As part of the 2011/12 GMS contract changes, NHS Employers and the General Practitioners Committee (GPC) agreed a number of changes to the quality and outcomes framework (QOF) effective from 1 April 2011.
The key changes were:
- the retirement of 12 indicators (CH5, CHD7, DM5, DM11, DM16, STR5, MH7, EP7, Information 4, Records 21, PE7 and PE8) releasing 92.5 points to fund new and replacement indicators
- the replacement of 13 indicators with 17 new NICE recommended indicators focusing on eight clinical areas namely CHD, CVD-PP, Diabetes, Mental Health and Depression
- the introduction of three new NICE recommended clinical indicators one each in the Epilepsy, Learning Disabilities and Dementia indicator sets
- the introduction of eleven new organisational indicators for improving Quality and Productivity.
Quality and productivity indicators
The eleven quality and productivity (QP) indicators were agreed for 2011/12 only. They were aimed at securing a more effective use of NHS resources through improvements in the quality of primary care by rewarding more clinically and cost-effective prescribing, reducing emergency admissions by providing care to patients through the use of alternative care pathways and reducing hospital outpatient referrals. It was agreed that these indicators may be extended for a second year if significant progress had been made in achieving productivity savings at the mid-year point.
For information on which indicators were extended, see Changes to QOF 2012/13.
Quality and productivity prescribing indicator achievement
In England, ePACT data to measure achievement was made available on 17 May 2012. PCTs should use the ready reckoner (or formula on page 166 of the 2011/12 QOF guidance) to calculate the points achieved for each of their practices.
Due to the additional time required by PCTs to calculate achievement for a number of practices, practices should not delay signing off QMAS (approving and declaring achievement), as a PCT could withhold an achievement payment if QMAS has not been signed off. Early sign off will enable PCTs to complete pre-verification checks before payment is due. In particular practices do not have to wait until they receive their QP3 – QP5 results to sign off QMAS, as signing off QMAS does not prevent a practice from appealing their QP3 – QP5 results or raising a dispute.
Step by step process
1. Practice signs off QOF achievement (approves and declares achievement) for QOF 2011/12 on QMAS minus the QP3,4 and 5 results which only PCTs can input. This enables PCTs to carry out pre-payment verification checks.
2. In order to make sure that QOF payments are made by end June, PCTs may need to generate advance payments for QOF achievement on Exeter (not through QMAS) based on rest of QOF achievement plus an estimate of the QP3, 4 and 5.
3. PCTs await the ePACT results, calculate the actual prescribing achievement using the ready reckoner and input final results in QMAS.
4. QMAS calculates the final achievement payment and this generates the correct payment through QMAS. If the PCTs made an advance payment on Exeter, they need to recover the amount through an equivalent negative ad-hoc variance.
In Wales, it has been agreed that full achievement of the prescribing indicators will be paid on 30 June and any overpayments would be recovered at end of July/August.
In Scotland, practices and PCO’s have been informed that the last quarter data will be available at the end of May/early June 2012, as such they will work towards an aspirational payment for the end June 2012 with top up/claw back in the next quarter once finalised data is available. For full details, please see the October 2011 QOF update.
In Northern Ireland, there are currently no issues relating to the availability of the data required to calculate the achievement for QP3 – QP5.
In addition to the above, a number of other changes were agreed as follows:
- Changes to the points values for the following indicators:
- DEP1 - reduced by two points to six points (in addition, the points value for DEP4 has been reduced by eight points and DEP5 reduced by 12 points as part of wider negotiations).
- BP4 - reduced by two points to 16 points.
- The upper thresholds of the following indicators were increased by one percentage point:
- CHD6 is now 40–71 per cent
- Stroke 6 is now 40–71 per cent
- COPD1 was been renumbered to COPD14 following a change in the diagnostic threshold as per the updated NICE guideline.
- COPD12 was been renumbered to COPD15 in recognition of a coding change to include new codes for post bronchodilator spirometry and the removal of the reversibility testing codes.
- Mental health indicator level ‘remission exclusion codes’ were introduced from 1 April 2011. Please see the mental health section of the QOF guidance for full details.
- The MH6 business rules logic was updated in recognition of the ‘unbundled’ care review indicator (previously MH9) and the inclusion of the ‘remission exclusion’ codes, to ensure that the care plan is still reviewed annually and updated following a patient’s relapse from remission.
Please see ‘Summary of 2011/12 QOF indicator changes’ for a breakdown of indicator wording, points and thresholds.
Quality and productivity guidance
NHS Employers and the GPC published joint supplementary guidance for the 2011/12 QOF quality and productivity (QP) indicators. This guidance applied in England only and was intended to assist Primary Care Trusts (PCTs) and practices in understanding and working through the new QP indicators.
A ready reckoner is available to help PCTs calculate the point achievement for the prescribing indicators QP3 to QP5. To access this file please select save when prompted and save it to your PC before opening it.
In April 2011, NHS Employers, the GPC and four UK Heath Departments published the UK wide 2011/2012 QOF guidance which set out the requirements for the QP indicators. This supplementary guidance as well as the additional guidance already published in Wales and Scotland is in addition to the guidance contained within the UK wide QOF guidance.
QOF frequently asked questions
NHS Employers and the GPC published joint QOF frequently asked questions (FAQs) for use by primary care organisations and general practice. These FAQs apply across all four countries and cover a number of historical issues and commonly asked questions.
The QOF queries process is clearly outlined in this FAQs document and we ask that this document is consulted before any queries are raised with the relevant parties.
Chronic kidney disease frequently asked questions
NHS Employers and the GPC updated the chronic kidney disease (CKD) frequently asked questions (FAQs) on diagnosing and managing CKD, for use by primary care organisations and general practice. The updated version takes in to account the latest available evidence in line with the NICE guidelines for this disease area.
Typo in the 11/12 QOF guidance
A typo was discovered in the ‘Quality and Productivity 3.2 reporting and verification’ section in paragraph 4 (page 167). The date on the second line incorrectly stated ‘31 December 2011’, this date should read December 2010.
The achievement for QP3 to QP5 will be compared against the third quarter of the previous financial year. As such the calculation will be made based on the achievement for the quarter ending on 31 December 2010.
The error has been corrected in the QOF guidance and the updated version is now available.
This error is also mirrored in the Statement of Financial Entitlements which will be updated by the Department of Health and an amendment will be issued.
Download the detailed QOF guidance.
For details on the business rules process please see the ‘Developing the QOF Business Rules’