The QOF rewards practices for the provision of 'quality care' and helps to fund further improvements in the delivery of clinical care.
Practice participation in QOF is voluntary but most practices on GMS contracts, as well as many on Personal Medical Services (PMS) contracts, take part in QOF.
When QOF was first introduced as part of the GMS contract in 2004, the following principles were agreed on where QOF standards should apply:
- where responsibility for ongoing management of the patient rests primarily with the GP and the primary care team
- where there is evidence of health benefits resulting from improved primary care
- where the disease is a priority in a number of the four nations
For 2013/14 the QOF agreement in England is different to the agreements in Scotland, Northern Ireland and Wales.
How QOF works
QOF domains and indicators
The QOF has a range of national quality standards, based on the best available, research-based evidence covering four domains. Each domain has measures of achievement, known as indicators, against which practices score points according to their level of achievement. Practice payments are calculated on the points achieved and prevalence (see prevalence below).
The four domains are:
- Clinical - this domain has indicators across different clinical areas e.g. coronary heart disease, heart failure and hypertension.
- Public health (PH)- this domain has indicators across clinical and health improvement areas e.g. smoking and obesity.
- PH including additional services sub domain - this sub domain has indicators across the four service areas of cervical screening, child health surveillance, maternity services and contraceptive services.
- Quality and productivity - this domain has indicators aimed at securing a more effective use of NHS resources through improvements in the quality of primary care by rewarding reducing emergency admissions, reducing hospital outpatient referrals and reducing avoidable A&E attendances.
- Patient experience - this has an indicator on the length of patient consultations.
For 2013/14, there are a maximum of 900 points available to practices across QOF, which in turn determine payments. The key payment dates each year are:
- by 31 March - practices are paid retrospectively for points achieved in the previous year. For 2013/14 practices will be paid on average, £156.92 (in England) for each point they achieved. The value of a QOF point differs across Wales, Scotland and Northern Ireland.
- by the end of June - payments should be completed, although they can be made earlier when they have been agreed by the practice and NHS England.
Payments are subject to certain thresholds (targets) and take account of the national prevalence of diseases, by applying a standard calculation to all practices.
A practice's achievement payments, are based on the number of patients on each disease register, known as ‘recorded disease prevalence’. In certain cases, practices can exclude patients which is known as ‘exception reporting’ - more details are available in the Statement of Financial Entitlements. Strict criteria are used for this process and practices may be required to provide evidence of any patient that is ‘exception reported’.
The full set of indicators of achievement are outlined in the latest QOF guidance, published by NHS Employers, which is updated for each year.
QOF results are published annually for the following countries, by the following organisations: