There have been many tragedies through the COVID-19 pandemic, but in terms of quality improvement delivery in primary care, our inability to focus on the two new QOF QI Domains of earlier cancer diagnosis and care for people with learning disabilities, would be right up there. My colleagues Simon and Kate have both blogged on the concerns we all have in terms of cancer care during/post-COVID, and thankfully there has been an almighty effort across the whole NHS to get cancer diagnosis and care back up and running over the last couple of months.
But one area that risks slipping under the radar, which would equally be a tragedy and would represent a huge missed opportunity, is improving care for people with Learning Disabilities. As one of the QOF QI Domains for 2020/21, it would have sat as a key focus over the year for us. Inevitably COVID has meant a major restructure to what care we can deliver, with a significant relaxing on the QOF QI domains, but irrespective of the contractual arrangements a ‘reboot’ of the principles of the QI domain on Learning Disabilities should be high on our list of priorities.
Back in 2013, the CIPOLD report was published, and it made for very uncomfortable reading. It concluded that 42% of deaths in people with Learning Disabilities were premature, with delays to diagnosis and treatment being key factors. On top of that, the data still suggests over-prescribing of potentially harmful antipsychotics, and poor uptake of national screening programmes, including flu immunisations - a particularly key area we need to address this coming Winter.
As for the QOF QI Domain itself, this has inevitably been adjusted, and we are still awaiting confirmation of exactly what the requirements will be, but the latest from NHSE (9.7.2020) states that we will be ‘Asked to focus on early cancer diagnosis and care of people with a learning disability in the quality improvement domain but that the requirements will be recast to focus upon restoring care delivery in these two key areas. Payment of this domain will be conditional on practices working to these revised requirements. We are still working through the detail of this with GPC England and will publish full details shortly’.
Whether or not the details QOF are relevant to you, and whichever part of the country you work in, I’m sure we would all agree it’s time to focus again on this vulnerable group of people. How we do this will be very much down to the circumstances in your practices or PCNs, but reviewing Learning Disability registers, inviting them in for annual checks including a medication review, and getting them flu jabs would be a great start.
For a KISS of the whole QI Domain (pre-COVID) please click here. Although the contractual details have been superseded, the background and principles still apply, including some useful information and links for the annual checks, medication reviews and reasonable adjustment flags.
You can quickly add CPD to your account by writing a reflective note about the Learning Disabilities - time to reboot an important QI project post you've read.
Log in to your NB Dashboard and use the 'Add Reflective Note' button at the bottom of a blog entry to add your note.