General Practice - Quality & Outcomes Framework
Page last updated: 25-SEP-2007
General Practice - Quality & Outcomes Framework
Statistical Publication Notice
25 September 2007
Quality & Outcomes Framework (QOF) of the new General Medical Services contract. Achievement, exception reporting and detailed prevalence data 2006/07
INTRODUCTION
Published here are Scotland?s Quality & Outcomes Framework (QOF) data for 1st April 2006 ? 31st March 2007. The Quality & Outcomes Framework (QOF) is part of the new General Medical Services (GMS) contract, and was first introduced in 2004. It is designed to remunerate general practices for providing good quality care to their patients, and to help fund work to further improve the quality of health care delivered.
The QOF measures a general practice's achievement against a scorecard of evidence-based indicators. These indicators are grouped into four ?domains?: clinical, organisational, patient experience and additional services. The QOF was revised significantly for 2006/07, its third year. The biggest changes to the QOF are in the clinical domain. The framework now includes indicators for a wider range of health conditions than was the case previously. Furthermore, many of the conditions already included have had indicators introduced, changed, or dropped.
Data presented include points and payments achieved by each participating practice, for individual indicators and indicator groups, as well as prevalence rates for selected health conditions, drawn from QOF registers.
The release also includes information on exception reporting in 2006/07. Exception reporting allows practices to pursue the quality improvement agenda and not be penalised where, for example, patients do not attend for review, or where a medication cannot be prescribed due to a contraindication or side-effect. Exception reporting is a specialist area of the QOF and separate explanations of this are given on a page specifically covering this area.
KEY POINTS
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The structure of the QOF was revised significantly for 2006/07, reflecting agreement between the four UK Government Health Departments and The General Practitioner Committee of the British Medical Association as part of the 2006/07 GMS contract review.
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Across all participating Scottish practices with new GMS contracts, the mean number of points achieved was 970.2, out of a maximum 1000 points now available. Due to changes in the framework for 2006/07, overall points achieved can not be compared directly with totals in previous years.
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Payments associated with the QOF in 2006/07 totalled approximately £128.3 million, compared with £134.5 million in 2005/06. The difference between the two years is largely due to changes in the number of points and amount of money available to practices through the QOF, and the reallocation of this funding to a different part of the new GMS contract.
INTERPRETATION
1. There have been significant changes to the QOF for 2006/07, compared to previous years
As the QOF was revised significantly for 2006/07, its third year, direct comparisons can not be made between overall achievement in 2006/07 and achievement in the two previous years. This also applies to attempts to make comparisons between achievement in many of the individual areas within the QOF. However, careful comparisons could be made of achievement against individual indicators that have not been subject to definitional changes.
2. Achievement of full points may not be possible or desirable for some practices.
Participation in the QOF is voluntary; practices may aspire to achieve all, some, or none of the points available. Additionally, whilst most Scottish practices with new GMS contracts have participated fully in the QOF, it is important to note that for some of them it may be impossible to achieve all of the points available in the framework. For example, some of the clinical indicators relate to very specific subgroups of patients, and if the practice does not have any patients in that particular subgroup, they cannot score any points against the relevant indicator(s).
Practices with contract types other than GMS may include quality and outcomes as part of their locally negotiated agreements, and in many cases, they opt to use part or all of the new GMS QOF as a measurement tool. However, it is possible to tailor the quality and outcomes requirements of a ?Section 17C? or ?2C? practice agreement in accordance with local circumstances ? such as the needs of a particular group of patients. Such practices might use quality measures that, although rigorous and appropriate, are not identical to those used in the GMS QOF. Therefore, although 17C/2C practices may record full QOF data if they wish, they may deliberately use only part of the QOF, or may not use it at all.
3. Prevalence rates derived from QOF registers need care in their use and interpretation.
Apparent rates or changes in rates are influenced by how QOF registers are defined. For example, they may apply only to a specific subset of patients such as those over a certain age or diagnosed with a condition during a specified time period. QOF prevalence rates are used as an indication of relative workloads in the relevant area, and may differ from prevalence rates derived from other data sources. Furthermore, when new registers are introduced to the QOF, as has been the case for 2006/07, the numbers seen in the first year should be regarded as reflecting work in progress, and likely to settle more in future years.
DETAILED FINDINGS
1. There have been significant changes to the QOF for 2006/07, compared to previous years
In 2004/05 and 2005/06 practices could score up to a maximum of 1050 points across 146 indicators. For 2006/07, this was revised to a maximum of 1000 points across 135 indicators, reflecting agreement between the four UK Government Health Departments and The General Practitioner Committee of the British Medical Association as part of the 2006/07 GMS contract review.
Many of the changes were to indicators in the clinical domain. New health conditions and indicators were agreed, whilst various indicators for health conditions already included, were amended or dropped. Amendments included changes to the exact definitions of the indicators, changes to the numbers of points available, and increases in the thresholds that practices had to exceed in order to receive at least some points and payment for the indicator. In brief, the biggest changes applied to the following clinical areas:
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Eight clinical areas were included in the QOF for the first time in 2006/07, these being Atrial Fibrillation (a heart rhythm disorder), Chronic Kidney Disease (CKD), Dementia, Depression, Heart Failure, Learning Disabilities, Obesity and Palliative Care.
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Nine clinical indicator groups were amended, these being Asthma, Cancer, Chronic Obstructive Pulmonary Disorder (COPD), Diabetes, Epilepsy, Mental Health, Smoking indicators and Stroke & Transient Ischaemic Attack
Included in the original QOF but removed for 2006/07 were 50 ?Access Bonus? points. These points were awarded to practices if they could consistently offer their patients access to a GP, nurse or other healthcare professional within 48 hours, when clinically appropriate. Whilst the access bonus points were removed from the QOF at the end of March 2006, the requirement that practices demonstrate 48-hour access was formalized as a Directed Enhanced Service (Enhanced Services are another part of the new GMS contract, separate from the QOF).
2. Commentary on achievement in 2006/07
Achievement in the clinical indicator groups was generally very high. Across all practices with new GMS contracts, the percentage of available points achieved was highest for the hypothyroidism indicator group, at 99.9% (with a current maximum 7 points per practice). This condition, a failure of the thyroid gland to function properly, has been included in the QOF since its first year, 2004/05. The overall percentage of available points achieved was lowest in the depression indicator group, at 84.6% (with a maximum 33 points per practice). Depression indicators were newly introduced to the QOF for 2006/07. In the mental health indicator group, which was revised for 2006/07, the corresponding figure was 90.8% (with a current maximum 39 points per practice). The overall percentages of points achieved for the other clinical indicator groups are as follows:
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Asthma ? 97.4%
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Atrial Fibrillation ? 98.0%
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Cancer ? 97.8%
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CHD ? 99.0%
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Chronic Obstructive Pulmonary Disease (COPD) ? 97.3%
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Chronic Kidney Disease (CKD) ? 98.8%
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Dementia ? 98.1%
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Diabetes ? 98.9%
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Epilepsy ? 96.2%
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Heart Failure ? 97.0%
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Hypertension (high blood pressure) ? 99.0%
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Palliative care ? 96.2%
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Conditions assessed for smoking status ? 98.7%
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Stroke & transient ischaemic attack ? 98.6%
Achievement in the other indicator groups was similarly high overall. Across all practices with GMS contracts, 98.5% of all available points were scored in the additional services domain, which includes indicators relating to cervical screening, child health surveillance, contraceptive services and maternity services. Corresponding figures for the organisational domain (covering record keeping, education and training, practice management and medicines management) and the patient experience domain (relating to patient consultations and surveys) were 95.4% and 97.8%, respectively.
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MAIN CONTACTS:
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PRE-RELEASE ACCESS TO THIS PUBLICATION WAS GIVEN TO:
Scottish Executive Policy Leads
NHS Boards ? QOF/General Medical Services Leads and Chief Executives
Scottish GP Committee (2 days prior to release only)
NHS Boards ? QOF/General Medical Services Leads and Chief Executives
Scottish GP Committee (2 days prior to release only)
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HISTORY OF THIS PUBLICATION:
Last Published: September 2006 (achievement data) February 2007 (exception reporting data)
Next Due: September 2008
Data Available Since: 2004/05 is the earliest year available as this was the first year for which the QOF existed
Main contact: 
Julie Kidd
Julie Kidd
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