Quality and Outcomes Framework. The data from QOF can be used to estimate the prevalence of diagnosed disease across Hull for a number of medical conditions and diseases using the population as the number of patients registered with Hull GPs. As just under 10% of all patients registered with Hull GPs live in East Riding of Yorkshire, it means that the prevalence does not wholly apply to Hull residents.
As part of the General Medical Services contract implemented in April 2004, the Quality Outcomes and Framework was set out as a means for practices to measure achievement against a set of clinical and other indicators that reflected the quality of care provided to their patients. GP practices have been submitting QOF data since this time. A national system has been established to support the calculation of GP practice payments according to the achievements against QOF. Some of the indicators or measures included in the QOF relate to establishing a register of patients diagnosed with a specific disease or medical condition. From this information, an estimate of the diagnosed prevalence of these specific diseases can be calculated for each GP practice. Patients can be on more than one disease register as the prevalence is reported for each practice separately for each medical condition or disease, and thus it is not known how many patients are on multiple disease registers. The Excel data tables can be downloaded from NHS Digital. Further information is available relating to the quality of care received by patients on the specific disease registers. For instance, the number of people on the diabetes register who have had retinal screening during the previous 15 months, the number of people on the coronary heart disease register in whom the last blood pressure reading (measured in the last 15 months) was 150/90 or less, the number of patients on a specific medication, the percentage of patients with coronary heart disease who have had their influenza vaccination, etc. Patients can be counted as ‘exceptions’ if there is a medical reason for them not to have that specific treatment or intervention. There are a number of reasons why patients can be made an ‘exception’ from specific quality of care measures. These include medical associated reasons such as experiencing side-effects of specific medications, or on other medications more suited to that patient due to multiple medications taken, but patients can also be made an ‘exception’ when they are invited to three review or annual check appointments and fail to attend. These ‘exceptions’ are allowed so that practices are not penalised financially on not achieving set levels for the quality of care measures due to influences outside their control. Practice targets relate to achieving a specific percentage of patients who have had the intervention or care measure after ‘exclusions’ have been removed. However, in terms of examining coverage, it is often useful to report on the percentage of patients having the intervention out of the entire patient population diagnosed with the condition. On the 1st April 2019, exception reporting was replaced with the Personalised Care Adjustment (PCA) which essentially did the same thing as exception reporting in that practices were not penalised for not achieving a target when that indicator was not appropriate for that patient or the patient did not attend or refused the medication. The PCA records patients as unsuitable, refusal through patient choice following a discussion with the patient, patient not attending review appointments, that the indicator was a limited service (not available to all but this only applies to a small number of indicators), or that the patient was newly diagnosed (so, for example, had not yet had a review appointment to discuss medication).
The national QOF data files for each financial year ending April are generally available around November, and in some years previously, some practices have since closed or merged with another practice in Hull in the meantime. As a result, the most recent data for Hull is generally presented as the practices that exist at the time of the analysis (with QOF data from merged practices combined). This generally relates to a small number of practices, but for the financial year 2016/17 a large number of practices merged during or just after the end of the financial year. For this particular financial year, this resulted in errors in relation to the results for Hull as a whole (Hull’s Clinical Commissioning Group), although this is only relevant when examining trends over time. Due to the way in which the QOF data was defined and presented (with list size data extracted on the 1st April 2017 and the prevalence data extracted on the 6th July 2017) and the high number of practices that merged during or just after the financial year 2016/17, the list size within the national QOF data file was artificially inflated for Hull as some practices were included when they had already merged with another (and closed). The ‘true’ list size as at 1st April 2017 from the April 2017 GP registration file is 295,969 registered patients. However, for the purposes of reporting the 2016/17 QOF data, a denominator of 292,167 (3,802 lower) has been used as two practices have been excluded (they had data within the April 2017 GP registration file (i.e. they had registered patients at the time), but the practices did not have any QOF data or the QOF prevalence data was zero).
Some of the points that were assigned from achieving specific levels of quality of care targets were subject to income protection during the COVID-19 pandemic so that practices were not penalised financially during this time. The total points available to practices was 567 in 2020/21, and 354 (62%) were subject to income protection based upon historical practice performance and to practices agreeing an approach to QOF population stratification with their commissioner. The four indicators relating to flu coverage for patients with coronary heart disease, chronic obstructive pulmonary disease, stroke / transient ischaemic attack, and diabetes, two cervical screening indicators, and the disease register indicators continued to be paid based on practice performance as well as some quality improvement indicators.
NHS Digital. Quality and Outcomes Framework. https://qof.digital.nhs.uk