level corresponds to 90% or more of the appropriate LES fields on the CDSS / EMIS template or INPS guideline (as per the payments screen). A recorded level of 75-89% of the LES fields on the template will attract a payment of £15.50 per patient. A recorded level of 65-74% of theLES fields on the template will attract a payment of £11.00 per patient. Patients with a recorded level of theLES fields on the template of under 65% will be deemed not to have had the appropriate LES work carried out and no payment will be given.

Practices in areas carrying out this LES for the first time will have lower payment thresholds, being 15 percentage points below those applied to experienced Practices. Thus the full payment threshold will be 75%, with the lower payment thresholds being 60% and 50%. This will apply only to Practices in an area in the first year that the LES has been commissioned.

EMIS Practices can use either EMIS or “CS for EMIS” templates (when these become available). Practices with INPS clinical software will use the “guidelines” developed jointly by NHSGG&C and INPS, or “CS for Vision” templates when these become available. NHS Greater Glasgow & Clyde has developed new LES payment screens to enable Practices to view the activity and payment status of all their patients.

An “administration” payment of £5 will be made in respect of CHD patients exception coded as DNA, Housebound etc., unless the EMIS / CDSS / VISION guideline screens are completed to a level that triggers an achievement payment, when the appropriate achievement payment will be made.

Initial payments (quarters 1 to3) will be made where90% or more of the fields on the LES payment screens are completed. At year end a payment reconciliation will be carried out and final payment will be made, comprising full, partial and administration payments.

Both parties will provide a minimum of 3 months noticeif they wish to withdraw from

the contract. This 3 month notice period appliesunless there are fewer than 3 months remaining in the current contractual year. In this instance, less than 3 months notice may be given by either party.

Additional Information

8. A combined CHD & Diabetes disease template has been designedto assist those Practices that hold co-morbidity consultations. This or the separate CHD and Diabetes templates can be used by the Practice Nurse, along with the HRB template, whichever is easiest for the Nurse.

The major amendments from 2011/12 are as follows:

  1. The weighting of the LES indicator/business rules to reflect the importance of specific indicators and the time it might take a Practice Nurse to cover the area. The HRB indicators to be a total of around 60% of the indicator achievement.
  2. A combined CHD & Diabetes template, for use by Practices that wish it.

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