One of the major changes to QOF 2019/20 was the introduction of personalised care adjustments (PCA’s) - exception codes failed to distinguish between patients who were offered care and those who made a choice not to attend, PCA’s have now been split to identify those who choose not to attend (informed dissent) and those who did not respond following a minimum of two invites.
The 5-year GP Contract for Reform detailed all of the QOF changes back in January 2019 - this document also highlighted IT clinical systems removed decision-support prompts (patient alerts) once the patient is recorded as an exception and as a result practices left adding exception codes until the end of year resulting in increased workload and scrutiny. The aim was to reduce the burden of this workload - patients who receive two invites will automatically be taken out of the target (as soon as the 2nd invite code is entered) but the prompts would remain available to support opportunistic care (especially when the codes relate to non-responders).
However, it would appear this detail was not written into the QOF Guidance 2019/20 or v42 business rules, therefore, once you have added the second invite code the patient will be taken out of your QOF target for that disease area and the prompts will disappear. This is less of a problem for SystmOne practices as they will still receive an alert on the patient’s QOF timeline:
We have queried this with NHS Digital (QOF Rules) and explained this will result in:
- massive amounts of extra work for practices checking patients
- patients not being offered opportunistic reviews resulting in less patients actually being reviewed
- practices not coding the 2nd invite letter until the final month of the QOF year leaving us in exactly the same position as previous years
All of which completely defeats the aim of PCA’s.
NHS Digital have responded to say they are querying this with NHS England and as soon as we have a response from them we will update you. However, we suspect this will not be changed in this QOF year, practices will need to check each patient if they want to offer them opportunistic reviews.