Optimising QOF/enhanced services (direct, national, local)

So once you have sorted out your registers, you need to optimise your QOF annual achievement. Again, practices are doing a lot of work recalling and reviewing patients on disease registers but are not reaping the rewards of their hard work –

  • Use of non QOF recognised codes – there are thousands of read codes to choose from, using codes not included in the QOF rule sets will not count towards achievement. We will identify/advise on the use of non-QOF recognised coding and train all members of the practice team, both clinical and non-clinical, to maximise income and patient care
  • Incorrect use of episodes – using incorrect episodes can omit patients from QOF registers, resulting in patient reviews being carried out but not rewarded.
  • Inadequate recall systems – A robust recall & reminder system and identifying patients on multiple registers to send one letter for multiple conditions is a must have for all practices – whilst these take time to set up, a robust system will save you hours of work in the long-term and will ensure you fulfil your contractual requirements for all patients on your QOF disease registers. The average practice will have in the region of 2,500 patients on QOF registers – 7,500 letters per year which is more than 600 letters per month. Identifying patients on multiple registers.
  • Understanding exception codes and when it is appropriate to use/not use
  • What are resolved/remission codes and when it is appropriate to use them
  • Maximising claims for enhanced services – setting up robust processes for maximising enhanced service income, such as data entry templates/guidelines, identifying non-approved ES coding, creating target groups for resource management and searches and reports to ensure all services are claimed for

Insight consultants are all experts in QOF and enhanced services – this is a major income source for your business. To gain maximum return from any training/consultancy investment, knowing how your clinical system works is just not enough, knowing what you need it for as well is a must. For our consultants, each day working in practice is different – many practices just want us to identify areas for improvement; a small change can make a significant difference, to both workload and income. Other practices want us to train staff on identifying improvements. Either way, as long as we know what is important to primary care we can deliver exceptional solutions to pay for your investment over and over again.

I invite a consultant to attend the Practice on an annual basis to review our templates to ensure they are accurate for the oncoming financial year.  Reports (searches) are also created so that we can proceed each year with the knowledge that we have cleaned up our patient data. We certainly do not want to be doing the work and not claiming for it! Insight’s consultants are highly professional, they solve my issues immediately, their explanation has always been clear, concise and easy to understand and I would highly recommend them. Joanne, Assistant Practice Manager, West Sussex

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