last updated 29/4/05

From Frequently Asked Questions #2

Q1 Under N_INT 2.2 'Source of numerator data' it lists, Type 1 Emergency Department Patients, Type 2 Medical Patients, Type 3 Surgical Patients.. Will divisions need to report on one, a combination or all of these patient categories? Can a Division add its own local priorities?
 
A1 Divisions are able to report on one, a combination or all of these categories - the Division will determine which arrangements they focus their activities and report on, in keeping with identified local needs and priorities.  Similarly, a Division can add its own local priorities as indicated by Type 5 - other patients (as specified).

Q1 Are Divisions expected to report at Levels 1 and 2 if they are also reporting at levels 3 and 4?

A1 Yes, Divisions could be reporting at all levels in any domain.  As there are relatively few indicators at levels 3 and 4, they cannot act as proxy indicators for the effectiveness of all the organisational structures and processes of Levels 1 and 2 that is necessary information for Divisions and also needs to be assessed in 2005-08.  Over time and with the growth of the capacity of the network, the need for some of the indicators at levels 1 and 2 will be replaced with an emphasis on more indicators at levels 3 and 4. 

Indicators across the levels that must be responded to are marked ?compulsory?
 
Q2 There seems to be no measurement of quality in the indicators, such as quality practices within general practice, or the GP engagement issues. Where do Divisions enter the GP/member engagement aspects of their core work into the templates?
 
A2 Many of the national performance indicators include measurements of quality. Quality impacts upon all areas of a Division?s work and therefore other activities specifically relating to improving quality should be reported against the most relevant national priority area (NPA).  For example, improving GP/member engagement should be reported against the 'General Practice Support' NPA and activities designed to improve the quality of asthma management within the Divisions should be reported against the 'Chronic Disease Management' NPA.
 
Q3 Do the Diabetes KPIs refer to Type II Diabetes?
 
A3 For this purpose, diabetes refers to all patients with diabetes, not just Type 2 diabetes.  In clinical practice, HbA1C levels relevant to good glycaemic control do not differ between types of diabetes.  The Service Improvement Payments (SIP) do not discriminate between types of diabetes and to enforce discrimination for this purpose would increase the burden of collecting the information.
 
Q4 Is the Asthma KPI for Asthma or COPD?
 
A4 For this purpose, asthma is present if the doctor is treating the person for asthma.  In clinical practice asthma is identified on the basis of signs and symptoms.  There remains no gold standard for the diagnosis of asthma.
 
Q5 Are strategies compulsory? Or only KPIs?
 
A5 Only the KPIs are compulsory. Divisions are free to develop their own strategies to achieve the KPIs, based on their local knowledge and expertise and the needs of their communities.
 
Q6 What are the links between KPIs and funding?
 
A6 In 2005/06 there is no link between KPIs and funding.  Assessment of performance in 06/07 and onwards will be based in part on the Divisions' achievements against the national performance indicators.  The assessment of performance will lead to results such as 'earned autonomy' and access to the performance and development pool.  Where Divisions do not meet expectations then long-term funding is at risk.
 
Q7 How do divisions access the smoking information on the Asthma indicator?  It is identified as a compulsory indicator on the Asthma Chronic Disease Management NPA?
 
A7 This information can be collected using standard clinical software.  Participating practices/GPs may need support to ensure that collecting the information becomes part of routine practice, particularly for patients with asthma on practice register/recall/reminder systems.  
 
Q8 Are the new indicators about monitoring how GPs practice medicine?
 
A8 The new indicators are about collecting information to allow a national overview of the effectiveness of Divisional support for general practices/GPs to improve the health of their patients and communities. In part, this effectiveness will be reflected in practice systems and the care those practices provide for patients.  The Performance Indicators are designed to drive continuous improvement across the Divisions Network in order to strengthen the Divisions Network as a whole and to ensure Divisions are providing the maximum benefit to GPs and the community.  The indicators have been developed with extensive input by GPs and Divisions representatives to support quality practice and clinical autonomy.  There is no requirement or intention to provide data about individual GPs or general practices.
 
Q9 If a Division implements a program that enables them to report at Levels Three and Four but not at Levels One and Two what do they do?
 
A9 If the indicators at Levels One and Two are compulsory, the Division would need to make some changes to the program, to allow them to report on these indicators.  If the indicators at the lower levels are not compulsory, reporting on them is at the discretion of the Division.  There is capacity within the new planning and reporting proforma for Divisions to report any exceptional or extenuating circumstances.
 
Q10 Will growth and progress on an issue be seen as significant progress?
 
A10 Yes, progress will be assessed on an issue-by-issue basis.  In some areas maintenance of the status quo will be seen as significant, e.g. maintenance of smoking targets among patients on practice register/recall/reminder systems with asthma. 

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