222 QI Answers to Your Quite Ingenious Questions: More of Your Questions Answered by the QI Elves

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Each series of QI is themed around a letter. The Christmas special from Series P will air at 10pm on Tuesday 18 December (with the XL edition to follow at 10:30pm on Saturday 29 December) and is pub-themed with questions covering pints, pies and pool tables. There are similar time sensitive indicators for follow up after a diagnosis of depression or cancer, and another for referral to a diabetes education programme. The diagnosis may have occurred during the 2021-22 ‘protected’ QOF year, which means the deadline for follow up of individual patients may be approaching. The actual timescales vary from 56 days for a depression review to three and 12 months for the cancer review. Diabetes education referral should be within nine months of the date of diagnosis. That is not to say that practices haven’t been active delivering routine care over the last couple of years. There is plenty of evidence to show that chronic disease monitoring and treatment has continued all through the pandemic.

Two areas that require action within six months of diagnosis are asthma (AST006) and heart failure (HF005). For the former, there should be confirmatory spirometry and one other objective test in that timescale. For heart failure, this should involve an echocardiogram, or at a minimum, a referral for one. Crucially, these apply to all patients who were diagnosed after the 1st of April 2021. This means that, although these indicators were nominally suspended last year, your achievement during 2021-22 will still count towards this and subsequent year’s QOF. The second QI area, optimising access to primary care, has the same general structure. In this case most of the suggestions are around monitoring demand for appointments and how efficiently the appointments are used. The monitoring and auditing can be done by non-clinical staff although patient facing staff should be involved in plans to remodel services. Compiled by James Harkin, Anne Miller, John Lloyd and John Mitchinson Competition: How fabulous are your facts?Most indicators have been based on data from the end of the QOF year. It is normally possible to work through the year and then have a ‘tidy up’ right at the end.

During the Second World War, Foyle’s bookshop bomb-proofed itself by covering the roof with copies of Mein Kampf. There is detailed guidance and suggested actions in the QOF documentation. For prescription drug dependency, the priorities are around the prescribing of opiates, gabapentinoids, benzodiazepines and Z-drugs – particularly when they are used over long periods. There should be a baseline audit of prescribing and drug monitoring, followed by a review of the audit results in a meeting with the rest of your PCN, and then an action plan. After implementation of the action plan there should then be a further PCN meeting which, the guidance says, should be focused on ‘celebrating success’, although do remember that this is a business meeting! The Elves are currently in research mode for next year’s Series Q so are quietly working their way through books about quails, Quebec and quadratic equations. Closely monitor indicators that are time sensitive and require follow-ups after a set time period after a diagnosis. These are in relation to depression, cancer and diabetes.Don’t be misled by the wording used for these indicators suggesting that only patients who are diagnosed in the current QOF year are included. This is not accurate – it is the date of the review or referral deadline that needs to be in the current QOF year, instead. On a slightly brighter note, any failure to achieve these indicators will only affect one year rather than every subsequent year, as happens with investigation indicators discussed above. There are no new indicators in QOF for this year and no significant changes to the existing ones. There have, however, been appreciable changes over the last couple of years that have never been fully implemented. Paddington Bear wears a hat when swimming because Michael Bond’s father always did, in case he needed to raise it politely.