Chapter 2 - Improving quality in the UK
2.1 From April 2006, a revised Quality and Outcomes Framework (QOF) will continue to provide financial rewards for general medical services (GMS) providers to provide high quality care.
2.2 The revised QOF measures achievement against a set of evidence-based indicators, allowing a possible maximum score of 1000 points. The reduction from the 2005/06 total of 1050 points is due to the reallocation of the resources associated with the access bonus points to become part of an access Directed Enhanced Service (DES) in each of the countries.
2.3 Annex 1 provides detailed guidance about the revised QOF. In summary, the revised QOF comprises:
the clinical domain:
coronary heart disease, heart failure, stroke and transient ischaemic attacks, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, epilepsy, hypothyroidism, cancer, palliative care, mental health, asthma, dementia, depression, chronic kidney disease, atrial fibrillation, obesity, learning disabilities, smoking (totalling 655 points)
the organisational domain:
records and information, information for patients, education and training, practice management, medicines management (totalling 181 points)
the patient experience domain:
length of consultations, patient surveys (totalling 108 points)
the additional services domain:
cervical screening, child health surveillance, maternity services, contraceptive services (totalling 36 points)
a holistic care payment:
based on achievement across the clinical domain (totalling 20 points)
2.4 Annex 2 provides specific detail of the changes to individual indicators and highlights the 166 indicators that have been removed. There are 138 points for new work and 28 points have been redistributed amongst the existing indicator sets.
2.5 As part of Primary Care Organisations’ (PCOs’) clinical governance responsibilities, they should note that many of the removed indicators are part of good medical practice.
2.6 In light of 2004/05 achievement data, all lower thresholds will be raised to 40%. The upper threshold will remain at 90% for the majority of indicators. For those indicators with an upper achievement threshold of less than 90%, this will be raised in line with 2004/05 average achievement and expert advice.
2.7 As previously, participation in the QOF is entirely voluntary for General Medical Services (GMS) contractors.
2.8 Achievement against indicators will continue to be measured by the Quality Management and Analysis System (QMAS) or its equivalent. Further information about changes to QMAS or its equivalent will be available at a later date.
2.9 PCOs will need to make a manual calculation of QOF aspiration monies for 2006/07. This will need to reflect the change in overall available points in QOF from 1050 in 2005/06 to 1000 points in 2006/07. The aspiration payment can be calculated in one of two ways:
(i) for practices aspiring using the Aspiration Points Total method the method has not changed and is set out in the 2006/07 Statement of Financial Entitlement (SFE)
(ii) for practices aspiring using the 60% method, which is based on previous achievement, the aspiration payment will be calculated as normal and adjusted, as described in the 2006/07 SFE, to reduce it proportionally.
2.10 There will be no change to the mechanism for calculating the prevalence adjustment which is explained in chapter three of Delivering Investment in General Practice: Implementing the new GMS contract (Department of Health, December 2003) and Implementing the new GMS contract in Scotland (February 2004). However, due to the small numbers involved it has been agreed that palliative care points will not be adjusted by prevalence.
2.11 There will be no change to the criteria for exception reporting. New guidance will be issued to PCOs to assist them in their assessment of the appropriateness of the use of exception reporting during QOF visits and pre-payment verification. This guidance will be issued during 2006.
2.12 Delivering Investment in General Practice makes clear that PCOs should visit their contractors annually to review each contractor’s achievement against the QOF indicators. However the frequency and intensity of visits may decrease if the PCO is confident of the contractor’s performance against the QOF indicators, subject to the mandatory requirements for financial audit. Equally, the frequency of visits may increase where there is serious concern about data accuracy or quality of patient care.
2.13 PCOs in England are asked to note that guidance was released in 2005 to assist with the QOF review process. This guidance, “Establising Accuracy in QOF data” is available online .
2.14 PCOs in Scotland are asked to note that guidance was released in 2005 to assist with the QOF review process. This guidance, "Introduction to the QOF review: Guidance for practies" is available online .
2.15 During the QOF review the negotiators were supported by an expert panel, hosted by the University of Birmingham. It is anticipated that the expert panel reports will be published in spring/summer 2006.