PTI in relation to the Quality and Outcomes Framework (QOF)

QOF Clinical Domain Areas

The new General Medical Services (nGMS) contract came into effect in April 2004 and a significant element of this is the Quality & Outcomes Framework (QOF).  The QOF measures achievement by general practices against a range of evidence-based indicators. In 2004/05 and 2005/06 the management of ten common chronic conditions was included within the "clinical domain" of the QOF. For 2006/07 this was further expanded to include 18 diseases or health related coditions.

The information collected for QOF includes a prevalence estimate for each condition in each participating practice. These prevalence rates are available on the QOF pages of ISD's website at Scotland, NHS Board, Community Health Partnership (CHP) and practice level. PTI information can supplement prevalence information from the QOF by giving further insight into the contacts generated by the conditions, taking into account age, gender and levels of deprivation (as shown in the 'Information on specific conditions' section) and allowing the examination of co-morbidities, i.e. patients who have more than one chronic condition.

While the management of the chronic conditions included in the QOF accounts for a substantial part of the practice workload, the QOF by no means covers all conditions encountered in general practice. The figure below provides information on the relative number of contacts for any of the conditions included in the QOF in 2006/07, compared to other contacts. Note that if for one consultation both a QOF and a non-QOF condition were recorded, this consultation will be included in the QOF category only.

For GPs and practice nurses combined, 77% of the consultations relate to conditions other than those included in the QOF clinical domain; more than 80% for GPs and nearly 70% for practice nurses. That a relatively large percentage of the practice nurse workload can be attributed to QOF-related conditions is consistent with their increasing share in carrying out the routine monitoring of chronic conditions.

Defining the workload due to QOF-related conditions is somewhat imprecise and is different from workload strictly due to QOF. Our definition includes those contacts that specify a Read code included in either the QOF business rules (version 9), or in our own Read Code Groupings defining the conditions part of the QOF. Some Read codes listed in the QOF business rules are administrative codes (e.g. test results), which will likely not come up in the PTI analysis of face-to-face contacts. Any patients with these codes, but without activity or morbidity codes relating to this condition, will be missed (this is a particular issue with Chronic Kidney Disease). Conversely, some codes are specific to a condition but will not trigger inclusion on the QOF register. By chosing to use the union of both groups of Read codes, we aim to maximise the number of records included under the ?QOF-related conditions? category.

QOF related conditions ¹ - contacts as percentage of total contacts ²; 2006/07 ^3,4

¹ The diseases or health conditions included in the QOF clinical domain for 2006/07 are: asthma, atrial fibrillation, cancer, CHD, chronic kidney disease, COPD, dementia, depression, diabetes mellitus, epilepsy, heart failure, hypertension, hypothyroidism, learning disabilities, mental health, obesity, palliative care and stroke (incl. TIAs).
² "QOF contacts" are defined as consultations that mention a QOF-related condition. "Other contacts" are defined as consultations that do not mention a QOF-related condition. Any consultation that mentions both a QOF and non-QOF condition will be included in the QOF category only.
³ Based on 45 practices that submitted complete GP and practice nurse data for the year ending 31 March 2007.
⁴ Population source: Community Health Index (CHI) record, as at 30 September 2006.

Note: Following a substantial review of PTI data and subsequent revisions to the methodology for all PTI analyses, direct comparisons with figures produced prior to 27th March 2007 are not valid. See the Note of Revisions for further information.

Source: Practice Team Information (PTI), ISD Scotland (last updated 25 March 2008).



Related information:
Excel version of data for this chart   (25KB)
Co-morbidities of CHD, diabetes and Hypertension (chart)  
Comparison of PTI and QOF figures