From April 2012, osteoporosis will be included in the Quality and Outcomes Framework (QOF) giving GP practices financial incentives for diagnosing and treating osteoporosis in their patients. This follows a seven year campaign led by the National Osteoporosis Society.
The new indicators mean that GP practices will receive funding for:
- Producing a register of patients (a) aged 50-74 years with a record of a fragility fracture after 1 April 2012 and a diagnosis of osteoporosis confirmed on DXA scan; or (b) aged 75 years and over with a record of a fragility fracture after 1 April 2012
- Ensuring that patients on the register who are aged between 50 and 74 years, with a fragility fracture, in whom osteoporosis is confirmed on DXA scan, are treated with an appropriate bone-sparing agent
- Ensuring that patients aged 75 years and over with a fragility fracture are treated with an appropriate bone-sparing agent.
Three QOF points have been awarded for each of these areas. The amount of funding per QOF point for 2012/13 has not yet been disclosed. This will replace current Directed Enhanced Service incentives for osteoporosis in England, Northern Ireland and Scotland.
More details about the 2012/13 QOF indicators can be accessed from the NHS Employers website.
The indicators will mean better access to diagnostic scans for people who have had a fracture and better support with treatments for people with osteoporosis.
Support for GPs and practice teams
Support for GPs and practice teams
Our new website, ‘osteoporosis resources for primary care’, developed in partnership with the Royal College of General Practitioners provides clear, concise information for GPs and practice teams, helping them to provide excellent care for their patients and meet the QOF indicators. Find out more at: www.osteoporosis-resources.org.uk
Other changes to QOF 2012/13
New indicators have also been included for Atrial Fibrillation, Smoking and Peripheral Arterial Disease (PAD), and some existing indicators have been replaced with indictors developed under the NICE process. Seven indications have been retired, freeing up QOF points for these changes.
What is QOF?
The General Medical Services (GMS) Contract is the contract for GPs which was introduced in 2004. QOF rewards good practice in GP surgeries. GPs are given a proportion of their funding for meeting the criteria outlined in the QOF.
One section of the QOF outlines a set of criteria called ‘clinical indicators’ which relates to specific conditions such as asthma, heart disease and stroke. The QOF has been found to be a successful way of making national improvements to the diagnosis and treatment of these conditions, as the majority of practices will work to meet the criteria.
QOF is jointly negotiated and agreed by the British Medical Association (BMA) and NHS Employers (on behalf of the UK Government) as part of the GMS contract annually between August and September. Under the recently reformed system, the BMA and NHS Employers choose from a ‘menu’ of QOF indicators which are developed by the National Institute for Health and Clinical Excellence (NICE) to ensure that they are evidence based and cost effective.
Why is QOF important?
Evidence has shown that identification rates of fragility fractures within both primary and secondary care are poor. This suggests that many osteoporosis patients have not received the investigations and treatments recommended by NICE. They remain at an unnecessarily greater risk of sustaining a more serious fracture in the future.
In the year following a fragility fracture, people make between four and 14 extra visits to their GP depending on the site of the fracture. In relation to the estimated incidence of fragility fracture in the UK, this is likely to lead to around 2.4 million GP consultations per year.
Where individuals with fractures are not assessed for osteoporosis in secondary care, or even admitted to hospital, GPs have a critical role in post-fracture case finding. They also have an important part to play in identifying the presence of clinical risk factors for osteoporosis, carrying out fracture risk assessments and helping patients to persist with their treatments.