Quality Outcomes Framework

The Quality and Outcomes Framework (QOF) aims to deliver substantial financial rewards for high-quality care. This page gives an overview of QOF and agreed changes for 2009/10 and 2008/09.

The QOF framework sets out a range of national standards based on the best available research evidence. The standards are divided into four domains:

• clinical standards linked to the care of patients suffering from chronic diseases
• organisational standards relating to records and information, communicating with patients, education and training, medicines management and clinical and practice management
• additional services, covering cervical screening, child health surveillance, maternity services and contraceptive services
• patient experience, based on patient surveys and length of consultations

A set of indicators has been developed for each domain to describe different aspects of performance. Practices are free to choose the domains that they want to focus on.

Changes to QOF 2009/10

NHS Employers and the General Practitioners Committee have agreed to reallocate 72 Quality and Outcomes Framework (QOF) points to five clinical areas, to reward practices for delivering a range of new services for patients.

The five clinical areas are:

• helping to prevent the development of cardiovascular disease in people diagnosed with high blood pressure - 13 points
• improved advice and choice on contraceptive methods - 10 points
• a new indicator for depression to reduce early cessation of treatment - 20 points
• improvements to the indicators for chronic kidney disease (11 points), diabetes (7 points) and chronic lung disease (2 points) - totalling 20 points
• improved drug treatment for people with heart failure - 9 points

We have produced more detailed information for primary care trusts and practices.

FAQs to support local handling

We will continue to develop the FAQs in response to trust queries about the contract changes.

What impact with the change in the prevalence have on practices and primary care organistions?

It is recognised that a small number of practices may experience a significant reduction in their current QOF income following changes to how we calculate QOF payments. The health departments will be issuing the following guidance to trusts:

Primary care organisations should work with practices which identify themselves as experiencing a significant loss in their income to understand the impact of the changed arrangements on their current service provision.

Primary care organisations will also wish to use the opportunity to consider the local health needs of populations and, working with local medical committees and practices to identify whether new services or improvements in care should be commissioned to address these local needs.

Changes to QOF 2008/09

The agreed changes to the Quality and Outcomes Framework (QOF) for 2008/09 are outlined in the detailed guidance document. The key changes are:

• recycling 58.5 Quality and Outcomes Framework (QOF) points to incentivise access (48 hour and advanced booking) based on patient satisfaction. This will be measured by the new national patient survey
• a small number of changes to the evidence base for some existing indicators

NHS Employers has also produced a brief overview of the changes for PCTs.

Changes to financial and accounting arrangements for QOF 2008/09

National Prevalence Day

This will move to the 31 March from 31 March 2009 onwards, so that prevalence is calculated on the same basis as disease registers for indicator denominators.

Calculating year-end payments

The deadline for year-end achievement payments will be extended to the end of the first quarter of the financial year, following the year in question. This is to give PCTs more than one month to carry out appropriate pre-payment verification checks. To compensate for any effect on cash-flow for contractors, aspiration payments made during 2008/09 will increase from 60% to 70% of achievement in 2007/08.

Calculating QOF payments for mid year practice splits

Currently, if a contract ends mid-year, there is no procedure in the Statement of Financial Entitlements (SFE) for adjusting the payment for prevalence until the end of the financial year. The negotiating partners have agreed to give PCTs the flexibility to cash up on the date that the original contract ceased. PCTs should follow the procedure set out in Delivering Investment in General Practice (chapter 3, section F, paragraph 3.64). The achievement payment made at the end of the original contract would be adjusted for prevalence on the basis of the previous year's prevalence. If there is no previous year figure, then the payment would not be adjusted by prevalence