New General Medical Services Contract.docx

New General Medical Services Contract.docx

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NewGeneralMedicalServicesContract

NewGeneralMedicalServicesContract

SpecificationfortheProvisionofanEnhancedService

SERVICE

REFERENCE

VascularRiskAssessmentandManagementProgramme（NHSHealthCheck）2009/10

usingasystematicsearchstrategytoproritisepatientsforprimaryprevention

LES37

May09

ThisEnhancedServicespecificationcomplementstheworkinvolvedinthePBCLifestylesscheme（wherethefocusisonthehardertoreachpatients）andthenewQOFpoints（fornewlydiagnosedhypertensivepatients）.Itwillruninthisformatfora12monthperiodandbereviewedin2010.

1.EnhancedServices

Allpracticesareexpectedtoprovideessentialandthoseadditionalservicesthattheyarecontractedtoprovidetoalltheirpatients.Thisenhancedservicespecificationoutlinesthemorespecialisedservicestobeprovided.Thespecificationofthisserviceisdesignedtocovertheenhancedaspectsofclinicalcareofthepatient,allofwhicharecurrentlybeyondthescopeofessentialservices.Nopartofthespecificationbycommission,omissionorimplicationdefinesorredefinesessentialoradditionalservices.ThePCTreservestherighttoamendorwithdrawthisenhancedservice.

2.Introduction

ThespecificationfortheprovisionofaLocalEnhancedService（LES）fortheprimarypreventionofcardiovasculardiseasewaslastupdatedinNovember2007.Sincethenthreeimportantpublicationshavebeenreleased:

oTheHandbookforVascularRiskAssessment,RiskReductionandRiskManagement–areportpreparedfortheUKNationalScreeningCommitteebyagroupworkingfromtheUniversityofLeicester.（March2008）http:

//www.screening.nhs.uk/vascular/index.htm

oNICEClinicalGuideline67–CardiovascularRiskAssessmentandLipidModification.（May2008）http:

//www.nice.org.uk/guidance/index.jsp?

action=byID&o=11982

oPuttingPreventionFirst

NHSHealthCheck:

BestPracticeGuidancefortheAssessmentandManagementofVascularRisk（April09）

http:

//www.dh.gov.uk/en/Publicationsandstatistics/Publications/DH_097490

ThispaperintroducestheconceptofNHSHealthCheckspreviouslyreferredtoasCVDchecksorassessments.

ThislatestamendmenttotheLEStakesaccountofthedocumentsaboveandaimstoprovideapreparationyearforthePCTandpracticesbeforefurtherclarityisprovidedonhowanationalNHSHealthcheckcallandrecallprogrammewillwork.

3.ServiceAims:

Tosystematicallyidentifypeopleagedbetween40-74whoareindicatedtobeathighriskofcardiovasculardisease（thatisheartdisease,stroke,diabetesandchronickidneydisease）andofferthemafacetofacefullriskassessment,appropriateadvice,treatmentorreferral.4.Themaincomponentsoftheserviceare:

∙Identificationofpatientswhoseriskshouldbeassessed-throughsystematicsearches（seeAppendix1foranexampleofhowthiscanbetakenforward）.

∙Fullassessmentofriskusingpatientdetails,measurementsandtestsinlinewithBestPracticeGuidance.

∙Useofariskcalculatortoestimatethe10yearriskofcardiovasculardisease（FraminghamhasbeenrecommendedbyDepartmentofHealthalthoughQRisk2isalsobeingconsidered）.

∙Facetofacecommunicationofriskscore-usingpatientdecisionaids.

∙Generalortailoredadviceonmaintaininghealthylifestylestoalllevelsofrisk.

∙Managementofrisk-personalisedinterventionsandortreatmentplansofferedforthesepatients（seeAppendix2foratemplatepatientheldhealthplan）.

∙CodingandpopulationofaCVDRiskRegisterandotherrelevantdiseaseregisters.

ThisLESisnotintendedforthosepeoplewhoalreadyhaveavasculardisease,e.g.peoplewithexistingdiagnosisoftype1ortype2diabetes,heartdisease,stroke,TIA,CKD.Itisassumedthatwhereidentified,thesepeoplewillbeontheappropriatediseaseregistersandreceivingtreatmentasnecessary.

InadditionnewlydiagnosedhypertensivepatientswillbeincentivisedwithnewQOFpointsintroducedforthefirsttimeinApril2009.ThestandardsandguidanceinthisLEScanbeappliedtotheseindividuals,howeverpaymentwillbemadethroughtheQOFroute.

5.Eligibility:

AllGPpracticesareeligibletoprovidethisservicefortheirownpatients.AspartofsignuptotheLESyouwillbeexpectedtonominateapracticelead,developandmaintainaCVDRiskRegisterandparticipateintraining.

6.Payments

ThemajorchangetothisLEShasbeentosimplifythepaymentstructure.ThePCThasagreedwiththePCTandClinicalExecutiveafixedfeeof£26.50foreachNHSHealthCheck.Thisshouldincludeboththeinitialfacetofaceassessmentandfeedbackappointment.IntheapplicationforthisLESpracticesareaskedtoestimateactivitysothatpaymentscanbemadebasedon66%ofthisactivitythroughouttheyear.Afinalaudit（seedetailsinsection8）dueon1stMay2010willthenallowustoreconcilethesepaymentsaccordingly.PleasenotethatNHSHealthChecksundertakenaspartofthePBCLifestylesSchemeornewhypertensivepatientsidentifiedunderQOFshouldnotbeclaimedforunderthisLES.

7.ServiceOutline

7.1HowtoidentifythosepatientswhoseCVDRiskshouldbeassessed

PracticesareencouragedthroughthisLEStouseasystematicapproachtoidentifyinghigh-riskpatients,usingReadcodestosearchtheirpatientdatabasetoidentifyclearly-definedgroupsofpatientswhoshouldthenbeinvitedforassessment.Ifthisisdonegroupbygroup,inastepwisefashion,practicescanpacetheiruseofresourcesandpatientsseeninearliergroupscanbefilteredoutofthesubsequentsearchesandwillnotreceiverepeatinvitationsforassessment.Appendix1providesasearchstrategywhichwillensurethatyourCVDriskregisterisbuiltupinitiallywiththehigherprioritygroups.Fortheyear2009/10thissystematicapproachtopatients“known”tothepracticewillcomplementworkunderthePBCLifestyleSchemewherethefocuswillbeonpatientsin“hardtoreachgroups”.Manypracticesalreadyhavewellestablishedriskregistersandhaveusedavarietyofapproachestosearchforpatientsthatincludesystematicandopportunistic,theformerbeingthemostefficient:

Systematicrecordsbasedapproach–involvesasearchforpatientsagedbetween40and74wherethepracticealreadyholdsrecordeddataonriskfactors/disease.Thiscanbeusedforapreliminaryriskassessmentbeforecallingthoseathigh/borderlineriskinforafullriskassessment–seeAppendix1.OpportunisticapproachcapturingpatientsfromidentifiedprioritygroupswhoseCVDriskshouldbeassessedwhentheyvisitthesurgeryforaGPornurseconsultationorrepeatprescription.Usingthisopportunitytoassesspatientsortobookafutureappointmentforassessment.PatientNotescanbeflaggedtopromptthisapproach.PublicitymaterialdisplayedinclinicalareasforstaffandinwaitingareasforpatientscouldbehelpfulinexplainingwhataCVDcheckis.

7.2InvitingPatientsin

Patientsidentifiedaboveneedtobeinvitedforup-todatetests,wherenecessary,andfacetofacecontactsothatafullriskassessmentorNHSHealthCheck,asitisnowbeingbranded,canbecompletedwithafullexplanationofwhatthismeans.Anationallyrecommendedstandardlettertogetherwithapatientinformationleafletareavailabletodownloadfromhttp:

//www.dh.gov.uk/en/Publicationsandstatistics/Publications/DH_097490Youcanalsoorderhardcopiesoftheinformationleafletfromthislink.

7.3TheNHSHealthCheck

ThepurposeoftheNHSHealthCheckistoidentifyapatient’sriskofcoronaryheart

Disease,stroke,diabetesandkidneydisease;tocommunicatetheirriskeffectively;

andtorecommendinterventionsandlifestylechangestoreducetheirrisk.

TheNHSHealthCheckshouldbecarriedoutfacetoface,andwillrequirepatientstoattendbothforclinicalassessmentandforafeedbacksession.

Patientsshouldbeinvitedtoattendforaninitialassessmentappointmentofaminimumof20minutesduration.

TheinitialassessmentcanbeundertakenbyanymemberoftheclinicalteamaswellasHealthCareAssistants（HCA）qualifiedtoNVQLevel3.TheDepartmentofHealthisplanningtopublishaHCACompetencyFrameworkforNHSHealthChecksandfurtherdetailswillbecirculatedassoonasthesebecomeavailable.

ThecontentofthecheckissetoutinthenationalBestPracticeGuidanceavailableathttp:

//www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_097489. Pages13to26oftheDHguidancespecifythecontentoftheriskassessmentinfull,includingdatadefinitionsfortheCVDriskengine,clinicalguidelinesrelatingtotests/measurementsandtheclinicalthresholdsforadditionaltesting.Thefollowingsectionsbrieflysummarisethecontentofthisguidance,howeverthefullnationalguidanceshouldbeusedtoimplementtheprogrammeingeneralpractice.

Thefollowinginformationshouldberecordedaspartoftheinitialassessment（withasystematicsearchsomeofthismayalreadybeavailable）:

∙Age

∙Gender

∙SmokingStatus

∙PhysicalActivity

∙Ethnicity

∙BodyMassIndex（BMI）

∙Cholesterol（randomnon-fastingcholesteroltest）

∙Systolicanddiastolicbloodpressure（SBP/DBP）

∙Alcoholconsumption（notrequiredforFramingham）

Pleaseensurethefulldata-setrequiredfortheCVDriskengineusedwithinyourpracticeiscollected.

ItisnotanticipatedthatthedeliveryofNHSHealthChecksingeneralpracticewillinvolvenearpatienttesting/pointofcaretestingforcholesterol.IfyouwishtodiscussthisfurtherpleasecontactthePCTprimarycarecommissioningteam.

7.4CVDRiskCalculation

Everypatientattendingforanassessmentshouldhavetheir10-yearriskofcardiovasculardisease