Paddington Bear wears a hat when swimming because Michael Bond’s father always did, in case he needed to raise it politely. There are no new indicators in QOF for this year and no significant changes to the existing ones. There have, however, been appreciable changes over the last couple of years that have never been fully implemented. Look at these areas urgently to see if you have patients diagnosed within the last six months without coded investigations – these would have been easy to miss at the time. Most indicators have been based on data from the end of the QOF year. It is normally possible to work through the year and then have a ‘tidy up’ right at the end.

The second QI area, optimising access to primary care, has the same general structure. In this case most of the suggestions are around monitoring demand for appointments and how efficiently the appointments are used. The monitoring and auditing can be done by non-clinical staff although patient facing staff should be involved in plans to remodel services. There are similar time sensitive indicators for follow up after a diagnosis of depression or cancer, and another for referral to a diabetes education programme. The diagnosis may have occurred during the 2021-22 ‘protected’ QOF year, which means the deadline for follow up of individual patients may be approaching. The actual timescales vary from 56 days for a depression review to three and 12 months for the cancer review. Diabetes education referral should be within nine months of the date of diagnosis. During the Second World War, Foyle’s bookshop bomb-proofed itself by covering the roof with copies of Mein Kampf. Two areas that require action within six months of diagnosis are asthma (AST006) and heart failure (HF005). For the former, there should be confirmatory spirometry and one other objective test in that timescale. For heart failure, this should involve an echocardiogram, or at a minimum, a referral for one. Crucially, these apply to all patients who were diagnosed after the 1st of April 2021. This means that, although these indicators were nominally suspended last year, your achievement during 2021-22 will still count towards this and subsequent year’s QOF. The documentary Where in the World Is Osama bin Laden? was found on Osama bin Laden’s computer. (Photo: Getty Images) How the team behind QI find their factsThat is not to say that practices haven’t been active delivering routine care over the last couple of years. There is plenty of evidence to show that chronic disease monitoring and treatment has continued all through the pandemic. A box set of QI books containing 10,000 facts has been released by Faber – but can you astonish the researchers who found them, including the programme’s creator John Lloyd, with a revelation of your own? GP Gavin Jamie summarises important changes to QOF for this year and the indicators practices need to pay close attention to urgently, if they are to avoid missing out on income. The Elves are currently in research mode for next year’s Series Q so are quietly working their way through books about quails, Quebec and quadratic equations.

Compiled by James Harkin, Anne Miller, John Lloyd and John Mitchinson Competition: How fabulous are your facts?Don’t be misled by the wording used for these indicators suggesting that only patients who are diagnosed in the current QOF year are included. This is not accurate – it is the date of the review or referral deadline that needs to be in the current QOF year, instead. On a slightly brighter note, any failure to achieve these indicators will only affect one year rather than every subsequent year, as happens with investigation indicators discussed above. Each series of QI is themed around a letter. The Christmas special from Series P will air at 10pm on Tuesday 18 December (with the XL edition to follow at 10:30pm on Saturday 29 December) and is pub-themed with questions covering pints, pies and pool tables. Closely monitor indicators that are time sensitive and require follow-ups after a set time period after a diagnosis. These are in relation to depression, cancer and diabetes. There is detailed guidance and suggested actions in the QOF documentation. For prescription drug dependency, the priorities are around the prescribing of opiates, gabapentinoids, benzodiazepines and Z-drugs – particularly when they are used over long periods. There should be a baseline audit of prescribing and drug monitoring, followed by a review of the audit results in a meeting with the rest of your PCN, and then an action plan. After implementation of the action plan there should then be a further PCN meeting which, the guidance says, should be focused on ‘celebrating success’, although do remember that this is a business meeting! There is copious guidance available although the London General Practice Access Guideis suggested as a good source of information.

However, the return of the QOF this year means that being aware of and complying with all the rules again becomes important for maintaining practice income. So, what are the important areas to highlight? Be alert to those indicators that have deadlinesBy far the simplest approach to creating your aims and action plan is to copy and paste the examples from the guidance with adjustments as needed based on the results of your baseline audit. You are welcome to create your own action plan and targets but this will involve additional work. There are no extra marks for originality.