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GMS Contract Guide - Cancer

The cancer disease area of the QoF is worth 11 points, generating a payment of £1,370 in 2007/8 for those with average list size and prevalence.

Cancer: Clinical Indicators
Target (%)Points
Records
Register of patients with cancer, excluding non-melanotic skin cancers, diagnosed after 1 April 2003Register5
Ongoing management
Patients with cancer diagnosed within the past 18 months, with a review recorded within six months of confirmed diagnosis906
Total 11

ACTION PLAN

Overview

  • National prevalence rates for cancer as shown by the 2006/7 QoF data are 0.89 per cent in England and 0.77 per cent in Northern Ireland. Figures for 2005/6 for Scotland, are 0.7 per cent and 0.8 per cent in Wales.

  • Exception reporting rates for cancer were 8.87 per cent in England in 2005/6.

  • This indicator set is not evidence-based but is based on two principles. First, that cancer care is a priority in all four UK countries. Second, that although patients with cancer will be principally managed in secondary care, GPs play a key part in referral, support and co-ordination of care. The guidance says the indicator set represents good practice.

  • Cancer care is also covered elsewhere, particularly in the indicator set for palliative care. There are points for significant event analysis, which includes new cancer diagnoses and deaths where terminal care has taken place at home, and points in the smoking indicators.

  • The indicators do not reflect the numerous aspects of cancer care, of which many are specific to cancer type, that a practice will offer. Where you are involved in managing patients with cancer, treatment should be based on national and local guidance.


Step 1: Setting up the register


  • This disease area requires practices to record patients with a new diagnosis of cancer after 1 April 2003. Start by searching for all cancer diagnoses going back to that date. Check the notes and record the preferred Read codes.

  • Circulate this list of patients to all GPs, nurses and other clinical staff in the practice to find out if any patients are missing.

  • Another alternative source of information will be hospital letters and you will need a system to ensure all future diagnoses are correctly coded and followed up with a review within six months of the diagnosis.

  • One major problem is that a search carried out at the end of the contract year will exclude patients who died during the year. They will not be in the quality cohort and will fall through the indicator net.

  • Note that only the first cancer per patient counts for QoF, unless the latest cancer code has an episode code of ‘new’ added.


Step 2: From now onwards


  • The second indicator requires patients diagnosed with cancer within the past 18 months to have a review recorded within six months of the practice receiving confirmation of the diagnosis.

  • The guidance says the review should cover two components: the patient’s individual health and support needs, and co-ordination of care between sectors. As in several disease areas, ‘review’ has been changed to ‘patient review’, perhaps emphasising that it should take place with the patient present. It had been suggested that if a primary care team had regular meetings on cancer, a discussion of a patient covering the review points above would constitute such a review and the Read code could be added to the patient’s record.

  • Check progress by searching for patients with a new diagnosis of cancer who have had a review within six months of diagnosis using the code 8BAV ‘Cancer care review’. Consider checking for all patients diagnosed within the past 18 months, particularly those diagnosed in the past six months, to ensure a review has been performed and coded.

  • Decide how cancer care reviews will be organised in your practice, who will do the work and what will be covered in the review.

  • To check progress, practices can run a search of all patients on the register who do not have an acceptable review code in their notes. If the review has taken place but there is no code, this can be added. If no review has taken place, the practice needs to ensure it will happen. Remember, patients who fail to attend for review after three invitations can be exception coded.


Useful Resources for Cancer

Cancer in Scotland

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