QOF success will lead to more women with epilepsy getting pre-conception counselling

The QOF is one way that family doctors in the UK are paid for their work.  It is a list of different actions that, if carried out, provide extra money for their practice from the health service.

Epilepsy Action has been campaigning for a pre-conception counselling indicator for a number of years, first proposing this indicator in 2007.  In 2009 it was agreed that this indicator should be introduced. However, the swine flu crisis meant that there were no changes to the QOF last year.

Nicole Crosby-McKenna, development officer for women at Epilepsy Action, said:

“We are delighted that this has finally been recognised and that pre-conception counselling is to be included as an indicator in the QOF. Pre-conception counselling is vital as it allows women and health professionals to work together to plan pregnancies and reduce risks. Ultimately, this should mean that fewer babies with physical malformations or neurological problems will be born to women with epilepsy. We are very hopeful that by including pre-conception counselling as a new indicator, more women will receive support before and during pregnancy.”

What is the Quality and Outcomes Framework (QOF)?

There are currently four QOF indicators for epilepsy. These are:

• EP5 - A register of patients aged 18 and over receiving drug treatment for epilepsy.
• EP6 - The percentage of patients aged 18 and over on drug treatment for epilepsy who have a record of seizure frequency in the previous 15 months.
• EP7 - The percentage of patients aged 18 and over on drug treatment for epilepsy who have a record of medication review involving the patient and/or carer in the previous 15 months.
• EP8 - The percentage of patients aged 18 and over on drug treatment for epilepsy who have been seizure free for the last 12 months recorded in the previous 15 months.

As part of the changes, indicator ‘EP7’ will disappear. This is because the work for this indicator could overlap with another indicator, meaning that doctors are paid twice for the same action. We accept the arguments for retiring this indicator. It is also important that the list of indicators does not grow so large that the actions cannot be carried out.

We think that the QOF is important because it encourages doctors to carry out work that they have not been doing in the past. We know that until the QOF indicator ‘EP5’ was introduced, many parts of the country did not know how many people had epilepsy in their area.

Pre-conception counselling

Pre-conception counselling is a special advice session between a woman with epilepsy and a health professional with knowledge of pregnancy or epilepsy. It’s aim is to make pregnancy as safe as possible.

We expect that this new indicator will dramatically increase the number of women who are offered this advice and information.

It is estimated that there are approximately 131,000 women with epilepsy of child-bearing age in the UK. Around 5,000 of these women become pregnant every year. The majority of women with epilepsy have uncomplicated pregnancies and give birth to healthy babies. However, women with epilepsy have a higher risk of maternal death. Those taking certain AEDs have a higher chance of giving birth to a baby with neuro-developmental problems or a physical malformation.

Advice and support before pregnancy helps women to be informed of potential risks, and allows them to make informed decisions about their treatment. Pre-conception counselling can also reduce the risk of unplanned pregnancy by discussing possible interactions between AEDs and contraceptives.

Women should be referred for pre-conception counselling before they begin trying for a baby. But because half of all pregnancies are unplanned, women with epilepsy should be given regular opportunities to have pre-conception counselling. This will help to protect her, and her baby’s, health if she becomes pregnant.

The Royal Society of Medicine has produced guidance for GPs on managing epilepsy in women. Epilepsy Action has provided advice for this guidance, which is available online.

We will now be working to make sure that all family doctors in the UK know what they should be discussing, and why, when they hold pre-conception counselling sessions.