REPLACEMENT INDICATORS (indicator wording amended) continued AGREED CHANGES TO QOF 2011/12 2009/11 2011/12 2011/12 Indicator wording Points Threshold
With effect from 1 April 2011, 12 QOF indicators have been retired:
Indicator Indicator
CH5, CHD7, DM5, DM11, DM16, STR5, MH7, EP7, Information 4, Records
The percentage of patients with diabetes in whom the
21, PE7 and PE8. New and replacement indicators are listed below. For
last blood pressure is 150/90 or less in the preceding 15 months
details, see www.nhsemployers.org > Pay & Contracts > General Medical
The percentage of patients with diabetes in whom the
Services Contract > Quality and Outcomes Framework
last blood pressure is 140/80 or less in the preceding 15 months
REPLACEMENT INDICATORS (indicator wording amended) REPLACEMENT INDICATORS (changed to reflect coding or business logic amendments) 2009/11 2011/12 2011/12 Indicator wording Points Threshold
The practice can produce a register of patients with COPD
Indicator Indicator
The percentage of all patients with COPD diagnosed
The percentage of patients with a history
after 1 April 2011 in whom the diagnosis had been
of myocardial infarction (from 1 April 2011)
confirmed by post bronchodilator spirometry
currently treated with an ACE inhibitor (or ARB
The percentage of patients on the register who have a
if ACE intolerant), aspirin or an alternative anti-
comprehensive care plan documented in the records
platelet therapy, beta blocker and statin (unless a
agreed between individuals, their family and/or
contraindication or side-effects are recorded)
For patients with newly diagnosed angina
POINTS REDUCED (change only in point value)
(diagnosed after 1 April 2011), the percentage who are referred for specialist assessment
2009/11 2011/12 Indicator wording 2009/10 2010/12 Threshold Indicator Indicator
In those patients with a new diagnosis of
hypertension (excluding those with pre-existing
CHD, diabetes, stroke and/or TIA) recorded between
the preceding 1 April to 31 March: the percentage of
THRESHOLD INCREASED (by 1 percentage point)
patients aged 30 to 74 years who have had a face to face cardiovascular risk assessment at the outset
2009/11 2011/12 Indicator wording Threshold
of diagnosis (within 3 months of the initial diagnosis)
Indicator Indicator
The percentage of patients with diabetes in whom
STROKE6 STROKE6 Unchanged
the last IFCC-HbA1c is 59 mmol/mol (equivalent
to HbA1c of 7.5% in DCCT values) or less (or equivalent test/reference range depending on local laboratory) in the preceding 15 months
NEW INDICATORS for 2011/12
The percentage of patients with diabetes in whom
Indicator Indicator wording Points Threshold
the last IFCC-HbA1c is 64 mmol/mol (equivalent
The percentage of women under the age of 55 years who are
to HbA1c of 8% in DCCT values) or less (or
taking antiepileptic drugs who have a record of information and
equivalent test/reference range depending on local
counselling about contraception, conception and pregnancy in the
The percentage of patients with diabetes in whom
Percentage of patients on the Learning Disability register with
the last IFCC-HbA1c is 75 mmol/mol (equivalent
Down’s Syndrome aged 18 years and over who have a record of
to HbA1c of 9% in DCCT values) or less (or
blood TSH in the preceding 15 months (excluding those who are on
equivalent test/reference range depending on local
The percentage of patients with a new diagnosis of dementia from
The percentage of patients with diabetes with a
April 2011 to have FBC, calcium, glucose, renal and liver function,
record of a foot examination and risk classification:
thyroid function tests, serum vitamin B12 and folate levels
1) low risk (normal sensation, palpable pulses),
recorded 6 months before or after entering on to the register
2) increased risk (neuropathy or absent pulses),
QP1–QP5 Indicators QP1–QP5 relate to prescribing.
3) high risk (neuropathy or absent pulses plus
This indicator set requires practices to conduct an internal review of their prescribing
deformity or skin changes or previous ulcer) or
followed by an external peer review that will include an assessment of clinical and
4) ulcerated foot within the preceding 15 months
cost effectiveness. Practices will be required to agree three areas in which to make improvements. Agreed for 2011/12 only, may be extended if effective.
A to Z Handbook for Nurses in General Practice Montgomery Plester 2011
A to Z Handbook for Nurses in General Practice Montgomery Plester 2011
NEW FROM NICE www.nice.org.uk CG122 Ovarian cancer (Apr 2011) Recognition and initial management
The National Institute for Health and Clinical Excellence (NICE) is
of ovarian cancer Care and early treatment of women with suspected or
an independent organisation that provides national guidance on
confirmed ovarian cancer. Updates and replaces recommendation 1.7.4 in
promoting good health and preventing and treating ill health. Referral guidelines for suspected cancer (CG27, 2005)
• Clinical guidelines (CG) offer evidence-based
Cardiovascular disease
• Public health guidance (PH) recommends
CG126 Stable angina (Jul 2011) The management of stable angina
activities, policies and strategies to help prevent
Care and treatment of adults with stable angina, usually caused by
disease or improve health in populations and
individuals. It may focus on a particular topic (eg, smoking),
CG127 Hypertension (Aug 2011 - updates and replaces CG34). Clinical
population (eg, schoolchildren) or setting (eg, the workplace). management of primary hypertension in adults Care and treatment of
• Technology appraisals (TA) are recommendations on the use
primary hypertension, with new and updated advice on diagnosis, drug
of new and existing: medicines; medical devices (eg, hearing
aids or inhalers); diagnostic techniques; surgical procedures (eg, hernia repair); and health promotion activities
Diabetes prevention PH35 Type 2 diabetes (May 2011) Preventing type 2 diabetes: Alcohol dependence and harmful alcohol use population and community-level interventions in high-risk groups CG115 (Feb 2011) Alcohol-use disorders: diagnosis, assessment and the general population Aimed at those working in national and local and management of harmful drinking and alcohol dependence
public health services, including GPs, practice nurses and dietitians, or
Advice on alcohol-use disorders in adults and in young people aged
involved in physical activity interventions and community engagement.
10–17 years. Read CG115 along with the below earlier guidance:
Risk factors include being overweight or obese, and lack of physical
PH24 (2010) Alcohol-use disorders: preventing the development
activity, and certain ethnic communities and people from lower
of hazardous and harmful drinking Includes advice on how best to
socioeconomic groups are particularly at risk.
detect alcohol misuse, and on brief interventions to manage it, in the
• integrating national strategy on type 2 diabetes with national
CG100 (2010) Alcohol-use disorders: physical complications
activities to prevent other non-communicable diseases (such as
Covers acute unplanned alcohol withdrawal, including delirium
cardiovascular disease and certain cancers).
tremens, alcohol-related liver damage and pancreatitis, and
• national action to promote a healthy diet and physical activity.
management of Wernicke’s encephalopathy.
• local needs assessments and strategies, including
local action to promote a healthy diet and physical
Anaemia in patients with CKD
activity among communities at high risk.
CG114 (Feb 2011 - updates & replaces CG39) Anaemia management
• training for those involved in helping to spread awareness
in people with chronic kidney disease Covers: detecting and
of the risks and how to prevent the condition.
diagnosing and managing anaemia of chronic kidney disease (CKD)
and other health problems or treatments that may affect it
Food allergy in children and young people CG116 (Feb 2011) Diagnosis and assessment of food allergy in children and young people in primary care and community setting CG121 Lung cancer (Apr 2011 - updates CG24) Diagnosis and
Covers children and young people up to their 19th birthday who:
treatment of lung cancer Care and treatment of people with
• have symptoms or signs that could suggest food allergy.
lung cancer. Includes new and updated advice on communication,
• are at greater risk of developing a food allergy, eg, already have
diagnosis and staging; follow-up and patient perspectives.
asthma, atopic eczema or allergic rhinitis, or have a parent or sibling with a food allergy.
A to Z Handbook for Nurses in General Practice Montgomery Plester 2011
A to Z Handbook for Nurses in General Practice Montgomery Plester 2011
CG116 does not specifically look at individuals who have a reaction to
a food, eg, lactose intolerance, not caused by the immune system
Mental health: anxiety & other common disorders CG123 (May 2011) Common mental health disorders: identification and pathways to care Advice on the care and treatment common
mental health disorders, with a focus on primary care. New
recommendations on: access to care; assessment; and developing
local care pathways for common mental health disorders (depression,
generalised anxiety disorder, panic disorder, obsessive-compulsive
disorder, post traumatic stress disorder and social anxiety disorder). CG113 Anxiety (Jan 2011 - updates and replaces CG22) Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults New and updated advice on managing ‘DO NOT DO’ ADVICE www.nice.org.uk/usingguidance/
To access NICE’s database of ‘Do not do’ recommendations, from the home page > Putting Guidance into Practice > left-hand menu, and click on ‘Do
Skin cancer PH32 (Jan 2011) Skin cancer prevention: information, resources,
For example: type ‘primary prevention’ in the ‘Do not do’ recommendations search box to find 10
environmental changes Being out in the sun can benefit health,
recommendations on cardiovascular disease and the following advice on osteoporosis prevention:
providing a good source of vitamin D and the opportunity for physical
Osteoporosis - primary prevention
activity, but prolonged exposure can significantly increase skin
Guidance ID NICE ‘do not do’ recommendation Interventions
cancer risk. The guidance encourages a balanced approach, helping
Raloxifene is not recommended as a treatment option for the primary Raloxifene
to ensure that skin cancer prevention activities do not discourage
prevention of osteoporotic fragility fractures in postmenopausal women
outdoor physical activity, while encouraging people to use sensible skin protection.
NHS Evidence www.evidence.nhs.uk NICE Pathways access only current NICE guidance. Use NHS Evidence Tuberculosis
to find and access high-quality clinical information from both NICE and
CG117 Tuberculosis (Mar 2011 - updates and replaces CG33) Clinical diagnosis and management of tuberculosis, and measures for its prevention and control Covers diagnosis and treatment of active and latent tuberculosis (TB) in adults and children, NEW FROM SIGN www.sign.ac.uk
and on preventing the spread of TB, eg by offering tests to people at
The Scottish Intercollegiate Guidelines Network (SIGN) develops evidence-
based clinical practice guidelines for the National Health Service (NHS) in Scotland. NICE PATHWAYS http://pathways.nice.org.uk/ Use NICE Pathways, a new on-line tool, for quick and easy access to SIGN app for Apple & Android devices
all the NICE advice on a specific topic. Related pathways link up with
Visit the SIGN website to download the SIGN Guidelines app. The app
one another, eg, those for diet and physical activity, and those for
includes the 2011 edition of The British Guideline on the Management of Asthma SIGN 101, with a new section on asthma in adolescents
Listed overleaf are the first 20 pathways developed.
www.sign.ac.uk/pdf/qrg101.pdf, and Quick Reference Guides (QRGs) of recently published SIGN guidelines, including:
A to Z Handbook for Nurses in General Practice Montgomery Plester 2011
A to Z Handbook for Nurses in General Practice Montgomery Plester 2011
• Management of atopic eczema in primary care SIGN 125
NEW FROM NHS Diabetes www.diabetes.nhs.uk
NHS Diabetes is a service improvement team that works to improve care
for people with diabetes. Use the website to source guidance, resources,
• Psoriasis and psoriatic arthritis in adults SIGN 121
diabetes information data and support, and contact the team with your
questions through the ‘Ask a question?’ button on each page.
• Management of sore throat and indications for tonsillectomy SIGN 117• Management of diabetes SIGN 116
Improving the diagnosis, classification and coding of diabetes
Diagnosing, classifying and coding diabetes can be complex, and getting it
• Non-pharmaceutical management of depression SIGN 114
right is essential for correct patient management.
• Diagnosis and pharmacological management of Parkinson’s disease SIGN 113
A new report and fact sheet, produced by NHS
Getting it right: Improving the
Diabetes with the RCGP, offer practical advice
classification, diagnosis and coding of diabetes: report and fact sheet NEW FROM THE DEPARTMENT OF HEALTH www.dh.gov.uk Improved website
You can browse and search the DH’s updated site, subscribe to email
Diabetes information guides
alerts or RSS feeds, or view it on your mobile phone. You can also follow
New reports in the Knowledge and Information Repository summarise
DH on Twitter, and order publications on line
latest guidance and evidence in key areas, including: structured education;
New items are highlighted on the homepage, and the news and publications
emotional and psychological support; prevention; and care planning.
pages. The ‘Policy’ pages (the NHS, public health, and social care) aggregate
Access them at www.diabetes.nhs.uk →> Areas of care
content at the top level. If you are interested in, for example, nutrition, you can bookmark or subscribe to the nutrition page. NEW FROM THE NPC www.npc.nhs.uk Cancer awareness
National Prescribing Centre’s work is now integrated into NICE – note
Bowel cancer In England, bowel cancer is the
the above new web address. Visit the site for guidance and resources to
third most common type of cancer (in men,
NHS Choices information: www.nhs.uk/conditions/Cancer-
the third most common after prostate and lung
cancer; in women, the second most common after breast cancer). Following the success of regional pilots, a national ‘Be
Constipation advice
Clear on Cancer’ campaign to increase awareness of bowel cancer starts
Topics in a new bulletin include: when to use non-pharmacological
treatments in adults; when to use laxatives; the
The management of constipation “If you’ve had blood in your poo or looser poo for 3 weeks, your
evidence for different laxatives; when to review
laxative treatment; new treatment options.
Lung cancer October 2011 saw the launch of a regional campaign across the East and West Midlands to highlight signs Safer prescribing
and symptoms of lung cancer; local TV and radio ads
Find advice on avoiding medication errors in primary care in an article by
prompt people with a persistent cough for more than
Tony Avery, Professor of Primary Health Care, University of Nottingham
Medical School, Strategies for safer prescribing: 10 Top tips.Strategies for safer prescribing: 10 Top tips Dementia awareness
www.npc.nhs.uk/publications_resources.php
An estimated 750,000+ people in the UK have
dementia. Numbers are expected to double in the
next 30 years. A significant number (currently
c. 15,000) develop dementia relatively early in life.
A to Z Handbook for Nurses in General Practice Montgomery Plester 2011
A to Z Handbook for Nurses in General Practice Montgomery Plester 2011
Eric Rudnick, MD, FACEP EMS Medical Director Best Practices for Pulmonary Hypertension and the Interaction Pulmonary hypertension is a disease process where there is increased resistance to blood flow in the pulmonary arterial circulation. This is occurs as the small pulmonary arteries and capillaries become blocked, narrowed, and/or destroyed. As you recall, the right side of the heart pumps
David Andorsky Harvard Medical School Mario Tristan IHCAI Foundation 25 March 2002 Screening for malnutrition and vaccination status among the children of migrant Nicaraguan workers in Grecia, Costa Rica Introduction Nicaraguans form a large immigrant community in Costa Rica, consisting of approximately 315,000 individuals out of the country’s total population of 3 million.