Quality & outcomes framework guidance
Section 5: Additional Services
For practices providing additional services the following organisational markers will apply.
| Additional | Cervical Screening (CS) |
| CS 1 11 points |
The percentage of patients aged from 25 to 64 (in Scotland from 21 to 60) whose notes record that a cervical smear has been performed in the last five years Standard 25 – 80% |
| CS 2 3 points |
The practice has a system to ensure inadequate/abnormal smears are followed up |
| CS 3 2 points |
The practice has a policy on how to identify and follow up cervical smear defaulters. Patients may opt for exclusion from the cervical cytology recall register by completing a written statement which is filed in the patient record (exception reporting) |
| CS 4 2 points |
Women who have opted for exclusion from the cervical cytology recall register must be offered the opportunity to change their decision at least every 5 years |
| CS 5 2 points |
The practice has a system for informing all women of the results of cervical smears |
| CS 6 2 points |
The practice has a policy for auditing its cervical screening service, and performs an audit of inadequate cervical smears in relation to individual smear-takers at least every 2 years |
| Additional | Child Health Surveillance (CHS) |
| CHS 1 6 points |
Child development checks are offered at the intervals agreed in local or national guidelines and problems are followed up |
| Additional | Maternity Services (MAT) |
| MAT 1 6 points |
Ante-natal care and screening are offered according to current local guidelines |
| Additional | Contraceptive Services (CON) |
| CON 1 1 point |
The team has a written policy for responding to requests for emergency contraception |
| CON 2 1 point |
The team has a policy for providing pre-conceptual advice |
Additional - Cervical Screening (CS)
CS Indicator 1
The percentage of patients aged from 25 to 64 (in Scotland from 21 to 60) whose notes record that a cervical smear has been performed in the last 5 years Standard 25 – 80%
CS 1.1 Practice guidance
This indicator reflects the previous target payment system for cervical screening and is designed to encourage and incentivise practices to continue to achieve high levels of uptake in cervical screening.
The practice should provide evidence of the number of eligible women aged from 25 to 64 (from 21 to 60 in Scotland) who have had a cervical smear performed in the last 60 months.
This indicator differs from all the other additional service indicators in that a sliding scale will apply between 25 and 80%, in a similar fashion to the clinical indicators.
Exception reporting (as detailed in the clinical section) will apply and specifically includes women who have had hysterectomies involving the complete removal of the cervix.
CS 1.2 Written evidence
There should be a computer print-out showing the number of eligible women on the practice list, the number exception reported and the number who have had an a cervical smear performed in the last 5 years. (Grade A) In many areas the PCO may provide these data although, other than patients with hysterectomy, they will be unaware of exceptions, for example patients who have been invited on three occasions but failed to attend or those who have opted out of the screening programme. Practices should remove patients from the denominator in the same way as with the clinical indicators.
CS 1.3 Assessment visit
The print-out should be inspected.
CS 1.4 Assessors’ guidance
The assessors should enquire on how patients who are exception-reported are identified and recorded.
CS Indicator 2
The practice has a system to ensure inadequate/abnormal smears are followed up
CS 2.1 Practice guidance
If a good system is not in place this is an area of great risk for general practice. The system can be run outwith the practice but needs to cover inadequate and abnormal smears and the practice team need to be aware how it operates.
CS 2.2 Written evidence
The system should be described. (Grade C)
CS 2.3 Assessment visit
The system for follow up is checked.
CS 2.4 Assessors’ guidance
It is important to ascertain where the responsibility for the follow-up of abnormal and inadequate smears lies. This is increasingly becoming a centralised function.
CS Indicator 3
The practice has a policy on how to identify and follow up cervical smear defaulters. Patients may opt for exclusion from the cervical cytology recall register by completing a written statement which is filed in the patient record (exception reporting)
CS 3.1 Practice guidance
The policy may have been drawn up outwith the practice but the members of the team need to have knowledge of the policy.
CS 3.2 Written evidence
There should be a written policy. (Grade A).
CS 3.3 Assessment visit
The policy should be discussed with relevant staff.
CS 3.4 Assessors’ guidance
It may be necessary to ask the practice to demonstrate how its policy operates.
CS Indicator 4
Women who have opted for exclusion from the cervical cytology recall register must be offered the opportunity to change their decision at least every 5 years
CS 4.1 Practice guidance
Women who wish to opt out should not be permanently excluded from the register. Although they need not be sent a reminder letter on a regular basis, it is important that periodically women who have opted out of cytology are given the opportunity to reconsider their decision. There should be a system in place to offer cervical cytology at least every 5 years to those women who have elected to be excluded from recall for cervical cytology.
CS 4.2 Written evidence
There should be a description of how women who opt out of the cervical cytology recall register are identified and offered cervical cytology every 5 years. (Grade C)
CS 4.3 Assessment visit
The practice should demonstrate how women who opt out are identified and recalled.
CS 4.4 Assessors’ guidance
The system may be run centrally but it is important to identify where the responsibility for the system lies.
CS Indicator 5
The practice has a system for informing all women of the results of cervical smears
CS 5.1 Practice guidance
It is generally accepted as good practice for all women who have had a cervical smear performed to be actively informed of the result. Responsibility for the system may be outwith the practice.
CS 5.2 Written evidence
There should be a description of system and example of letters sent to patients (Grade C)
CS 5.3 Assessment visit
The team should be questioned on how women are informed of the way they will obtain the result of their smear.
CS 5.4 Assessors’ guidance
A letter sent to the patient containing and explaining the result is ideal.
CS Indicator 6
The practice has a policy for auditing its cervical screening service, and performs an audit of inadequate cervical smears in relation to individual smear-takers at least every 2 years
CS 6.1 Practice guidance
In this audit the criteria, the results, analysis of results, corrective action, the results of the re-audit and a discussion of them need
CS 6.2 Written evidence
An audit of inadequate smears should be recorded. (Grade A)
CS 6.3 Assessment visit
A discussion with smear-takers should take place, dealing with the audit and any educational needs which arose and how these were met.
CS 6.4 Assessors’ guidance
All the elements for an audit stated in the practice guidance need
Additional - Child Health Surveillance (CHS)
CHS Indicator 1
Child development checks are offered at the intervals agreed in local or national guidelines and problems are followed up
CHS 1.1 Practice guidance
The child health surveillance programme should be based on either local or national guidelines. It is important that the practice has a system to ensure follow-up of any identified problem and that referrals are made as appropriate.
CHS 1.2 Written evidence
There should be a description of the child health surveillance programme and how problems are followed up. (Grade C)
CHS 1.3 Assessment visit
The practice team is asked for details of child health surveillance in the practice and how problems are followed up.
CHS 1.4 Assessors’ guidance
The practice should be aware of which guidelines it has adopted. The assessors should be content that there is a process to ensure problems are followed up.
Additional - Maternity Services (MAT)
MAT Indicator 1
Anti-natal care and screening are offered according to current local guidelines
MAT 1.1 Practice guidance
Most local areas have produced guidelines, which should be adopted within the practice.
MAT 1.2 Written evidence
There should be written guidelines on ante-natal care and screening. (Grade A)
MAT 1.3 Assessment visit
The assessment should involve a description of ante-natal care, using the illustration of one case.
MAT 1.4 Assessors’ guidance
The case should show that the guidance is known and is being used.
Additional - Contraceptive Services (CON)
CON Indicator 1
The team has a written policy for responding to requests for emergency contraception
CON 1.1 Practice guidance
The purpose of the policy is to ensure requests for emergency contraception are appropriately handled so that it can be offered within the effective time. Receptionists as well as clinicians will need to be aware of and act on the policy.
CON 1.2 Written evidence
There should be a written policy on responding to requests for emergency contraception. (Grade A)
CON 1.3 Assessment visit
The policy should be discussed.
CON 1.4 Assessors’ guidance
The policy must allow emergency contraception to be given within the effective time.
CON Indicator 2
The team has a policy for providing pre-conceptual advice
CON 2.1 Practice guidance
The policy should cover such areas as smoking, alcohol, diet, prophylactic folic acid, rubella status, any genetically inherited condition, substance abuse and any pre-existing medical condition.
CON 2.2 Written evidence
There should be a written policy for providing pre-conceptual advice. (Grade A)
CON 2.3 Assessment visit
The policy should be discussed.
CON 2.4 Assessors’ guidance
All the elements contained in the practice guidance (2.1) should be present in the policy.