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Quality and Outcomes Framework

19th February 2007

What is the Quality and Outcomes Framework (QOF) for GPs - why was it introduced and how does it work?

consultant1

1 What is QOF?

The Quality and Outcomes Framework (QOF) is part of the General Medical Services contract for general practitioners and was introduced in April 2004. It rewards general practices financially, according to their level of achievement in:

• Caring for patients with certain chronic diseases.

• Practice organisation / management.

Participation by practices in the QOF is voluntary, but most practices choose to participate.

2 How does QOF work?

‘The QOF is intended to measure, encourage and support clinical care and a patient experience which is constantly improving’ – Primary Care Contracting

The process measures practice achievement against a range of evidence-based clinical indicators and a set covering practice organisation and management. Practices score points according to their levels of achievement against these indicators, and practice payments are calculated from points achieved.

Each practice is reviewed annually by a small team, comprising the PCT QOF lead, a GP and a lay person / patient representative. The purpose of the visit is to review:

• Progress / achievements of previous and current year.

• Data collected for QOF.

• Examples of good practice.

It also seeks to reflect the principles of continuous improvement, learning and development.

3 What are the QOF indicators?

The QOF measures the practice’s achievement against 146 indicators, plus 3 measures of breadth of care. Practices score points on the basis of achievement against each indicator, up to a maximum of 1050 points.

QOF comprises the following four domains:

Clinical (Up to a maximum of 550 points.)

This covers 76 indicators in 11 chronic disease areas:

o Coronary heart disease

o Left ventricular disease

o Stroke or transient ischemic attack

o Hypertension

o Diabetes

o Chronic obstructive pulmonary disease

o Epilepsy

o Hypothyroidism

o Cancer

o Mental health

o Asthma

Organisational (Up to a maximum of 184 points.)

This covers 56 indicators in 5 areas:

o Records and information about patient

o Patient communication

o Education and training

o Practice management

o Medicine management

Patient experience (Up to a maximum 100 points.)

This covers 4 indicators in 2 areas:

o Patient surveys

o Consultation length

Additional services (maximum 36 points.)

This covers 10 indicators in 4 areas:

o Cervical screening

o Child health surveillance

o Maternity services

o Contraceptive services

The QOF also rewards breadth of care through:

• Holistic care payments that measure overall clinical achievement
(Up to 100 points.)

• Quality practice payments which measure overall achievement in the organisational, patient experience and additional services domains
(Up to 30 points.)

• Achievement in delivering the access standards. (Up to 50 bonus points.)

4 What is QMAS?

The data required to manage this complex assessment is collected in a national database system called the Quality Management Analysis System (QMAS). It was developed by NHS Connecting for Health to ensure consistency in the calculation of quality, achievement and prevalence. Although QMAS is primarily used to determine QOF payments, it also gives GP practices, PCTs and SHAs objective evidence and feedback on the quality of care delivered to patients.

Each participating practice needs to collect QOF data and submit it to the QMAS database. This is achieved in one of the following ways:

• The data to support the clinical quality indicators (i.e. clinical achievement data) can be extracted from individual practice GP clinical systems and sent automatically to QMAS once a month.

• Organisational, access, patient experience and additional service indicators can be entered by the practice directly into QMAS via a web-browser over NHSnet.

• Data from practices without QMAS-compliant systems can be manually entered into QMAS by PCT staff.

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