Frequently Asked Questions (FAQs)
Q. I see you publish figures on the numbers of patients on practice QOF registers (for example diabetes) and the numbers of patients included in QOF indicator measurements. Can I have this information broken down further, for example by patient age or gender, or by sub-type of disease (such as type 1 versus type 2 diabetes)?
A. No. The register and other QOF indicator data submitted by practices in order for their QOF achievements and payments to be calculated is in aggregated form only. We can not break it down into any more detail than published here.
Q. Can the register for the QOF smoking indicators (or other information on these indicators) be used to measure the overall population prevalence of smoking?
A. No. QOF data can not be used to measure the overall population prevalence of smoking. A longer explanation of why this is follows below.
There are two smoking indicators in the QOF. The short names for these indicators, from 2008/09 onwards, are smoking03 and smoking04. These are designed to measure whether practices have recorded the smoking status in patients with one or more of a list of chronic conditions and/or mental health conditions, and then if applicable offered them smoking cessation advice.
Both indicators require that practices keep a register of the patients covered by these indicators. The register, although called the smoking register in GMS contract documentation, actually counts patients who have one or more of a list of chronic and mental health conditions. This is why, in ISD’s QOF publications, we have referred to this register as the "Conditions assessed for smoking" register and NOT as the “smoking” register.
What the indicator smoking03 measures is the proportion of patients with one or more of the listed chronic conditions/mental health conditions who have had their smoking status recorded by the practice. This can include patients that the practice ascertains are non-smokers. Therefore smoking03 does not indicate a prevalence of smoking, as non-smokers can be counted in the indicator numerator, and as patients who are smokers but do not have one of the listed conditions are not included in the indicator denominator.
The indicator smoking04 then measures, amongst the subset of the above patient group who have been recorded as being smokers, the proportion of patients who have been offered smoking cessation advice. The denominator for this indicator is therefore comprised of patients who smoke, but it does not count all smokers in the practice, only some of them. It does not count patients who smoke but do not have at least one of the chronic conditions/mental health conditions listed. Furthermore, some patients who do have one or more of the listed conditions and are also smokers may still not be counted in the denominator for smoking04. This is because patients can be exception-reported from the indicator (that is, not included in denominator or numerator counts). This can be, for example, because the patient refuses to attend the practice for a review or because they registered with the practice only a couple of weeks prior to the end of the QOF year (31st March).
Overall, whilst the QOF indicators smoking03 and smoking04 (and their predecessors in previous years - smoking01 and smoking02) reward practices for measuring smoking status in certain high-risk patients and for offering smoking cessation advice where appropriate, the data gathered to support measurement of achievement against these indicators does not provide an overall indication of smoking prevalence in the practice's patients.
More detailed information on the QOF smoking indicators is available via our Links section on our QOF home page.
Q. Could I make a league table to show which practices, NHS Boards, or CHPs provide the best care or the worst?
A. Levels of QOF achievement will be related to a variety of local circumstances, and should be interpreted in the context of those circumstances. Users of the published QOF data should be particularly careful in undertaking comparative analysis. Some of the reasons for this are discussed below.
- QOF points do not reflect practice workload issues, for example around list sizes and disease prevalence. QOF payments include adjustments for these factors.
- QOF achievement and prevalence do not take into account the underlying social and demographic characteristics of the populations concerned. The delivery of services may be related to, for example, population, age/sex breakdown, ethnicity or deprivation characteristics, as well as large student populations, number of drug users and homeless populations. These factors are not included in QOF data collection processes.
- QOF achievement could be affected by local circumstances around general practice infrastructure. In undertaking comparative analysis, users of the data should be aware of any effect of the numbers of partners (including single handed practices), local recruitment and staffing issues, issues around practice premises, and local IT issues.