|Relevant Tools: A.9, A.11, A.15, A.16, A.18|
National guidance recommends all people with a diagnosis of epilepsy should receive an annual review in primary care.
The establishment of disease registers is an important feature of the Quality and Outcomes Framework (QOF).The GMS contract encourages the compilation of a register of patients receiving drug treatment for epilepsy and sets three quality indicators for ongoing management with financial rewards.1
These quality indicators aim to encourage the establishment and delivery of a structured management system for patients with epilepsy in primary care.2
|QOF indicator||Points||Payment stages|
|EP001||The contracter establishes and maintains a register of patients aged 18 or over receiving drug treatment for epilepsy.||1|
|EP002||The percentage of patients aged 18 years and over on drug treatment for epilepsy who have been seizure free for the last 12 months recorded in the preceding 12 months.||6||45–70%|
|EP003||The percentage of women aged 18 or over and who have not attained the age of 55 who are taking antiepileptic drugs who have a record of information and counselling about contraception, conception and pregnancy in the preceding 12 months||3||50–90%|
QOF indicator EP001: Records
Using the patient identification protocol and Read codes in A.16 enables the identification of ALL patients with a diagnosis of epilepsy, as the NICE and SIGN guidelines recommend that all these patients receive annual review.3-5 However, for the purposes of the GMS contract point scoring, only those patients with a diagnosis of epilepsy, who are on AEDs, and who are over the age of 18 will be included.
Patient annual review
Once a register of people with epilepsy within the practice has been established they should all, where possible, receive an annual review to assess seizure control, side-effects experienced and psychosocial issues.3-6 Using the protocol provided in section 3, practices will be able to invite patients for review.
Remember that patients may be excluded from calculation of points allocation if they refuse to attend (see exception reporting, A.18). Even then it is possible to perform an opportunistic epilepsy review when patients attend the surgery for a consultation on another topic. The on-screen prompts provided by supplier software help to alert the GP or nurse that an epilepsy review has not been carried out, and assists them to collect the correct information using the correct Read codes. The different elements of this website can be used to help you fulfil the GMS contract quality indicators. Section 3.2.1 gives information on how to produce a register of patients receiving drug treatment for epilepsy. Although initially much work will have to be done to ensure that this register is accurate, once it has been established annual maintenance is not too difficult. Following the process outlined in section 3.6 will help practices to establish this register.
How does annual review relate to the indicators?
The GMS contract7 notes that epilepsy is often poorly managed in general practice, and there are insufficient specialist resources to provide specialist supervision for most patients. However, it also states that although few types of epilepsy are preventable, much of the morbidity that results could be prevented by appropriate clinical management.1
To help improve clinical management NICE recommends that the following information should be recorded in the annual review of all patients with epilepsy:3
- seizure type and frequency, including date of last seizure
- AED therapy and dosage
- any adverse drug reactions arising from AED therapy
- other related morbidities, such as fractures, suicidal thoughts, depression and anxiety, and accidents
- key indicators of the quality of care such as topics discussed and plans for future review.
QOF Indicators EP002 and EP003: Ongoing management
Recording seizure frequency
Read codes have been developed to record seizure frequency (see A.16).
If patients have had any seizures in the past 12 months, discuss with them the possibility of referral to an epilepsy specialist for adjustments to the dose of their medication or consideration for epilepsy surgery. The date of the last seizure needs recording.
If patients have been seizure-free for more than two years, there is a possibility that, with specialist advice, they could stop their medication. However, adults with a driving licence often prefer to remain on medication,4 rather than not drive during the withdrawal phase and for six months after cessation of treatment, or risk losing their licence if they have another seizure.8
The decision to stop AEDs must be taken by the specialist who will advise on how to gradually withdraw the AEDs. Usually this is carried out by reducing the dosage in small amounts over a long period of time. Information on referral is included in A.15.
1 British Medical Association, 2011. QOF guidance, 2013-2014. (Accessed 01/05/2013).
2 Lambert MV, Bird, JM, 2001. The assessment and management of adult patients with epilepsy – The role of general practitioners and the specialist services. Seizure. 10: 341-346.
3 National Institute for Health and Clinical Excellence (NICE), 2012. The epilepsies: The diagnosis and management of the epilepsies in adults and children in primary and secondary care. [CG137]. London: NICE.
4 Scottish Intercollegiate Guidelines Network (SIGN), 2003. Diagnosis and management of epilepsy in adults. A national clinical guideline. Edinburgh: SIGN.
5 Epilepsy Action, 2005. Role of Primary Care in Epilepsy Management 2. Leeds: Epilepsy Action.
6 Shorvon S, Kitson A, 2000. Clinical standards advisory group. Services for patients with epilepsy: a report of a CSAG committee.London: Department of Health.
7 NHS Confederation, 2003. Investing in general practice. The new general medical service contract. [online] Accessed 22/06/2012).
8 Driver and Vehicle Licensing Agency, 2004. Guidance for Withdrawal of Anti-Epileptic Medication Being Withdrawn on Specific Medical Advice. Swansea: DVLA.