The Quality and Outcomes Framework (QOF) is a scheme to reward GP practices in the UK for providing preventative and quality care with the goal of improving population health, managing chronic diseases, and reducing the use of secondary care. Participation is voluntarily, but QOF payments tend to be an important part of GP practice income.
QOF points are achieved based on the number of patients on your register who have certain conditions and who receive certain defined interventions¹.
The value of each QOF point depends both on the overall number of patients registered with your practice and whether you have more or less than the national average for certain conditions on your register.
Let’s look at an example.
Say a practice has 14,500 patients on their register, 675 of whom are coded as having asthma. Their practice asthma prevalence is therefore 5.4% versus the national prevalence of 6.5%. Of these asthmatic patients, 91.2% had the recommended two diagnostic processes and 90.9% of youths had their smoker/non-smoker status recorded. However only 67.3% of patients had their asthma controls reviewed in the last 12 months. The practice earns 42.8 of the 45 QOF points possible for asthma. Each QOF point is worth £263.60, for a total asthma QOF payment of £12,245.
By lifting its prevalence and hitting its QOF target, the practice could have earned over £14,460 for asthma— an increase of £2,215 for one QOF category alone.
So how are these numbers calculated and where could they be improved?
- There are a total of 559 QOF points available, with 45 achievable for asthma². The full breakdown of QOF points and targets by category is available here.
- The practice maintains a register of patients with asthma, and receives an automatic 4 QOF points for doing so. It receives a further 15 for meeting the minimum threshold of the recommended diagnostic procedure and 6 QOF points for keeping a record of whether asthmatic youths are also smokers³.
- To achieve the full 20 QOF points for asthma management the practice needs to undertake a review of at least 70% of asthmatic patients on their register each year. There is also a minimum threshold, and if they did not review at least 45% they would receive no QOF points for this indicator at all. Between 45% and 70%, the number of QOF points is pro-rated and therefore the practice achieved 17.8 QOF points.
- The baseline value of a QOF point is £194.83 in 2020/21, however this increases for larger than average practices or where conditions are more common than average. The value of each point depends on numbers called your ‘Contractor Population Index’ (CPI) and your ‘Adjusted Practice Disease Factor’ (ADPF). The CPI is calculated by dividing your practice list size by the NHS ‘average’ list size. In 2020/21 the average list size 8,799 (it changes every year). The CPI for this practise is therefore 1.65. The APDF is the practice prevalence divided by the national prevalence (available here), and in this case is 0.89 (5.8%/6.5%).
The total value of QOF points for asthma is equal to:
Base Value * Number of QOF Points * CPI * APDF
£194.83 * 42.8 * 1.65 * 0.89 = £12,245
So how can you achieve more QOF points? There are three ways:
- Look for quick wins where clinical records have missing or incorrect SNOMED codes, which will falsely decrease your prevalence. For example, can you see more patients prescribed insulin than are coded as diabetics? This would suggest there codes missing from your register. You can go even further and use a tool such as Codepilot which uses AI to thoroughly scan all clinical records for coding errors.
- Look for opportunities to proactively diagnose or monitor certain key conditions. For example, some practices are installing self-service blood pressure meters in their waiting rooms to help them achieve QOF targets for hypertension.
- Create a practice plan to stay on top of your interventions throughout the year and share the load with your team to avoid March madness. You can use a tool such as Codepilot to prepare the plan automatically, assign tasks and track progress.
Each QOF category has it’s own rules and nuances, and these are updated every year. For example, in 2020/21 the age brackets to be included in both the asthma and youth smoker/non-smoker registers has been expanded. Staying on top of all these rules and changes can be challenging, and if you like some help please check out our product.
Codepilot integrates with your EMR (either EMIS or SystmOne), calculates your projected QOF points and provides a practice plan and task management tool to make sure you hit your QOF goals and maximise your income. In doing this it uses sophisticated AI to check your clinical coding for errors, and highlight where there are opportunities to improve your prevalences and find other missed income.
If this sounds interesting please don’t hesitate to reach out and organise a demo.
If you’ve found this article helpful or have any questions or comments, we’d love to hear from you via hello@dyad.net or in the comments section below.
(1) There are a few exceptions to this rule — for example where QOF points are awarded for the performance of certain tasks such as the production of disease registers. Also note that QOF income is partially protected for 2020/21 due to the impact of coronavirus.
(2) These numbers are set by the NHS.
(3) Note that it is only necessary to meet a threshold of 80% for either of these indicators to achieve the full allotment of QOF points.
