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Excel – manipulating data from your clinical system Recorded Webinar
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Changes to QoF 2012/13 Recorded Webinar
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QoF Back To Basics Recorded Webinar
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CQC Webinar Recording
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Latest news items from Insight Solutions and other sources. If you require further information about any of the items displayed or services we offer please contact us

Insight Solutions News




Desk-top flip guides, page per disease area, based on the most common codes for every register & indicator (QoF 2013/14)

Also includes relevant exception codes
Ideal for every desk where QoF data is entered.

Can be ordered via our website - & click on the products tab (payment by card)

Request an order form by emailing (payment by BACS or cheque)


25/10/2013 CCG Wide Data Quality Validation

CCG Wide data Quality Validation.

We have worked with CCG's to improve their data across all their practices.

For Example a CCG with 23 Practices:

CKD Prevalence across the CCG was 3.7%
1781 patients with possible CKD identified but not currently on the register.

CCG prevalence for CKD would increase to 4.72% (national prevalence is currently 4.3%)

9836 Patients identified as 'missing' off the obesity register - obesity costs the NHS millions each year, this number equates to more than 400 patients per practice.

Data improvements in Year 2 demonstrated that more than 7000 patients were added to the Chronic Disease register and Prevalence increased in 307 registers out of a possible 460.

For an informal discussion and costing for CCG-wide data quality validation, please contact us on 01527 557407 or email email


25/10/2013 Analysis of current QoF workload to include earnings so far - where are you at now?

Analysis of current QoF workload to include earnings so far - where are you at now?

Analysis of workload required to maximise year end earnings - what do we need to do to get to our end of year target?

QoF management software will tell you which patients have not achieved or not currently to target - but, what does this mean to you financially? Which are you high priority areas which will give you the best return for your activity?

For Example

Diabetes - after 5 months £6.5k achieved out of possible £34.5k. Still lots of work to do, but where? Have patients not attended or are they not to target?

COPD - after 5 months, no income achieved out of possible £13.5k. 166 reviews required to achieve which = 23 per month - do you need to reallocate resources as currently only target 17 per month?

Are you aware of which indicators are going to give you the greatest loss?

The timeframe reduction means you will need to see a 1/5th more patients within this QoF year to achieve the same level of points

How are you going to mitigate this?

Is your current recall system up to the job to cope with the increased workload due to threshold & timeframe changes?

Do you have the expertise & resource in-house to ensure your data entry templates & protocols are working for you, making best use of limited time by collecting the right data first time?

Call the office on 01527 550407 or email for more information



Patients will be notified by post in the New Year-that confidential data from their records will be shared outside the NHS, as a campaign begins to encourage patients to opt out of the programme.






07/10/2013 Online Data Quality Assessment

For one reason or another you haven’t yet booked an on-site data quality assessment. You may be convinced that your data is already as good as it can be or you may not really understand prevalence and the difference patients missing off your register will make to your annual practice income.

Whatever the reason, we are now offering you the chance to analyse your own data (register totals) from the privacy of your own practice! To access our on-line DQA toolkit click on the Exclusives tab and select the link to register for access.

Follow through the registration process, enter in your practice population and current disease register totals and hit the calculate button. If there are any figures that you are unsure about, or you want to follow-up with an on-site assessment, do not hesitate to contact us. On-site DQA’s come with a full 100% money back guarantee if we do not find more than your initial investment - you cannot possibly lose out.

Further Information: Click here for more Info


Other News

18/11/2013 GP contract 2014/15: Scotland, Wales and Northern Ireland talks progress


GP leaders in Wales, Scotland and Northern Ireland will resume talks with devolved governments over GMS reforms after negotiations over changes in England concluded.

NHS Employers revealed earlier this year that it would negotiate changes in England alone for 2014/15, formally ending the UK-wide GMS negotiation process.

NHS England also represented the Welsh government over QOF changes, but Scotland and Northern Ireland will hold entirely separate contract talks.

GPC Scotland and the Scottish government have agreed to ‘pursue minimal changes’ to the GP contract in 2014/15, but could yet adopt reforms planned in England.

The two parties have agreed that any English reforms they see as mutually beneficial could yet be adopted.

The English deal reversed many of the damaging changes to QOF imposed last year, but Scotland avoided many of these issues in 2013/14 and had already diverted part of its QOF funding into core pay, a move now adopted in England.

Talks on a ‘more Scottish contract’ are at an early stage.

In Northern Ireland, GP leaders are seeking a reduction in QOF, potentially similar to the reforms agreed in England.

Reforms to increase the role of GP federations, commissioning and a move to more equitable GP funding are also under discussion.

GPC Wales hopes to announce a contract deal before Christmas this year, and could also agree a reduced QOF with funding moving into core pay as in England.

Although the phasing out of MPIG in England is expected to begin in 2014/15, Wales along with Scotland agreed to keep the top-up funding.

Welsh GP leaders are working with the government to model the impact any decision to remove MPIG could have on practices.




15/11/2013 QOF Cut by 40% and boosts global sum


GP practices will have their QOF work slashed by almost 40% next year as part of a sweeping new contract deal which will increase the value of the global sum, create a new emergency admissions DES and see individual GPs forced to publish their net pay.

Under the new deal, practices will see 341 out of 900 QOF points removed from the framework - the equivalent of £54,000 for the average practice - with the majority reinvested in core GP funding.

But in return, GPs will have to accept ‘named GP’ responsibility for all patients aged 75 years and older, publish their net income from 2015 and commit to police the care their patients receive from out-of-hours providers.

Seniority payments will be reduced by 15% each year and eventually phased out and practice boundaries will be abolished completely in October 2014, although practices will not have responsibility for home visits for patients out of their catchment area.

Some 238 points (£37,000 for the average practice) will be reinvested in the global sum, and a further 100 points (£16,000 for the average practice) from the axing of the quality and productivity domain in QOF, will be ploughed into into a new ‘inappropriate hospital admissions’ DES. Three points will be invested in the learning disabilities DES.

The new DES will mean GPs will have to case-manage vulnerable patients and allow emergency providers to contact GPs to decide whether patients should be admitted to hospital or A&E.

The main thrust of the changes to the GMS contract for 2014/15 are:

Reducing the size of the QOF by 341 points, with 238 QOF points being put into the global sum;

A new DES to prevent patients being inappropriately admitted to hospital, with an overall budget of £162m. This will replace the current risk-profiling DES, with extra funding from the removal of 100 QOF points from the quality and productivity domain;

Practices will have to publish the full net income of their GPs from 2015;

Complete abolition of practice boundaries from October 2014, although NHS England local area teams will take responsibility for the home visits of patients from out-of-area patients,

A new contractual obligation for GPs to monitor the quality of out-of-hours services when used by their patients and report any concerns;

Reduction of seniority payments by 15% each year, with no new entrants from April next year;

‘Named GPs’ will take on accountability for patients over the age of 75, to be the main point of call for providers outside the practice;

Practices will have to display the result of their CQC inspection in the waiting room;

The introduction of the Friends and Family test from December 2014 asking patients how likely they are to recommend a GP practice;

The introduction of new IT systems including the ability for patients to book appointments online and access their Summary Care Record.

Please click the link below for the full story

***look Out for INSIGHT SOLUTIONS QOF Changes FREE WEBINARS EARLY Next year for all the updates in QOF 2014/2015.

ALSO coming 2014- as soon as all the QOF Rulesets have been released for 2014/15 SEMINARS will BE RUNNING IN YOUR AREA- PLEASE CONTACT if you would like your area to be included in our seminar road shows

Further Information: Link to pulse article


15/11/2013 Enhanced Service 2013/2014


NHS Employers and the General Practitioners Committee (GPC) agreed the following enhanced services changes for 2014/15.

A new one year scheme for Avoiding Unplanned Admissions and Proactive Case Management of Vulnerable People - a programme of action for general practice.

The ES aims to:

Provide timely telephone access, via ex-directory or bypass number, to relevant clinicians and providers to support decisions relating to hospital transfers or admissions, in order to reduce avoidable hospital admissions or A&E attendances

Case manage vulnerable patients (both those with physical and mental health conditions) proactively through developing, sharing and regularly reviewing personalised care plans, including identifying a named accountable GP and care coordinator

Improve access to telephone or, where required, consultation appointments for patients identified in this service

Work with hospitals to review and improve discharge processes, sharing relevant information and whole system commissioning action points to help inform commissioning decisions.

Undertake internal reviews of unplanned admissions/re-admissions

The Patient Participation scheme will be extended for a further year with the requirement to carry out a local survey removed. This is due to the introduction of the Friends and Family Test.

The Extended Hours Access scheme will be extended for a further year with a number of flexibilities included to allow practices to work together to provide the most appropriate service for their patients.

The Dementia, Alcohol and Learning Disabilities will be extended for a further year with some changes made.

It has been agreed that the Patient Online (£24m) and Remote Care Monitoring (£12m) ESs will cease on 31 March 2014 and the associated GMS funding reinvested into core funding.

Guidance will be published on the above schemes in early 2014.

Further Information: LINK TO NHS EMPLOYERS


05/11/2013 Hundreds of GPs to be threatened with breach of contract over use of 084 numbers


All GP practices providing 084 numbers for patients to contact their surgeries will be threatened with breach of contract notices if they cannot prove that they are doing all they can to stop using the premium rate numbers.

NHS England said yesterday that it will be writing to all 27 area teams asking that they contact the 8% of GP practices still using 084 numbers to remind them that they will be in breach of contract if they ‘do not take all reasonable steps’ to stop using premium rate telephone numbers.

The move marks a dramatic escalation of a long-running battle to force practices to stop using the premium rate numbers, with previous guidance from the Department of Health simply urging practices not to enter into any new agreements with companies providing 084 numbers.

But NHS England says that providers of GP telephone systems - including Daisy Communications, the providers of Surgery Line - have agreed to move GPs to geographic-rate 03, 01 or 02 numbers with no contractual penalties.
It also added that even practices who provided a normal landline service, alongside an active 084 number, for their surgeries would be in breach of contract as they were providing an ‘inequitable’ service to patients.

NHS England announced earlier this year that it had asked local area teams to identify practices still using 0844 numbers, and pledged to ‘act upon’ the findings in due course.

NHS England’s head of primary care Dr David Geddes, said: ‘Research showed that some GPs felt unable to change things, because of real or perceived contracting problems, so we are aiming to bust some of the contracting myths, and to support practices to make sure their patients get the best service.

‘If GPs are not doing everything they can to change, then they are not providing an equitable service and are in breach of their contracts. We expect our area teams to use their local understanding and authority to make sure appropriate action is taken wherever GPs are not making this a priority.’

NHS England said it would ‘continue to monitor GPs’ progress’ and will audit practices’ telephony services again in 2014.



04/11/2013 V27 QOF Business Rulesets Now released


30 OCTOBER 2013
The Health and Social Care Information Centre has released v27 of the QOF business rules.

Due to historical discrepancies between the version 2 and CTV3 codes for mental health two codes have been added to the mental health register in CTV3: E1124 (single major depressive episode, severe, with psychosis) and E1134 (recurrent major depressive episodes, severe, with psychosis).

Patients with a record of these codes will now be included in the mental health register and may be eligible for inclusion in the mental health indicators (along with smoking indicators SMOK002 and SMOK005).





30/10/2013 In summary: What does NICE want to remove from the QOF?

PULSE Article

Read a summary of the NHS England review of the QOF by advisors at NICE and download the full document.

NICE advisors recommended all indicators on atrial fibrillation, CHD, PAD, hypothyroidism, asthma, COPD, dementia, mental health, cancer, palliative care, epilepsy, osteoporosis and rheumatoid arthritis are retained.

They recommended the following should be removed from the QOF:

12-monthly annual reviews (revert to 15-monthly)

HYP004 and HYP005 (worth 11 points in total)

DEP001 (21 points)

OB001 for obesity case-finding (8 points)

Learning disability indicators LD001 and LD002 (7 points in total)

Maternity (MAT001) and child health surveillance (CHS001) (12 points in total) – more appropriately delivered through CCG outcomes indicator set

DM0015 and DM0016 – could be temporarily removed or included in DM0014

‘Some’ CVD prevention and smoking indicators
They also recommended the following should be looked at:

Cutting follow-up review invitations – as most patients may attend after the first invite

CKD indicators – to be reviewed after NICE guidance update

Cervical screening and contraception indicators – to be reviewed with Public Health England input

Moving further indicators into other frameworks, eg, CCG outcomes indicator set

Introducing broader clinical areas – to simplify

Recycling clinical areas – periodically removing and reintroducing them

Further Information: Link to PULSE and to download the minutes of the Nice Meeting




Practices have until 1 November 2013 to complete and submit their online declaration which replaces local and variable arrangements with PCTs.

A consistent process across all GP practices for quality improvement and assurance will reassure patients and the public that providers and NHS England are delivering high quality primary medical services.

Over 2000 practices have already used the online interface. You can register, submit your declaration, map your practice catchment area and review the policy and guidance documents.

Each area team has designated staff to support you through the process, should you need help.

The following link pasted into your address bar will take you to the Primary Care web tool

Or click the link below

Further Information: link TO PCC


25/10/2013 £1m national leaflet drop on

Taken from Ehealthinsider

The government will spend £1m sending a patient information leaflet about the controversial programme to every household in England.

As part of a joint £2m public awareness campaign being run by NHS England and the Health and Social Care Information Centre, 22m homes will receive the leaflet in January and extractions will begin in spring next year.

The total cost includes around £800,000 in funding for a helpline to answer people’s questions about the scheme, to help take the pressure off GP practices.

The A5 leaflet will not be addressed to anybody in the household, but will clearly indicate that it is from the NHS and explain how people can opt-out of their data being extracted.

Patients will have a minimum of four weeks from the time of the leaflet drop to be able to object before extracts begin, but can also opt-out after they have commenced.

The programme involves taking a large monthly dataset from all GP practices covering patient demographics, events, referrals and prescriptions.

This will be linked with Hospital Episode Statistics and other data-sets to create new Care Episode Statistics, giving a more holistic view of patient journeys in the NHS.

Datasets from will be available publicly in aggregate form and in pseudonymised form to commissioners and health researchers.

GPs received a letter in late August explaining and telling them that they have eight weeks to inform their patients about the scheme before extractions begin. Patients can opt out of the extracts by telling their GP, who can insert a Read code in their record.

However many GPs had expressed concern that this would not be sufficient to meet their obligation to inform patients under the Data Protection Act. Some had advocated a mass opt-out of the scheme until they felt patients were properly informed.

In a press conference held yesterday, NHS England’s director of patients and information Tim Kelsey, chief data officer Geraint Lewis, and clinical and public assurance director of the HSCIC Dr Mark Davies, emphasised that the eight-week period was always a minimum and not intended to indicate that extractions would begin directly after that time.

They focused on highlighting the benefits of in helping to manage the NHS by planning health services more efficiently and tracking patient outcomes. Lewis also said that individual patients would be able to download their personal confidential dataset or theograph. When asked why, he said they might choose to share this with a health professional or charity.




25/10/2013 Childhood flu programme Q&A for healthcare professionals

taken from GOV.UK
Phase 1 of the childhood influenza programme started on 1 September 2013. In the first year of the programme, flu vaccine will be offered to all 2 and 3 year old children and primary school children in 7 pilot areas.

Extending the current flu vaccination programme to all children aims to lower the public health impact of flu by:

protecting children and averting a large number of cases of flu in children reducing flu transmission in children protecting older adults and those with clinical risk factors and averting many cases of severe disease and flu-related deaths.





11/10/2013 Flu Recall audit tool that helps GP practices to identify ‘at-risk


PRIMIS has just released a new ‘Flu Recall audit tool that helps GP practices to identify ‘at-risk’ patients more accurately and validate their ‘flu recall register for use year-on-year.
The tool is designed to help GP practices organise their ‘flu, zoster and pneumococcal campaigns efficiently, with minimum waste, expense or unnecessary effort.

There are many searches and reports already available for GP practices to use, so why is ours different?

Existing tools are likely to be based on the specification for the ‘Flu Uptake Survey, also produced by PRIMIS. Since this is designed for broad-brush monitoring of ‘flu vaccination uptake, tools based on this specification won’t handle the identification of patients in at-risk groups to the required exactitude for recall purposes, which may result in more patients than is necessary being called in.

The PRIMIS ‘Flu Recall audit tool enables practices to identify and manage patients in ‘grey areas’, where it is uncertain whether a ‘flu vaccination is required. Once reviewed, practices can mark patient records, creating a validated, stable recall register for use year-on-year. The tool will also help practices track and manage patients who move in and out of the at-risk groups.

The tool includes a useful mail merge facility, assisting in the preparation of invitation letters.

CCGs will find that the tool will provide accurate reporting of activity for the Influenza and Pneumococcal Immunisation Scheme (DES).

The ‘Flu Recall audit tool is available as a free download* for full PRIMIS Hub members or to basic members for a small one-off fee.

* existing full members can access the audit tool via ‘Check for Updates’ from within the CHART software tool

Please contact PRIMIS if you are not a full Hub member but want to know more about obtaining the ‘Flu Recall audit tool by email#

click link below

Further Information: LINK TO PRIMIS


10/10/2013 CQC inspections uncover minority of GPs providing 'shocking' care

Story from PULSE

Most GP practices are passing their CQC inspections, but as many as a third are failing inspections based on one standard and a small number are providing ‘shocking’ care, according to the latest data from the regulator.

The figures, obtained by Pulse, show that although the majority of practices are compliant against the CQC’s essential standards, there are a handful of areas where a signficant proportion have failed inspections.

It comes as one LMC reported that ‘aggressive’ CQC inspectors and ‘stressful’ inspections have led to it setting up a liaison service for practices

So far there have been a total of 586 GP practice inspections across 580 locations since April, with the CQC selecting a number of outcomes to measure practices against during each inspection.

To date a third of the 104 practices inspected on the CQC’s standard for requirements relating to workers have been found to be non-compliant, while a fifth of the 139 practices inspected for cleanliness and infection control were non-compliant.

Some 15% of the 108 practices inspected against the outcome on management of medicines were non-compliant, and on safety and suitability of premises 13 out of 76 practices inspected were deemed to be below par.

One in 10 of the 270 practices checked for their processes for assessing and monitoring the quality of service provision were not up to scratch.

CQC leaders insisted that overall GP practices were providing ‘excellent’ care and pointed out that some of the first practices to be inspected where those where concerns had been raised by NHS England, while others had declared non-compliance and failed to produce action plans to rectify the situation.
But Professor Steve Field, who was appointed as chief inspector to oversee the regulation of GP practices last month, also warned that CQC inspections that had taken place since April had thrown up examples of poor care that he would ‘not tolerate’.

In an interview with the BBC earlier this week, Professor Field said: ‘Most general practice in England is very good but we’ve conducted 586 inspections so far and unfortunately a very small number of practices are providing shocking care. We want to make sure wherever you live in England you have the best GP care possible.’

‘We found practices not monitoring fridge temperatures for vaccines. If you’ve got vaccines for children in a fridge, it might be only a few practices but that’s hundreds of patients. This is a really obvious one because if you don’t monitor fridge temperature then the vaccine won’t work, the children won’t be immune.’

‘There are some surgeries we’ve found that aren’t supporting the people who work in the surgery, they’re not checking their references when they join, they’re not providing them with professional development. We’ve found also some out-of-date drugs. I must stress this is a minority. But a minority, because GPs have 1,800 patients on each list, can affect a lot of people. And I’m not going to tolerate it.’

He added: ‘Already we’ve found some practices and we’ve given seven warning letters in one practice. We have powers to close them down straight away. We’re talking about a tiny number, but it is quite amazing.’

Recently the CQC named and shamed its first practice. Pulse has already reported that two practices have launched legal proceedings to fight closure notices from the CQC, and another practice was closed by its local area team having failed to meet the regulator’s premises standards.
But Professor Nigel Sparrow, professional advisor for primary care for the CQC, said the inspections carried out so far were ‘really encouraging’ as the most risky practices had been inspected first.

He said: ‘We have seen some excellent practice. The figures of compliance are as expected in that the first practices that we inspected included 140 practices where concerns had been raised by NHS England Area Teams and also practices that had declared non-compliance but did not produce action plans to achieve compliance.

He added: ‘We have visited practices on the basis of data relating to QOF and patient surveys. We have also visited practices that have been selected randomly. We want to celebrate the good practice that we see as well as highlighting where improvements are needed. A large proportion of the visits have included a GP, practice nurse or practice manager and we are actively recruiting clinicians to accompany inspectors on visits.’

However the figures for the total number of GP practice inspections in the first six months of the financial year suggest the regulator is behind in its inspection schedule. A spokesperson for the CQC said it hoped to inspect approximately 20% of GP providers by April 2014; 1,513 of the 7,563 primary medical service providers registered in April, though new providers could have registered since then. The 580 locations inspected so far represent just 7.7% of the total.

In August, the CQC admitted it was drafting in additional inspectors and authorising staff to work overtime to clear the backlog.

Meanwhile Norfolk and Waveney LMC has begun to offer an LMC liaison service to every practice being inspected, following reports in the LMC’s September newsletter of reports of ‘aggressive CQC inspectors’.

Dr Tim Morton, chair of Norfolk and Waveney LMC, told Pulse: ‘There have been occasions where an inspector has been over-zealous. We’ve offered all practices LMC observers if they wish. It’s still at the early stage of inspections where inspectors are finding their feet as well as practices.’

‘Some of the reports of what inspectors have been asking were not understood and the inspectors didn’t take kindly to being asked for clarification. The wording of what they were requesting and their attitude was not what practices were expecting.’

‘We’ve done a lot of work with the CQC and they said “it won’t be aggressive - it’ll be about pointing out ways of improving” but it wasn’t quite like the friendly inspection they made out. It was a stressful and traumatic day.’

‘Saying that, they’ve all passed - so no difficulties there. And we do have an excellent relationship with CQC management team.’

Responding to this complaint, a CQC spokesperson said: ‘CQC is committed to driving improvement in services and as part of this, our inspectors may have to ask questions of providers to ensure the national standards are being met.’

He added: ‘CQC has a robust internal complaints procedure. We welcome feedback and will respond to concerns.’



09/10/2013 DH finalises CSC deal

From EHealth Insider

CSC and the Department of Health have signed a revised contract for the North, Midlands and East that the DH says will save the NHS another £22m.

The move marks the end of the long saga of talks between the department and the company over the future of its local service provider deal for the three clusters.

Under the National Programme for IT, CSC was contracted to deliver 'strategic' electronic patient record systems to the NME, but it has struggled to roll-out the Lorenzo EPR that was initially developed by iSoft.

In September 2012, the two parties signed an interim agreement that removed CSC’s exclusive rights to provide IT systems to the NME, in return for compensation from the DH, and an agreement from CSC not to pursue legal action.

The deal also made some central funding available for up to 22 trusts that may still want to take the system. So far, eight have agreed to do so.

The final contract, which was signed last week, has brought together the three original NPfIT contracts and the interim agreement into one contract.

It also underlines that CSC will no longer get paid if trusts decide not to take the company’s products.

The DH says it has already saved £1 billion on the CSC contract, but that the new deal will save another £22m by reducing the value of the contract and by only paying CSC for what it delivers.

In a statement, the company said: "CSC and NHS have signed an agreement that finalises the fundamental arrangements put in place in August 2012, reaffirming the foundation that enables hospital trusts throughout England to adopt the Lorenzo EPR.

"The new agreement does not contain any changes to budget or scope but does provide NHS hospital trusts that choose to take the system with greater flexibility, while helping to reduce administrative complexity.

"Three hospital trusts are already successfully running their day-to-day operations using the Lorenzo electronic patient record system, and six additional trusts have selected the system since August 2012."

The deal provides central funding for software and deployment costs to trusts wanting to take the EPR, if they can provide a robust business case.

Tim Donohoe, the senior responsible owner for the LSP programmes at the DH, told the Public Accounts Committee earlier this year that he estimated the lifetime cost of the CSC deal to be £2.2 billion.

EHI reported earlier this week that Tameside Hospital NHS Foundation Trust has become the first to go-live with Lorenzo since the interim agreement was signed.

The next trust due to go-live is Derby Hospitals NHS Foundation Trust, which recently delayed its deployment until March next year.

The three trusts using Lorenzo from the NPfIT era are University Hospitals of Morecambe Bay NHS Foundation Trust, Birmingham Women's NHS Foundation Trust, and Humber NHS Foundation Trust.

Humber replaced Pennine Care NHS Foundation Trust as the mental health 'early adopter' of the system, after Pennine pulled out of the programme in April 2011; triggering the contract talks that have just concluded



08/10/2013 extractions on hold

Taken from e Health Insider

Extractions of GP data for have been halted while issues around patient awareness of the scheme are resolved.

Representatives from NHS England and the Information Commissioner's Office presented on in what was, at times, a tense session at the Emis National User Group conference in Nottingham yesterday.

The programme will take a monthly dataset from practices covering patient demographics, events, referrals and prescriptions.

This will be linked with Hospital Episode Statistics and other data-sets to create new Care Episode Statistics.

GPs received a letter in late August explaining and telling them that they have eight weeks to inform their patients about the scheme before extractions begin. Patients can opt out of the extracts via a Read code in their record.

However, GPs at the NUG said most patients will not be in their surgery within that eight week time period.

They were therefore concerned about their ability to fulfil their obligations under the Data Protection Act to make sure that patients are properly informed about their confidential information leaving the practice in identifiable form.

Emis users said the current publicity campaign, which involves posters and leaflets in practices, is not adequate.

Many argued that NHS England should write to all patients about the scheme as they were required to do for the Summary Care Record service.

ICO lead policy officer Lynne Shackley acknowledged the issues, saying the ICO is working with NHS England on a national communications plan about the programme and all extractions are on hold until that is finalised.

One doctor advocated a mass opt-out of until patients explicitly give consent for their data to be used. The suggestion received a round of applause.

Rachel Merrett, who leads the workstream of NHS England’s information governance taskforce, said that would be a breach of their responsibilities under the Health and Social Care Act 2012.

She said she hoped the new communication plan being worked on with the ICO, would alleviate many of the GPs' concerns. She could not give a date for when extractions would begin.

"We are going to be making further information available about awareness raising plans regionally and nationally.

"The eight weeks is a minimum time for fair processing and in reality it's going to be longer and you will be notified before any extractions," she told the audience.

Attendees felt they were being put in an impossible position, whereby in one instance they will in breach of the HSCA and in the other in breach of the DPA.

Shackley confirmed that simply putting up some posters and having leaflets available in the surgery would not be considered "fair processing" under the DPA.

In response to a questions about how to deal with patients with a particular concern about data privacy, the speakers advocated writing to them individually to explain the scheme.

When a GP asked who should bear the cost of informing patients, Shackley responded that practices should consider this as one of a variety of costs they bear in order to comply with the law.

"The consequences of getting something like this wrong don't bear thinking about; the reputational issues would be extremely significant in terms of public trust and for that reason we are very keen to keep working with NHS England," she said.

Co-founder of QResearch and Emis user Professor Julia Hippisley-Cox said the data set being extracted will not be high quality unless it includes historical data.

Current plans are to only extract data entered since April this year. Professor Hippisley-Cox advocated a much larger extract, but said this should be pseudonymised at source, which would negate all the issues around the need to inform patients.

NHS England chief data officer Geraint Lewis said he is hungry for a wider dataset and NHS England will be making further requests in a phased process to expand the extract.

He also revealed that NHS England has asked the Health and Social Care Information Centre to review the possibility of pseudonymising at source, but said experts have told him that systems are not currently in place that would enable that across the necessary care settings.

Also, that the quality of data would not be good enough to allow it to be reliably linked with other datasets. "This is something I have got an open mind about, I can see the attractions articulated," he said.

Further Information: Link to Ehealth story and more


06/10/2013 Hunt's 'radical' GP overhaul sets scene for contract clash

GP contract talks for 2014/15 look set to become a battle to avoid a further contract imposition after BMA and RCGP leaders hit out at DH reform plans.

One GPC negotiator warned plans to make named GPs responsible for patients' health and social care around the clock were ‘unworkable’ and based on a ‘1950s view of general practice’.

Health secretary Jeremy Hunt warned in a speech at The King’s Fund think tank on Thursday that the NHS would become unaffordable without ‘bold and radical’ changes to care outside hospital.

He set out plans that could hand back out-of-hours duty to practices, called for a ‘dramatic simplification’ of targets and incentives for GPs, and pledged to shift hospital savings ‘back into general practice to pay for higher levels of care’.

Same-day access to GPs could also feature in the overhaul, after NHS England medical director Sir Bruce Keogh revealed this was a theme emerging in his urgent care review.

Full detail of how the proposals will be implemented will be worked out in negotiations later this year, Mr Hunt said. But the health secretary said he was confident the changes would be in place by April 2014.

Although senior GPs at the National Association of Primary Care, NHS Alliance and Family Doctor Association welcomed the government’s efforts to help patients have ‘a personal and continuing relationship with a named GP’, both the RCGP and BMA have criticised the plans.

GPC negotiator Dr Dean Marshall hit out at the lack of detail in the proposals, and urged ministers to stop announcing policy without talking to the profession's representatives.

‘GPC is the only representative body of GPs,' he said. ‘If anything is going to be discussed with the profession, we are the body. If they involved us in the planning stage we might be able to stop them making statements they can’t actually back up.’




06/10/2013 A third of A&Es to access GP patient records by end of 2014

A third of A&Es and a third of NHS 111 call centres will be able to access GP patient records by the end of next year, health secretary Jeremy Hunt has said.

Mr Hunt launched the government’s response to April’s Information Governance Review report led by Dame Fiona Caldicott, at Moorfields Eye Hospital NHS Foundation Trust in central London, today.

Mr Hunt said that clinicians should ask patients to view GP patient records but said that in emergencies this can be overridden, if it is in the best interest of patients.

The health secretary said that any patient who does not want to have their personal data from their GP record shared with the Health and Social Care Information Centre (HSCIC), will be able to veto it. But patients cannot object to their anonymised data being collected from their GP patient records, by the HSCIC.

In its response, the government warned that practices with ‘an abnormal number of objections’ face being investigated by the BMA and NHS England.

NHS England is leading on Mr Hunt’s pledge to ensure patients have electronic access to their GP records by 2015. The DH said it will work with ‘partner organisations’ to consider how this is ‘might’ be extended to care records outside the NHS.

The DH’s response reads: ‘The DH will work with the professional regulators to investigate professionals who have undermined patient care by failing to share information effectively, and with defence unions to support professionals who share information in keeping with the standards and good practice contained in the review.’

In her report Dame Fiona recommended an audit trail so that patients can see who has accessed their records. The government said it will decide by the end of this financial year how best to achieve this. It has stated that this could include investing in ‘breach detection tools’ instead of creating a ‘viewable audit trail’.

Mr Hunt said: ‘I am expecting around a third of A&Es will be able to access GP patient records by the end of next year. And around a third of 111 call centres will be able to do so as well.

‘People will have to cross lots of bridges in order to make those kinds of changes happen.

‘As part of the chancellor's announcement of the £3.8bn joint NHS and social care fund, which will come in, in 2015, proper electronic data sharing based on the NHS number is a condition of accessing that funding.




06/10/2013 CQC fees for GPs to rise from April


CQC registration fees for GP practices are set to rise 2.5% in 2014/15, but could double in the coming years as the regulator seeks to recover its operating costs in full from the profession.

Registration for 2013/14, worth up to £850 a practice, recouped only half of the amount the CQC estimated it would cost to regulate primary care.

The regulator has launched a consultation on hiking the fees by 2.5% next year and confirmed plans to raise fees further in future to recover the full cost of regulating general practice from GPs.

This month the CQC's first chief inspector of primary care, Professor Steve Field, began his post on a salary of up to £175,000.

Professor Field said that his inspection teams with be ‘loaded with GPs’, with inspection pilots beginning in December.

GPC deputy chairman Dr Richard Vautrey said any registration fee rise was unacceptable.

‘There is no justification for a rise when general practice is facing unfunded rising expenses that are leading to resource cuts,' he said.

‘GPs will be angry but not surprised that yet again they are expected to foot an even bigger bill to pay for being regulated and at the same time have to cope with the extra workload that regulation brings.

‘The threatening comments GPs will have heard about CQC's approach to GP inspections, and the uncritical support CQC have offered to political pronouncements about things such as opening 8-8 seven days a week, a policy which could undermine the quality of care if current services are spread more thinly, will not fill GPs with confidence that CQC independence will make any material difference.’

The CQC will be given statutory independence ‘so ministers can never again lean on it to suppress bad news’, health secretary Jeremy Hunt announced this week at the Conservative party conference in Manchester.

The new powers would mean that the CQC would no longer have to receive the health secretary’s approval to carry out an investigation into a hospital or care home. It will also remove the health secretary’s power to direct the CQC on the content of its annual report.





Further Information: MIMS



Taken from the PCC website


The PAD business rules v26 (CTV3) contain a code X205v for “venous insufficiency of leg” which is not actually related to peripheral arterial disease.

The Health and Social Care Information Centre has advised that this will be removed from the business rules at the next opportunity, ie in version 27 of the business rules.



Taken from the PCC website

Asthma is one of the most challenging long term conditions for patients and the NHS – with the UK having the highest prevalence of asthma in the world. Many children and young people with asthma are still having their daily activities limited and their sleep disturbed. Asthma admissions in children and young people show a 19-fold variation around the country. PCC has produced a good practice guide on asthma in children and young people, which will guide commissioners, service developers and providers on best practice asthma care.

Asthma is one of the most challenging long term conditions for patients and the NHS – with the UK having the highest prevalence of asthma in the world. Many children and young people with asthma are still having their daily activities limited and their sleep disturbed. Asthma admissions in children and young people show a 19-fold variation around the country.

To help improve asthma care, PCC has produced a good practice guide on asthma in children and young people, which will guide commissioners, service developers and providers on best practice asthma care. NICE published the Asthma Quality Standard in February 2013, and this good practice guide builds on that evidence-based guidance. The publication has had input from the major professional bodies and patient groups, as well as health service managers. It sets out the 20 points that good asthma services need to include, and highlights what commissioners can do to drive improved asthma care at each part of the care pathway, with examples of good practice at each step.

This is a partner document to the good practice guide for asthma in adults that was published in 2012.

click link to the PCC website where you can down load the guidance and the guide for Adults

Further Information: Link to the PCC website Asthma Guide


05/09/2013 GP PATIENT SURVEY RESULTS released


The GP patient survey is a detailed survey asking patients about their experiences with GP services and other NHS primary care services. The aggregated 2012/13 results collected during July to September 2012 and January to March 2013 have been published

Click Link below to go to the results page

Further Information: Link to GP results


03/09/2013 GMC forced to apologise after sending 'threatening' revalidation letters to GPs

taken from PULSE

Exclusive The GMC has been forced to apologise after it sent letters to hundreds of GPs threatening removal of their licence to practise - even though many had already submitted all their evidence for revalidation.
LMC leaders say the the tone of the letter - which warned GP in bold letters that their licence to practise was ‘at risk’ - alarmed and upset those who received it, particularly because many had already sent all the required documentation to their responsible officer.

Pulse has learnt that following complaints from LMC leaders about the ‘distressing’ letters, the GMC has apologised and agreed to tighten up its procedures and alter the wording of the letter.

A GMC spokesperson said the letters were generated automatically if a responsible officer had not sent a recommendation within ten days of a GP’s revalidation date. In some cases they were received by GPs whose paperwork was still being processed by their responsible officer.

The GMC was not immediately able to say how many GPs across the country had received the letters, although LMC leaders estimated hundreds had been affected.

One letter sent to GPs in the Thames Valley - obtained by Pulse - said: ‘We have not received a revalidation recommendation. Your license to practise is at risk.’

‘If you have a responsible officer or suitable person you should contact them immediately and ask them to submit their recommendation about you to us.’

GPs in Bedfordshire and Hertfordshire have also complained to their LMC over the letters. Dr Peter Graves, chief executive of Bedfordshire and Hertfordshire LMC, said: ‘The bluntness of the wording was distressing, especially when as far as they were concerned they’d done all the work. They were sent without any prior warning. [The GMC] doesn’t understand it’s very worrying for GPs.’

Dr Simon Poole, GPC representative for Bedfordshire and Hertfordshire said many of the GPs involved received the emails at weekends when they were unable to make contact with their responsible officer to clear up the problem.

Please click the link below to read the full story

Further Information: Link to pulse article


23/08/2013 BMA begins offering private medical insurance to all staff

Taken From Pulse

The BMA has recently begun offering private medical insurance to all its staff as part of a salary exchange scheme, which the body claims does not contradict the association’s support for a publicly funded NHS.

The association says it has introduced a policy by which employees can exchange part of their salary for private medical cover.

A BMA spokesperson said the policy does not result in any costs to the BMA and is an staff member’s individual choice.

They also clarified that the BMA chair Dr Mark Porter, the BMA Council and the GPC are not provided with private health insurance.

The news comes after Pulse first reported in April that the BMA admitted it offers private medical insurance to a small number of ‘very senior staff’ in order to attract suitably experienced employees.

Pulse also revealed that the GMC spent £255,000 on private medical insurance for almost two thirds of its staff this year, after a review of the policy concluded it was needed to attract and retain quality staff.

BMA treasurer Dr Andrew Dearden, a GP in Cardiff, said that the policy was not in opposition to their warnings over opening up the NHS to private companies.

He said: ‘The BMA only offers private medical insurance as part of our remuneration packages to a very small number of the BMA’s most senior staff members.

Further Information: Link to Pulse article


21/08/2013 NICE warns against prescribing paracetamol for osteoarthritis

Taken from Pulse
NICE has warned GPs against prescribing paracetamol for patients with osteoarthritis after its experts said they were ‘extremely concerned’ about the links of higher doses to cardiovascular, gastrointestinal and renal adverse events.

Draft updated guidance on osteoarthritis has warned of the potential side effects of paracetamol and said it has ‘limited benefit’. When used, it should be the ‘lowest effective dose’ for the ‘shortest possible time’ and clinicians should be particularly cautious of using it in combination with an oral NSAID, the guidance added.

Experts welcomed the move but criticised the guidance for not also reviewing the use of opioids, which was a ‘major failing’.

The consultation, due for release in 2014, said: ‘Do not routinely offer paracetamol for the management of osteoarthritis. Be aware of the potential side effects and limited benefit. If prescribing paracetamol, use it at the lowest effective dose for the shortest possible period of time and use cautiously if prescribing in combination with an oral NSAID.’

It added: ‘There is uncertainty about the clinical benefit and risks of side effects when paracetamol is taken intermittently or for the management of exacerbations of osteoarthritis.’

The explanatory section of the guidance said that the guideline development group (GDG) was ‘extremely concerned’ about its links to possible fatal events.

It said: ‘The group were extremely concerned about the very definite trend from observational data linking paracetamol at increasing doses to cardiovascular (fatal/non fatal MI, stroke, heart failure), gastrointestinal (upper and lower) and renal adverse events.

‘The GDG felt that the increase in renal adverse events with long-term cumulative doses of paracetamol particularly would be a surprising finding for most clinicians and wishes to highlight this issue.’

Further Information: Click Link to read full article


20/08/2013 GPs plan trials of seven-day opening to combat A&E crisis

from pulse

Practices in some areas of the north west of England could soon be offering routine appointments seven days a week, under radical plans put forward by GPs to help ease pressure on A&E services.

Under the proposals, some practices in one area would open until 8pm every evening and from 8am to 6pm at weekends.

Triage nurses in some A&E departments would also be able to directly book patients in for GP evening and weekend appointments.

The plans are from two areas that have submitted bids to a gain a share of a £2million pot offered by NHS England Manchester area team to come up with innovative ways to develop integrated services and shift care out of hospitals into the community.

Teams from Radcliffe, Heywood, Middleton, Bolton, Stockport and central Manchester have been told they have won grants, although they are still waiting to hear which parts of their schemes will be funded for the six-month trial.

In Bury, a GP federation has put in a bid for £260,000 of funding to reshape local services, which would include extending the core hours of six practices in Radcliffe, providing routine and planned urgent appointments from 8am to 8pm on Monday to Friday and 8am to 6pm on Saturday and Sunday.

The federation says that the move will improve primary prevention and reduce emergency demand, reducing the number of people attending A&E departments and walk-in centres with minor ailments by 40% in the first six months and 95% within 12 months.

They also hope to deliver a ‘substantial reduction’ in the use of out-of-hours services by patients with minor ailments, and aim to reduce use to zero by the end of 12 months.

The document says: ‘The success of this project will be measured by a range of indicators including the reduction of A&E attendances and unplanned admissions to hospitals for the residents of Radcliffe.’

It adds: ‘The GP federation is currently working with NHS Bury CCG and the local authority to translate these impacts into measurable KPIs which will be translated into a joint outcomes framework across all providers.’

Michelle Armstrong, chief officer for Bury GP Federation, told Pulse the practices were still working out details of how to cover the extended practice hours, but one option could be bringing in additional salaried GPs.

Further Information: Click link for full story


16/08/2013 Shingles vaccination programme

taken from NHS employers site

On 18 March 2013, the Department of Health (DH) announced the changes to the GMS contract for 2013/14. This announcement followed the consultation on proposed changes to the contract that ran from 6 December 2012 to 26 February 2013.

As part of the changes implemented and following a recommendation made by the Joint Committee for Vaccination and Immunisation (JCVI), a new vaccination programme for a new vaccination programme for patients aged 70 years against shingles will be implemented from September 2013.

The Shingles vaccination programme is being introduced through a national enhanced service with an item of service (IOS) fee of £7.63 per vaccinated patient.

For details on the catch-up campaign, please see the Shingles catch-up campaign web page.

For further details on this programme including coding, payment and validation, please see the '2013/14 general medical services (GMS) contract - Guidance and audit requirements for new and amended services.

Additional information can also be found in the tripartite letter and Public Health England's shingles vaccination programme webpages.

Further Information: Please go to NHS employers link below to read more


15/08/2013 Shingles and childhood seasonal influenza vaccination programme FAQs

Taken from the PCC site
NHS Employers, in agreement with the General Practitioners Committee of the BMA and NHS England have published a set of frequently asked questions (FAQs)for the shingles and shingles catch-up vaccination programmes and also for the childhood seasonal influenza vaccination programme.

Further Information: Click Link to go to the PCC site


09/08/2013 Calculating Quality Reporting Service - (CQRS) - Rotavirus

information from CQRS service email

Information about this email communication
• Do I need to read this? There is an important action for GP practices to take if they are participating in the Rotavirus Enhanced Service (ES). For all other stakeholders this email is for information only.
• Why should I read this? To provide you with guidance on how to manually enter your achievement data for Rotavirus.
Briefing Information on Rotavirus ES
• GP practices participating in the Rotavirus ES can now enter their manual data for July.
• Data will need to be entered by 31st August in order for the payment to be received by the end of September.
• GP practices can still continue to declare achievement for the Rotavirus ES after this date however, depending on local arrangements practices may not receive the payment by the end of September.
• For details on how to manually enter data please visit the CQRS Participation and Payment webpage.
• Further guidance, including Read Codes, calculation and payment details on new and amended services can be found on the NHS Employers website:


09/08/2013 QRISK2 Calculator

Taken from QRISK org

Welcome to the QRISK®2-2013 Web Calculator. You can use this calculator to work out your risk of having a heart attack or stroke over the next ten years by answering some simple questions. It is suitable for people who do not already have a diagnosis of heart disease or stroke.

The QRISK®2 algorithm has been developed by doctors and academics working in the UK National Health Service and is based on routinely collected data from many thousands of GPs across the country who have freely contributed data for medical research. It is updated annually each April, refitted to the latest data to remain as accurate as possible.

Whilst QRISK2 has been developed for use in the UK, it is being used internationally. For non-UK use, if the postcode field is left blank the score will be calculated using an average value. Users should note, however, that CVD risk is likely to be under-estimated in patients from deprived areas and over-estimated for patients from affluent areas. All medical decisions need to be taken by a patient in consultation with their doctor. The authors and the sponsors accept no responsibility for clinical use or misuse of these score.

The science underpinning the QRISK®2 equations has been published here:

•Predicting cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2, BMJ 2008;336:1475-82.



08/08/2013 QOF kidney disease definition 'overdiagnoses patients'

Taken from gponline
The definition of chronic kidney disease (CKD) used in the QOF may be over diagnosing thousands of patients and leading to unnecessary treatment, experts have argued.
An internationally adopted definition of CKD, which is used in NICE guidelines and the QOF, identifies one in eight adults in the US as having the disease, according to researchers in Australia.
Yet, studies suggest few patients with moderate disease go on to develop serious illness.
This may be prompting unnecessary and potentially harmful treatment of patients and adding to healthcare costs, the researchers argued in a BMJ analysis.
They called for a review of the current definition, and urged clinicians to be cautious about labelling patients with the disease.
A new framework for defining CKD was introduced in 2002 by the US National Kidney Foundation. This has been amended over the years, most recently in 2012.
NICE uses this framework to define CKD in the QOF. Targets require GPs to hold a register of patients with stage three to five CKD and to keep BP under tight control.
It was hoped that a standardised definition would lead to earlier detection and treatment to slow progression to more serious disease.
However, Ray Moynihan from Bond University in Australia and colleagues said this definition identifies one in eight US adults (14%) as having the disease.
Research has shown less than 1% of people with moderate CKD (stage 3A disease; eGFR 45-59ml/min/1.73m2) under this definition go on to develop end-stage renal disease after eight years.
This suggests thousands of people with moderate CKD may be treated to prevent one case of end-stage disease, the authors said. Caution urged

A study by the University of Cardiff found specialist referrals for CKD had risen 60% in a single trust covering a population of 560,000 people after the CKD QOF targets were introduced.
The authors said: 'The benefits, harms, and costs of testing, monitoring, and treating the increased number of people being identified as having CKD need to be established by prospective studies.

'Meanwhile, the risk of overdiagnosis warrants greater professional scrutiny and more public awareness.'

They added: 'Clinicians should be careful not to apply disease labels to the many older people whose eGFR falls within the definition of CKD but who are at very low risk of developing clinical problems.'

They concluded: 'It is in everyone’s interest to find the best way to maximise prevention of kidney disease and its consequences while minimising the risks and costs of over diagnosis.'

Further Information: Click link to go to GP online and for more stories


05/08/2013 GPs face stricter BP targets in QOF menu for 2014/15

Taken from GPONLINE

NICE's 'menu' of indicators will pass to the GPC and NHS Employers, who will negotiate later this year over which targets should enter next year's GMS contract.

As expected, NICE has proposed stricter BP targets for patients with CHD, stroke or TIA, or peripheral arterial disease.

If adopted, these new goals would see GPs treat patients aged 79 or under to a target of 140/90mmHg or less. This is lower than the current 150/90mmHg goal and in line with existing targets for hypertensive patients.

The menu includes a target to use ambulatory BP monitoring to confirm a diagnosis of hypertension, despite concerns that buying enough devices may prove expensive for practices. Home BP monitoring has also been added as an option following discussions among NICE's QOF advisory committee.

Another new target would expect GPs to ensure patients with dementia have been referred to a memory service up to 12 months before their diagnosis. However, a GP investigation recently found huge waiting times at memory services across England.

A proposed indicator would require GPs to keep details of a named carer on the records of patients with dementia.

There is also a new target for advice about pregnancy, conception and contraception for patients with diabetes.

To read full story and possible new indicators, please click the link below NB you may need a log in

Further Information: Link to GPONLINE full story and further links


26/07/2013 CQRS- Learning Disabilities

Item from CQRS information

Learning Disabilities Enhanced Service manual data entry date- A number of GP practices have raised the concern that they may not be able to manually enter the data for the Learning Disabilities Enhanced Service (ES) by 31 July.
We are aware that manual data entry is not available for a number of GP practices once they have participated in the Learning Disabilities ES due to a known system issue; this is expected to be resolved so users can manually enter data by Tuesday 30 July. We will update you once this issue has been resolved.
We want to reassure GP practices that data can continue to be manually entered on CQRS after 31 July for the Learning Disabilities ES and up until the point where achievement has been declared and approved by the Area Team.
Further information on how to input manual data can be found on the Participation and Payment webpage.

Declaring achievements
CQRS is currently experiencing an issue with achievement declarations resulting in GP practices being required to declare the achievement a second time.
To avoid this issue we recommend that practices wait one day after receiving their achievement declaration notification before starting the declaration process.

MMR catch-up Enhanced Service
CQRS will support the MMR catch-up vaccination programme from August. The specification and additional information on the MMR catch-up vaccination programme is available on the NHS Employers website.
NHS Employers will publish further guidance on the GPES extraction including read codes and payment and validation using CQRS shortly.

QMAS closedown
QMAS is currently available in read only format until 31 July when it will close down.
Historic QOF data for the years 2008/9 to 2011/12 has been migrated and can be viewed within CQRS. Data for 2012/13 is due to be migrated in August. From 31 July until the data is migrated the 2012/13 data will not be available.
If you need to access this data you can run reports and download it from QMAS before 8pm 31 July.

General Practice Extraction Service training
It is anticipated that GPES will start data extractions for CQRS from the end of August.
All GP practices need to complete the GPES training to ensure they understand how to participate in these data extractions.
Everything you need to know about the training, what you need to do, what you will learn, a link to the GPES training module, materials and other useful information is available on the GPES training web page with additional support from your GP system supplier.

If you experience any issues while using CQRS please contact the service desk via email: or phone 0800 440 2777 Monday to Friday 08:00 to 18:00.

Further Information: Click link to go to CQRS info site


26/07/2013 You can now register for the GPES training via their website

News from HCSIS GPES pages

You can now register for the GPES training. To get the most from the training, we recommend you complete the following steps:
Read the GPES Familiarisation pack. This pack has been designed to give you an overview of GPES including why it has been developed and what it means to your practice and patients
Register for the training. Go to You may be asked to accept an security certificate in order to open the registration page, depending on how up to date your browser software is
Print off a copy of the User Guide. This will provide in-depth information to refer to once you have completed the training
Print off the Quick Reference Guide. This guide will give you a brief overview you can refer to as an aid during your first few extraction requests
Complete the training. Practices will be informed when they can start their GPES training once the initial test sites have been completed. We recommend that the training is completed by anyone in the practice who manages the GP clinical system. The training should take around 30 minutes

Your GP system supplier will also provide support and guidance for submitting your QOF data via GPES for 2013/14.

Further Information: Link to GPES training pages


26/07/2013 CQRS Training available on the HSCIC site


It is important that GP practices undertake training to learn how CQRS works and what is required so that they continue to receive accurate payments throughout the financial year.
Training can be completed by logging onto the Learning Management System (LMS) and accessing the CQRS training modules.

You will need to use an N3 connection to access the LMS.

To access the LMS, use the link

CQRS training environment

All the training materials for CQRS, interactive simulations, job aids and other key resources are available via the CQRS online training environment within the LMS.

This information will also be accessible via the help icons and links to the LMS within CQRS.

The LMS is accessible 24 hours a day, seven days a week to the entire CQRS user population from any location in England, (provided that users have access to an N3 connection).




To download the new Business Ruleset V26 please go to

NB The Asthma code that were removed for V25 have now been added back into the indicator in V26.

Clinical systems will be updated to reflect this in due course.

Further Information: link to PCC rulesets


31/05/2013 Quick QOF tips, 2013-4: Hypertension (HYP), blood pressure and the GPPAQ

From Pulse

Dr Simon Clay explains the 2013/14 changes to hypertension, blood pressure and the GPPAQ

The hypertension requirements have changed considerably for QOF 2013-14.

Firstly, the entire ruleset is re-named – now being called ‘hypertension’ rather than ‘blood pressure’. There is, however, a new set of business rules called ‘blood pressure’ dealing with screening for hypertension.

Secondly, a new two-tier target for blood pressure targets has been introduced. So there are two new indicators:

- HYP002 (previously BP5). This requires the patient’s BP to be ≤ 150/90. There are only 10 points available for this now, with target thresholds of 44-84%.

- HYP003 (new). This requires that in those hypertensives aged <80, their last BP should be ≤ 140/90 from July each year. Target thresholds are 40-80% with 50 points available.

Thirdly, a further new indicator is introduced: HYP004.

This requires all hypertensive patients aged 16-74 to have annual assessment of physical activity using GPPAQ (General Practice Physical Activity Questionnaire). Five points are available with thresholds of 40-90%.

This questionnaire of a patient’s activity levels was developed by NICE in 2006. They’ve introduced it into the QOF – requiring GP’s to apply it to all their target patients, despite the fact that of the 7 questions, only the first three have been validated as being of any predictive value so the patient’s answers to the last four questions are ignored in the final calculation.1

GPPAQ posts seven questions:

1 How much work the patient’s job requires

2 How many hours of sport they do per week

3 How many hours of cycling they do per week

4 How many hours of walking,

5 Housework and

6 Gardening is done, and

7 Their usual walking speed

The questionnaire can be used on

Based on the patient’s first three answers, they are categorised into one of the following activity levels:

1 Inactive – e.g. sedentary job and no physical exercise or cycling

2 Moderately inactive – e.g. sedentary job and some but less than one hour of physical exercise and/or cycling per week

3 Moderately active – e.g. a standing job and some but less than one hour of physical exercise and/or cycling per week

4 Active – e.g. a physical job and some but less than one hour of physical exercise and/or cycling per week or heavy manual job

Finally, based on the patient’s GPPAQ score, there is a further new indicator: HYP005.

We’re required to ‘encourage’ any patients who score less than ‘active’ to do more exercise by what’s termed ‘brief intervention’. This is described as ‘opportunistic advice, discussion, negotiation or encouragement’. I’m sure GPs will embrace this opportunity wholeheartedly.

This brief intervention has to occur once each QOF year for those hypertensives scoring anything but active aged 16-74. 6 points are available with thresholds of 40-90%.

The valid code to score HYP005 is: 9Oq3. ‘Brief intervention for physical activity completed’.

If the patient tells you what to do with your well-meaning advice, there is an exception code you can use: 8IAv. ‘Brief intervention for physical activity declined’.

The GPPAQ assessment and the brief intervention can be done on the same day now. The original ruleset suggested that they had to be at least a day apart, but this is corrected in version 25.1 of the Ruleset.

Finally, I should say that all the above refers, I’m afraid, only to England. There are varyingly differing requirements for each of the other three U.K. countries: Some have differences in target thresholds, some countries have not introduced the two-tier BP target requirements and some have eschewed the GPPAQ indicator. (Well done, Wales). All details on the precise requirements for each country (based on present information) are available at the link below.

Dr Simon Clay is a GP in Erdington, Birmingham

For details of Dr Clay’s comprehensive QOF Resource disc go to




Further Information: Clcik link to go to Pulse and other stories


31/05/2013 QMAS closedown


All updates to QMAS will be suspended at 8pm on 2 July 2013. From this date QMAS will only be available in 'view only' mode for all users until 31 July 2013. QMAS will close on the 31 July 2013.

Where a GP practice has not declared its achievement for QOF 12/13, and the area team has not approved financial payment on QMAS by the 2 July 2013, they will have to do so manually “off system”. Neither QMAS or CQRS, or their project teams, can support this process after 2 July.

Full details on the QMAS closedown can be found on the QMAS pages on the Health and Social Care Information Centre website.

Further Information: Link To PCC Qmas info


30/05/2013 The June edition of the CQC


CQC strategy for 2013 to 2016
Last week the Department of Health published a joint policy statement to accompany the Care Bill introduced to Parliament on 9 May. The document brings together developments from our strategy for 2013 to 2016 and the Government’s response to the Francis Report to give a broad view of how organisations across health and social care will work together to drive up the quality of care.

click link to go to the website

Further Information: Link To CQC News Update for June


28/05/2013 Six in ten GPs 'could resign' over out-of-hours proposals

Story from Pulse

Six out of ten GPs would consider resigning if the Government forces GPs to take back out-of-hours responsibility, a survey of hundreds of grassroots GPs reveals - and an overwhelming majority believe the GPC should make it clear such proposals are ‘unacceptable’ without waiting for further detail to emerge.
The snapshot poll of almost 450 GPs, seen by Pulse, was commissioned by Bedfordshire and Hertfordshire LMC early last week following press reports trailing health secretary Jeremy Hunt’s speech, in which he suggested that the GP contract would have to be changed to hand back responsibility for patients’ out-of-hours care to general practice.

The survey is the first to examine how GPs could respond to Mr Hunt’s proposed changes, and the strongest indication yet of the depth of feeling among grassroots doctors. It follows a stormy debate at the LMCs conference on Friday, where delegates voted against a motion calling for out-of-hours responsibility to be transferred back to GPs but stopped short of formulating a response on behalf of the profession.

The chief executive of Bedfordshire and Hertfordshire LMC, Dr Peter Graves, told Pulse that the survey’s findings were particularly alarming because 67% of respondents said they were at the start or in the middle of their career.

The survey asked the question: ‘If the Government imposes a change on GP surgeries so that they have to stay open and have responsibility for out of hours, how would you respond?’

Of the 397 respondents who answered that question, 63% said they would resign or retire. A further 36% said they would ‘accept the change unwillingly’, while just seven GPs said they would welcome the change.

There was also an overwhelming majority of GPs - 85% - who said the GPC should make it clear that Mr Hunt’s proposals were ‘unacceptable to GPs’ even before any further detail is revealed.

Dr Jeremy Cox, a member of Bedfordshire and Hertfordshire LMC, said: ‘The survey response was quite remarkable. We have never seen anything like the torrent of responses.’

‘There was a huge amount of emotive stuff about how this made them feel…. Grassroots GPs just don’t want this to happen. They’ll walk.’

‘The young GPs said they would go to other specialties. It’s really upsetting. One young GP said she was at the end of the tether. This would finish her off – she’d leave.’

For full story and links to others click the link below

Further Information: Link to Pulse story


28/05/2013 Part 2 CQRS training now available for GP practices

Taken From PCC

Registration is now open for the second part of CQRS training. Sessions will run for four weeks from 29 May.

The sessions will focus on:
•What is needed to prepare for CQRS go-live
•What GP practices need to do to participate in the DES
•How to input achievement data for any payments eg DES, QOF
•How to run reports
•How to declare an achievement for payment.

Places are limited to one user per practice.

Phase two training booking for CQRS CQRS will go live early June to support the Learning Disability DES and soon after, practices will be able to access data for QOF 2013/14. It is important that GP practices undertake phase two training to learn how CQRS works and what is required to ensure that practices continue to receive accurate payments throughout the financial year. Phase two training sessions will run from the 29 May to the 26 June and are bookable via the CQRS Learning Management System (LMS). Following on from phase one training, which took place in February this year, this second phase consists of two webinar training sessions and will also use interactive simulations to mimic the service. These sessions will be hosted by a facilitator and users will be able to interact and ask questions. The sessions will focus on: What is needed to prepare for CQRS go live What GP practice need to do to participate in the DES How to input achievement data for any payments e.g. DES, QOF How to run reports How to declare an achievement for payment. The June go live has been chosen, in consultation with users, so the service is available to support the calculation of payments for the Learning Disability DES from the end June 2013.

Further Information: Click the link below to go to the PCC site and the link to register


27/05/2013 Welsh Government to prioritise MMR vaccinations for young children

Story from Pulse

The Welsh Government will prioritise MMR vaccinations of children up to four years of age, it has revealed in its programme for the coming year.

This follows the recent measles outbreak in Swansea, which led to more than 1,000 people contracting the disease, with more than 10,000 young people between the ages of 10 and 18 found to be unvaccinated.

The Welsh Government’s NHS Delivery Framework, published last week, said it is aiming for a 95% vaccination of all children up to four years of age.

It has also prioritised improving dignity in care through patient experience surveys and spot checks carried out by the independent health watchdog to assess improvements, it said.

The Welsh Government will also concentrate on improving ambulance response times, patient waiting times in A&E Departments and access to planned care and further reducing emergency hospital admissions through closer working between the NHS and social care agencies.

NHS Wales chief executive David Sissling said: ‘During the course of the next few months we will be looking to further improve our targets.

‘We will be working with our staff, stakeholders and service users to ensure we are monitoring and measuring the things which will really make a difference.’

Further Information: Link to the MMR pulse story


07/05/2013 Primary medical care functions delegated to CCGs

Taken from PCC website

Primary medical care functions delegated to CCGs

NHS England has the power to direct a CCG to exercise any of its functions relating to the provision of primary medical care services. This guidance sets out the arrangements for CCGs to manage, on a transitional basis, local enhanced services for primary medical care and primary ophthalmic services that were commissioned by PCTs, and commission out-of-hours primary medical services for their area.

Link to the Guidance- copy into your address bar

or go to our free download area

Further Information: Link to the PCC website and to further links


07/05/2013 The FRAX® tool

The FRAX® tool has been developed by WHO to evaluate fracture risk of patients. It is based on individual patient models that integrate the risks associated with clinical risk factors as well as bone mineral density (BMD) at the femoral neck.

The FRAX® models have been developed from studying population-based cohorts from Europe, North America, Asia and Australia. In their most sophisticated form, the FRAX® tool is computer-driven and is available on this site. Several simplified paper versions, based on the number of risk factors are also available, and can be downloaded for office use.

The FRAX® algorithms give the 10-year probability of fracture. The output is a 10-year probability of hip fracture and the 10-year probability of a major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture).

Further Information: Link to The FRAX® tool UK


22/04/2013 GP medical defence costs rise to almost £7,000 per year

Story Taken From PULSE

Exclusive GP medical indemnity costs have risen by over four times the rate of inflation in 2013, with an average annual premium of nearly £7,000 for the average GP partner.

Medical defence bodies approached by Pulse provided figures showing current average annual indemnity costs had risen by 13% for partners and 12% for salaried GPs, even though the current rate of inflation is 2.8%.

Medical defence bodies defended the indemnity costs rise, pointing to the rapid rise in the number of legal claims, which according to the Medical Protection Society was up by 40% in 2012.

But they also pointed out that recently enacted legislation clamping down on so-called ‘no win, no fee’ cases should reduce indemnity costs in time.

The rise in indemnity costs is slightly higher than last year when Medical Defence Union fees rose by 11% for salaried GPs and 3% for partners.

The MDU said the average cost of indemnity cover for for an eight-session GP partner in 2013/14 was now £6,975, compared with £6,200 in 2012. For an eight-session salaried GP legal indemnity costs had risen from £6,280 to £5,605.

The Medical Protection Society also said that their rates had risen, but refused to provide historical figures. It currently charges an average of £6,865 for an eight-session GP partner and £6,595 for a salaried GP working eight sessions.

The Medical and Dental Defence Union of Scotland said its current rates were £4,930 for a partner or salaried GP working seven to 10 sessions in England, but it would be reviewing prices in June.

MDU chief executive Dr Christine Tomkins said indemnity costs have continued to rise in order to meet the rising costs of claims.

She said: ‘We opened 15% more medical claims files in 2012 than 2011 and claims inflation is now running at over 10% per year, far exceeding other inflation measures.

‘The MDU is calling for legal change and a national debate in order to address the cost of compensation and its effects on the public interest.

‘Claimants’ legal costs - which in some no-win-no-fee cases are disproportionately high - are another contributing factor to high claims costs.

She added that legal aid reforms - stemming from the official review into civil litigation funding, including conditional fee arrangements -that came into force at the start of April should reduce legal costs in time, but warned: ‘It will take a while to work through to reduced legal costs as there are many cases still in the system under the old procedure rules.’

Further Information: Link to Pulse for story and more links


21/04/2013 Invitation to join NICE Quality and Outcomes Framework Advisory Committee

NICE is seeking new members to join its Quality and Outcomes Framework (QOF) Advisory Committee.

The QOF rewards practices for the provision of quality care and helps standardise improvements in the delivery of clinical care. Practice participation in QOF is voluntary but most practices on General Medical Services (GMS) contracts, as well as many on Personal Medical Services (PMS) contracts, take part in QOF. It was introduced as part of the new GMS contract in 2004

NICE works with the Advisory Committee to develop evidence based clinical and public health indicators for the QOF.

NICE's Public Involvement Programme (PIP) is also currently recruiting separately for additional standing lay members. Please refer to the NICE website for further information.

Committee members are drawn from the NHS, health, public health and social care professionals, patients/service users and academia. They do not represent their organisations but are selected for their expertise, experience of working with multidisciplinary and lay colleagues and understanding of evidence based care.

All QOF Committee members have equal status, which reflects the relevance and importance of their different expertise and experience. All group members need to attend regular meetings and undertake background reading.

Skills and experience

We are looking to appoint a number of standing members for three years (12 months for the trainee)

Please click the link below to go to the NICE website for more information and Skills and Experience required.

Further Information: Link to Nice Website and Full details


10/04/2013 CQC FEES and calculator Information


Every registered provider will pay a single annual fee on the same date each year. This fee will cover all registration and compliance requirements for all locations.

When is my fee due?

You will be invoiced on the same date each year. The date will depend on your specific circumstances, but is usually the anniversary of the date of your registration.

Providers that are new to registration will receive their first annual fee invoice once their registration has been completed and they have received their certificate of registration.

You will be sent your invoice in advance of your payment due date.

How much will my fee be?

You can find out how much your fee will be using the calculator above.

How do I pay my fee?

Full details of how to pay will be outlined in your invoice.

Who do I contact if I have any questions about my fee?

You can contact our National Customer Service Centre if you have any questions about registration fees.


Telephone: 03000 616161

Or you can write to:

CQC National Customer Service Centre
Newcastle upon Tyne

Full details of the scheme for 2013/14, which is applicable from 1 April 2013, are available to download.

Click the link below to go to the CQC website where you will find the Fees, Calculator and various documents to download.

Further Information: Link to the CQC Website


05/04/2013 Practices hit with £850 fee for CQC registration

News Item taken form GPONLINE

GP practices in England will have to pay up to £850 to register with the CQC this year and those with several premises face thousands of pounds of charges, the regulator has revealed.

Practices with multiple premises face thousands of pounds of fees to register with the CQC

Practices operating from a single location will be charged between £550 and £850 depending on list size in 2013/14, the CQC announced on Thursday.

Practices with more than 15,000 patients will pay the maximum £850 fee. Those with fewer than 5,000 patients will pay the minimum of £550, with all other practices paying on a sliding scale.

However, these rates rise quickly for practices with several premises.

A practice working out of two locations will pay a fee of £1,200, while a practice with more than 40 locations will be forced to pay £15,000.

The fees will cover the cost of registration and inspection during 2013/14.

Fees could double next year because the CQC is only seeking to recover half of its costs in the first year of registration.

CQC chief executive David Behan said: ‘We have managed to keep the majority of fees unchanged this year, and introduced fees for GPs who are new to regulation, at 50% of estimated costs on a sliding scale so that small practices pay less than large ones.'

The CQC will run a consultation on next year’s registration fee in September, with next year's fees announced in March 2014.

The GPC has called for NHS England, previously known as the NHS Commissioning Board, to cover the fees.

GPC negotiator Dr Chaand Nagpaul said: ‘It has always been our position that GP practices should not be incurring any additional expense for CQC registration.

‘We have always argued that it should be centrally funded. We believe that it is in iniquitous that practices in England face this extra charge on the back of workload increases and a reduction in contract funding.’

The CQC also revealed that 87% of people responding to its consultation on the fees disagreed with the proposals for charging practices. This included 332 GPs, who made up 81% of respondents.

Responding to the consultation, the CQC said: ‘We recognise the strength of feeling among GPs at the requirement to pay fees.

'We have set fees in line with our approach to other sectors new to regulation, to generate 50% of total expected cost overall, and sought to do so in way that distributes charges fairly.We propose to introduce fees at the levels set out in consultation.

'We will, however, keep options open and seek to work with the sector to consider fees for the future, as well as reviewing and evaluating our costs. In this way, we will demonstrate to the sector that we are taking their concerns into account.’

Link to the CQC web site

Further Information: Click link to go to GPONLINE for story and other links


26/03/2013 GPs to be given legal 'duty of candour' to highlight bad patient care

story from GPONLINE

GPs face a new statutory ‘duty of candour’ to report treatment or care that they believe has caused death or serious injury, says the Department of Health in its official response to the public inquiry into the failures of care at Mid Staffordshire NHS Foundation Trust.

The duty will apply to all all providers registered with the CQC, but the Department of Health said it would look at how how broadly the duty should apply.

Health secretary Jeremy Hunt also said they would explore whether to introduce a new ‘chief inspector of primary care’ to sit alongside chief inspectors for hospitals and care homes, which would act as ‘whistleblower in chief’ for the NHS.

But it stopped short of recommending an Ofsted-style quality rating for indivividual GPs - with ratings of ’inadequate’ to ‘outstanding’ - but the measure will be intrdoduced for hospitals and care homes. Mr Hunt said the ratings could not be entirely ruled out for GPs in the future.

The DH document said: ‘A spirit of candour will be critical to ensuring that problems are identified quickly and dealt with promptly. Openness is a key element of healthy organisational cultures in health.’

It added that while such a contractual duty already exists, it intends to go further and make this a statutory duty.

The document added: ‘We intend to go further and introduce a statutory duty of candour on health and care providers to inform people if they believe treatment or care has caused death or serious injury, and to provide an explanation. We will need to carefully consider the scope of this duty on all providers.’

It comes as the DH also published its revised version of the NHS Constitution today but it said further changes are likely to be consulted on in light of Francis later in the year.

Other actions that may come to be of relevance to GP practices include making nurses subject to revalidation; the CQC adopting a new peer-review model for assessments that will take into account whether patients are being listened to and are treated with dignity and respect; as well as the DH asking the GMC to tighten and speed up its procedures dealing with breaches of conduct.

Click link for full story

Further Information: link to GPONLINE story and more


25/03/2013 NHS Commissioning Board reveals final specifications for new DESs

Story from PULSE

GPs will have to inform their local area team by the 30 June if they are going to take up the various directed enhanced services for 2013/14, the NHS Commissioning Board said as it released the final details of how practices will be paid for the schemes.

The specifications reveal that the risk-profiling DES will provide the single biggest opportunity for a one-off payment for practices, as it will be worth 74p per registered patient, or £5,175 to an average-sized GP practice.

The board said that GPs will be invited by their Local Area Team to take part in the DESs before then end of June, although practices will also have to agree terms of the remote monitoring DES with their CCG before they can take part.

The biggest changes from the draft specifications released last year are to the remote monitoring DES, that was due to be for patients with one long-term condition chosen by the NHS Commissioning Board.

This has been revised so that practices have to agree an a group of patients with their CCG to introduce remote monitoring and register patients to the scheme this year, in preparation for next year, to gain payments of 21p per patient, representing a payment of £1,478 to an average-sized GP practice.

The most controversial DES - for dementia case-finding - will involve practices opportunistically offering an assessment for dementia to ‘at-risk’ patients during routine consultations. They will then have to refer patients for any specialist help needed, offer a care-planning discussion and identify any carers to gain the 37p per registered patient for the DES, representing a payment of £2,587 to an average-sized GP practice

GP practices will also earn separate payments for the online access DES, which incentivises practices to introduce online booking of appointments and online repeat prescribing.

Further Information: Link to the full pulse story and other stories from PULSE


25/03/2013 More than 100 practices set to miss CQC deadline

Taken form GPonline

More than 100 providers of primary medical services have not applied for registration with the CQC, less than a fortnight before the 1 April deadline.

The CQC said that as of 18 March, 114 potential providers had yet to apply for registration, and 46 had submitted applications but had not received their registration certificates.

Of a possible 7,700 eligible organisations 7,586 (98.5%) had submitted applications to the CQC, and 7,400 had received their registration paperwork.

A spokeswoman for the CQC said some of the outstanding providers may not need to register and they were being ‘followed up’ to establish this.

She said other providers may simply be late with their application, and the CQC was trying to determine why they had yet to submit an application.

These practices or other organisations would be ‘supported in making their applications by the required date’, she said.

As long as GP practices and other providers submit an application by 1 April, no action will be taken against them even if they do not receive their certificate before the deadline. In the short term the CQC is likely to work with any organisation that fails to submit an application by 1 April rather than taking immediate action.

The CQC is due to publish the fee level for GP registration in future years later this week. The annual fee could be as much as £1,600 for an average GP practice.

Further Information: clcik link to go to GPONLINE and more stories


23/03/2013 Northern Ireland GPs to block NHS reform in contract protest

Taken from GPONLINE

Northern Ireland GPs will boycott reforms that aim to move work out of hospitals unless ministers scale back GMS contract changes believed to be the 'harshest in the UK'
Details of GMS contract changes for 2013/14 have been finalised in England, Wales and Scotland, but the Northern Ireland health department has yet to confirm the changes it plans to impose.

Northern Ireland GPC chairman Dr Tom Black said that if the government presses ahead with tough GMS contract changes - believed to be the harshest in the UK - GPs will withdraw support for wider reforms.

NHS reform plans launched this week by Northern Ireland health minister Edwin Poots, dubbed Transforming Your Care (TYC), aim to move more work into the community through 'a focus on prevention, earlier interventions, integrated care and promotion of personalised care'.

Dr Black said GPs had supported the reforms 'from the start'. He said: 'We strongly believe this is what our local health service needs.'

But he added: 'TYC represents a huge shift of work from hospitals to general practice, which must be planned, agreed and resourced. We have yet to see the detail as to how this will proceed.

'In the midst of this, minister Poots plans to impose a new contract on GPs the same day as the start of TYC on 1 April 2013.'

Dr Black said the contract proposals outlined by the Northern Ireland government had not been 'negotiated or agreed by GPs' and were the 'harshest seen in the last 30 years'.

click link to read full story

Further Information: link to full story on GPONLINE


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