Page last updated: 24-JUN-2008

QOF

National Statistics. Link to further information on National Statistics.Statistical Publication Notice

24 June 2008

Quality & Outcomes Framework (QOF) of the new GMS contract
National Prevalence Day Scotland-level prevalence estimates for 2007/08

INTRODUCTION

The Quality & Outcomes Framework (QOF) is a system to pay general practices for providing good quality care to their patients, and to encourage further improvement of the quality of health care delivered.  It is a fundamental part of the new General Medical Services (GMS) contract, introduced on 1st April 2004.

The QOF, which is a voluntary part of the new GMS contract, measures achievement against a range of evidence-based indicators, with points and payments awarded according to the level of achievement.  Prevalence data collected by general practices as QOF ‘registers’ forms an integral part of the framework in determining the level of payment awarded to individual practices.  Prevalence is a measure of how common a particular disease or condition is within a given population at one point in time.

This release reports the national prevalence of the individual diseases and conditions within the clinical domain of the QOF for 2007/08, as at “National Prevalence Day”, 14th February 2008.  These figures are calculated by QMAS, the IT system that supports QOF reporting, as part of payment calculations.  More detailed and revised final prevalence information, along with full achievement and exception-reporting information from the QOF for 2007/08 will be published on 30th September 2008.  This is to allow sufficient time for all practice data submissions for the 2007/08 year to be finalised and formally signed off.

KEY POINTS

  • The reported prevalence rates for hypertension (high blood pressure) and hypothyroidism have both risen gradually in each year since the introduction of the QOF in 2004/05.  The rate for hypertension has increased from 11.5% in 2004/05 to 13.1% in 2007/08.  Meanwhile the rate for hypothyroidism has risen from 2.8% to 3.2% over the same period.  These increases are likely to be due at least in part to improved case ascertainment by practices.
  • QOF-reported prevalence of Chronic Kidney Disease (CKD) stages 3-5 has risen to 2.5% from an initial figure of 1.8% for 2006/07.  An increase was expected, due to improved availability across Scotland in the clinical tests required to make the formal diagnosis of the stage of CKD.

INTERPRETATION

Prevalence rates reported from the QOF are  based on disease or condition ‘register’ data recorded in the payment calculation system (QMAS), as at a date referred to in the QOF as “National Prevalence Day”. National Prevalence Day is the 14th February in each year up to and including 2008.  This date is to change to the 31st March in 2009 to bring it into line with the date to which other elements of QOF data relate.

Individual practices submit their register sizes to the QMAS IT system.  QMAS then calculates a national prevalence figure from these cumulative totals.  It does so as long as at least 90% of practices nationally have been able to submit data for each individual register.  For the purpose of this publication the figures are shown as rates per 100 people.  The practice list sizes used as the denominator for these rate calculations are as at 1st January in each year.

Some QOF registers were subject to definitional changes between 2005/06 and 2006/07, with the result that prevalence rates for 2004/05 and 2005/06 are not directly comparable with prevalence rates for 2006/07 and 2007/08.   Other registers were newly introduced in 2006/07 and thus only two years of comparative data are available. This is discussed further where applicable to individual registers.

QOF prevalence data are of interest to a range of people including general practices, NHS Boards, governments, public health practitioners, researchers and charities.  They do need to be interpreted carefully, for example due to the way in which they are calculated. It should be noted that QOF prevalence rates are crude rates, calculated across all ages, with no adjustment made for variations in age profiles between different practices, regions or countries.  Furthermore, whilst some QOF registers are age-restricted (e.g. obesity, diabetes), QOF prevalence rates are calculated using the whole practice list size as the denominator.  This means that the prevalence rates in these instances are are lower than they would be if based on an age-restricted population denominator.

For 2004/05-2006/07, final figures are shown (based on signed-off, finalised data fro all available data from general practices).  Added to these are initial figures for 2007/08, as calculated within the QMAS system to support practice payment calculations. Final figures for 2007/08 will be published as part of ISD’s full report on the QOF for 2007/08 on 30th September 2008 and may differ from those published here.

DETAILED FINDINGS

Unchanged Registers (comparable over 4 years)
Seven QOF registers have maintained a consistent definition since April 2004. Directly comparable prevalence statistics across the first four years of the framework have been provided in the following areas: asthma, cancer, coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), hypertension, hypothyroidism and stroke and transient ischaemic attack (TIA).

  • The prevalence of CHD as reported by general practices through the QOF has remained constant over the 4 years, at 4.5%.
  • For COPD the figure has remained at around 1.8% since 2005/06.
  • Rates for asthma and stroke & TIA appear consistent with 2006/07, at 5.5% and 2.0%, respectively, although in both cases the figures are a little higher than in the first two years of the QOF.
  • The reported prevalence rates for hypertension (high blood pressure) and hypothyroidism have both risen gradually in each year since the introduction of the QOF in 2004/05.  The rate for hypertension has increased from 11.5% in 2004/05 to 13.1% in 2007/08.  Meanwhile the rate for hypothyroidism has risen from 2.8% to 3.2% over the same period.  These increases, as well as the increases for asthma and stroke & TIA, are likely to be due at least in part to improved case ascertainment by practices.
  • The QOF-reported cancer prevalence rate has also increased over each of the four years, from 0.5% to 1.1%.  This reflects the fact that the QOF cancer register is a cumulative register, required to count all patients diagnosed with cancer since 1st April 2003.  Therefore, this rise largely reflects an overall accrual of new cases in each passing year rather than indicating a true large increase in cancer prevalence.

New and Redefined Registers (comparable over 2 years)
The remaining fourteen QOF registers are comparable only over two years, 2006/07 and 2007/08.  In four cases this is because their definitions were changed between 2005/06 and 2006/07, these being diabetes mellitus, epilepsy, left ventricular dysfunction and mental health.  In the other ten this because the registers were introduced to the QOF for the first time in 2006/07.  These are atrial fibrillation, chronic kidney disease (CKD), dementia, conditions assessed for depression, depression, heart failure, learning disabilities, obesity, palliative care and conditions assessed for smoking.

  • In six cases, initial reported prevalence for 2007/08 has remained the same as the final figures calculated for 2006/07.  These are epilepsy (0.7%), Left Ventricular Dysfunction (0.6%), selected Mental Health conditions (schizophrenia, bipolar affective disorder, other psychoses; 0.8%), Atrial Fibrillation (1.3%), Heart Failure (0.9%) and patients in need of Palliative Care (0.1%).
  • For a further six registers, initial reported prevalence for 2007/08 has increased to at least a small degree relative to 2006/07 (diabetes, conditions for depression screening, CKD, learning disabilities, obesity, conditions assessed for smoking).  For the final two (dementia and depression), the initial figures for 2007/08, are very slightly lower than the final rates calculated for 2006/07.  More detail on each of these is given below.
  • QOF-reported prevalence of diabetes mellitus has increased from 3.5% in 2006/07 to 3.7%.  Whilst this may in part reflect improved case ascertainment by practices it is likely also to reflect a genuine increase in the occurrence of diabetes in the Scottish population.
  • The register for the depression 1 indicator counts patients with diabetes and/or CHD.  The indicator then measures whether patients with either or both of these conditions have been assessed for depression. The proportion assessed will be published in September.  Nationally, 7.2% of patients registered to general practices at 14th February 2007 had either diabetes, or CHD, or both.  This rose to 7.4% at 14th February 2008.  This can be explained largely by the rise in reported diabetes prevalence over the same period.
  • Reported prevalence of Chronic Kidney Disease (CKD) stages 3-5 has risen to 2.5% from an initial figure of 1.8% for 2006/07.  An increase was expected, due to improved availability across Scotland in the clinical tests required to make the formal diagnosis of the stage of CKD.
  • QOF-reported prevalence of learning disabilities has increased from 0.4% in 2006/07 to 0.6% in 2007/08. This is lower than estimates of overall population-based prevalence given in QOF guidance (around 2% across all ages).  However, not all such persons may become known to general practices.
  • Obesity rates reported by general practices (related to patients aged 16 or over with a body mass index of 30 or more) rose from 7.0% in 2006/07 to 7.4% in 2007/08.  Both figures are lower than the generally accepted rates of over 20% as shown elsewhere (for example, those summarised by the Scottish Public Health Observatory (ScotPHO) at www.scotpho.org.uk).  Some of this will be due to the fact that QOF prevalence rates use the whole practice population as their denominator and do not exclude patients aged less than 16, meaning that the prevalence rates are lower than they would be if this age group was excluded from the population denominator.  However, this will not account for a great deal of the difference.  Another likely reason is that not all persons who are definitionally obese may necessarily be recorded as such by general practices, for example if they are relatively young and have not experienced any particular health-related difficulties.  However, there is likely to be scope for case ascertainment of obesity by practices to improve over time.
  • The QOF includes an indicator to count patients assessed for smoking status with one of six chronic conditions, these conditions being CHD, stroke/TIA, hypertension, diabetes, COPD or asthma.  The prevalence rates based on this register cannot be used to calculate a national prevalence of smoking, rather they indicate how many patients have at least one of the six chronic conditions specified.  The proportion assessed for smoking will be published in September.  In 2006/07 the proportion of patients who had at least one of the six conditions was 20.4%, whereas the initial figure for 2007/08 had risen to 22.4%.  An element of this observed increase is likely to be the increase in the recorded rate of hypertension amongst practice patients.
  • Initial QOF-reported prevalence rates of dementia and depression have decreased slightly relative to 2006/07.  For dementia the overall rate has changed from 0.6% to 0.5%; for depression the figures are 6.2% and 6.1% for 2006/07 and 2007/08, respectively.  The change for dementia, although small, nonetheless seems contrary to expectations that further case ascertainment over time may lead to increases in reported prevalence rates of dementia from QOF registers.  However, the final figure for 2007/08 may possibly differ from the 0.5% calculated initially.

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MAIN CONTACTS:

Alistair Smith
Information Analyst
0131 275 6784
Alistair.Smith@isd.csa.scot.nhs.uk

Julie Kidd
Principal Information Analyst
0131 275 6450
Julie.Kidd@isd.csa.scot.nhs.uk

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GLOSSARY:

QOF
Quality and Outcomes Framework

Prevalence
Prevalence is a measure of the burden of a disease in a population (the number of cases in a defined population size) at a particular point in time (and is different to incidence, which is a measure of the number of newly diagnosed cases within a particular time period).

National Prevalence Day
The national prevalence estimate used in the payment calculations is based on prevalence data recorded in the payment calculation system (QMAS) as at a date referred to in the QOF as “National Prevalence Day”.

Registers
The numbers of patients within each of the QOF clinical indicator groups, as reported for National Prevalence Day.

CHD
Coronary Heart Disease

CKD
Chronic Kidney Disease

LVD
Left Ventricular Dysfunction

TIA
Transient Ischaemic Attack

QMAS
The Quality Management and Analysis System

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PRE-RELEASE ACCESS TO THIS PUBLICATION WAS GIVEN TO:

Scottish Executive Health Department - Policy and QOF leads
NHS Boards - individual QOF/GMS/Primary Care contracting lead(s)
Scottish GP Committee (SGPC)

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HISTORY OF THIS PUBLICATION:

Last Published: 25/09/2008
Next Due: Full 2007/08 achievement date and exception reporting data due for publication on September 30th 2008
Data Avaliable Since: 2004/05

 


Main contact: Email Alistair Smith