Contract Specification: LES - Enhanced COPD Care v12012-13 Final
28/03/2012
LES - Enhanced COPD Care 2012-13
Contract Mechanism and Specification
Introduction
1. All practices are expected to provide essential and those additional services they are contracted to provide to all their patients. This enhanced service specification outlines the more specialised services to be provided. The specification of this service is designed to cover the enhanced aspects of clinical care of the patient, all of which are beyond scope of essential services. No part of the specification by commission, omission or implication defines or redefines essential or additional services.
This specification deals with Primary Care Services to patients with COPD and enhances the services provided by general practices achieving the quality indicator points in this area.
Background
2. COPD is a major cause of death and morbidity in Glasgow. It is associated with high levels of smoking and increasing levels of deprivation. Secondary prevention canslow the progression of the disease once it is diagnosed, and optimise symptom control and function. The quality indicators in nGMS will ensure that some aspects of secondary prevention are systematically addressed. However nGMS is limited and does not, for example, address the important factors of step-up medication, function, diet, exercise and alcoholamong others. The GOLD guidelines note that no pharmacological treatment has been shown to modify the longterm decline in lung function that is the hallmark of this disease. However appropriate use of drugs and relevant uptitration will improve symptoms and function, and reduce complications, This LES addresses those points. Smoking cessation will, however, modify the longterm decline in lung function. A holistic approach to management including rehabilitation is important and management should move beyond the medical model, especially since this disease may well end in a prolonged “end of life” phase with recurrent exacerbations and hospital admissions as well as serious loss of function. NHSGGC offers smoking cessation services and a comprehensive pulmonary rehabilitation service delivered locally In addition NHSGGC provides services to improving eating habits, getting more active and weight management. The LES will ensure a systematic approach, not only to the medical model, but also to the other risk factors, social factors and education which can contribute to improved symptoms, improved function and a better quality of life with fewer admissions..
In addition, depression limits an individual’s ability to change health related behaviours and increases mortality risk. This LES addresses that issue and does not mandate the pursuit of health related behaviour change until the issue of depression has been addressed.
COPD data entered on the LES screens are extracted from Practice clinical systems and held on behalf of Practices on the NHSGG&C “LES Server” at The Southern General Hospital. Only two members of the IT Department Software Development Team have unrestricted access to these data. These data are used for Contract monitoring, payment and support purposes. Should NHS or any other staff wish access to these data, permission must be sought for access to anonymised data. Permission is required from the Data Quality Group, a sub-group of the Enhanced Services & QOF Workgroup, which has LMC representation. Access to data will not be given without due reason and will never be given to unanonymised patient data.
Scope of this scheme
3. This scheme is for the provision of general medical services and the enhanced services set out at paragraph 5 to COPD patients.
Aims
4. To ensure that:
(i) COPD patients have equal access to an enhanced level of service from practices
designed to ensure that their health needs in relation to COPDare effectively tackled
(ii) practice staff are provided with the knowledge, training and resources to enable them to deal effectively with an enhanced level of COPD care
(iii) a patient pathway is used to ensure patients are managed in a seamless way across primary and secondary care, without duplication of services
(iv)support for changing individual behaviours is offered at each step change in their disease and available to patients asthey need and want them.
(v)patients have depression addressed
(vi)function and end of life care issues are dealt with
Service outline
5. This national enhanced service will fund:
(i)provision of (minimum) Annual Review of patients with COPD
(ii)completion of the review items which are not included in the Quality and Outcomes Framework of the New GMS Contract (as agreed between LMC and NHSGG&C) and recording using the agreed method.
(iii)ensure appropriate referral for COPD patients or those with complications as per the agreed referral documents (as agreed between LMC and Respiratory MCN).
(iv)allow electronic extraction of the data as required for verification/audit purposes.
Accreditation
6. Those doctors who satisfy at appraisal and revalidation that they have such continuing medical experience, training and competence as is necessary to enable them to contract for the enhanced service shall be deemed professionally qualified to do so.
First Level Registered Nurses are accountable for their own practice and must keep abreast of all new developments relating to their clinical practice. Therefore those nurses delivering the LES must have completed the one day COPD training course run by NHSGG&C. Those who participate in delivering this LES as part of their clinical remit must be strongly encouraged to attend, on an annual basis, update training provided by NHSGG&C.
Costs
7.In 2012/13 each practice contracted to provide this service will receive an annual payment of £23per patient with COPD(paid after Year End) for whom the appropriate LES work has been carried out and recorded on the appropriate computer screens.For payment purposes, the full payment recording level corresponds to 90% or more of the appropriate LES fields on the CDSS / EMIS template or INPS guideline (as per the payments screen).A recorded level of 75-89% of the LES fields on the template will attract a payment of £16.50 per patient. A recorded level of 65-74% of the LES fields on the template will attract a payment of £11.00 per patient. Patients with a recorded level of the LES fields on the template of under 65% will be deemed not to have had the appropriate LES work carried out and no payment will be given.
Practices in areas carrying out this LES for the first time will have lower payment thresholds, being 15 percentage points below those applied to experienced Practices. Thus the full payment threshold will be 75%, with the lower payment thresholds being 60% and 50%. This will apply only to Practices in an area in the first year that the LES has been commissioned.
EMIS Practices can use either EMIS or “CS for EMIS” templates (when these become available). Practices with INPS clinical software will use the “guidelines” developed jointly by NHSGG&C and INPS, or “CS for Vision” templates, when these become available. NHS Greater Glasgow & Clyde has developed new LES payment screens to enable Practices to view the activity and payment status of all their patients.
An “administration” payment of £5 will be made in respect of CHD patients exception coded as DNA, Housebound etc., unless the EMIS / CDSS / guideline screens are completed to a level that triggers an achievement payment, when the appropriate achievement payment will be made.
Initial payments (quarters 1 to 3) will be made where90% or more of the fields on the LES payment screens are completed. At year end a payment reconciliation will be carried out and final payment will be made, comprising full, partial and administration payments.
Both parties will provide a minimum of 3 months noticeif they wish to withdraw from
the contract. This 3 month notice period appliesunless there are fewer than 3 months remaining in the current contractual year. In this instance, less than 3 months notice may be given by either party.
Additional Information
8.The major amendments from 2011/12 are as follows:
- The weighting of the LES indicator/business rules to reflect the importance of specific indicators and the time it might take a Practice Nurse to cover the area. The Smoking indicators to be a total of 42% of the indicator achievement.
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