We have received enquiries from practices in relation to this years Personalised Care Adjustment (Exception Reporting) issues. You may or may not already be aware of the changes. Many practices are already experiencing problems. This issue has been caused by NHS England inappropriately putting in new business rules which are unfit for practical purpose and inevitably cause difficulties for practices in properly managing patients, leading to risks to patient safety. NHS England is denying that they have caused this problem and are putting the blame on clinical system suppliers, but that does not hold any water as it is the new business rules that are clearly at fault. The QOF Business Rules now state that once the appropriate coded invitations have been forwarded to patients, the patient is automatically removed from the indicator list after two invites, (in the case of Smears three invites). This will inevitably cause high exception reporting rates as practices will be unaware and unable to easily identify which patients should still be recalled for follow up. This may also create a problem with CQC’s guidance (and when inspecting) in relation to exception reporting.
This needs to be counteracted quickly in order to alleviate year end issues. Certain members of the Birmingham LMC Managers Forum Group are working with IT in an effort to try to counteract this problem. In the meantime please be aware that you can implement your own in-house system to support you with this issue. We have put together some basic guidance in an effort to try to help practices deal with this problem (please see attached document).This issue has been raised with the GPC in order to provide guidance and bring about a national solution to the problem but we have no faith that this will be forthcoming any time soon, hence the need for Birmingham LMC to produce this guidance for practices.
Please note Birmingham LMC information is available for guidance only. Please refer to the links below which provides a full explanation of the 2019 – 2020 QOF Indicators and Business Rules:
https://www.england.nhs.uk/wp-content/uploads/2019/05/gms-contract-qof-guidance-april-2019.pdf (For this link please refer to Section 6: Personalised care adjustment)