Maximising your QOF income: Rheumatoid arthritis

Updated November 2022

Summary – indicators and value

• Indicators: 2
• Points: 6
• Prevalence*: 0.6%
• £/patient on the register (estimated): £21

*Prevalence is an estimate based on latest available QOF data and current trends. For further explanation read more details here.

Background

A relatively recent addition to the QOF, rheumatoid arthritis has maintained a steady prevalence over the few years that we have been recording data.

Indicator 1: maintain patient register (1 point)

There are many diagnostic codes for rheumatoid arthritis and they will all put patients on to the register, along with codes for rheumatoid disease of the heart and lungs. In order to exclude juvenile arthritis, only patients of 16 years of age and over are included on the register. Patients diagnosed at an earlier age will be automatically put onto the register on their 16th birthday.

There is no way to remove patients from the register and patients will still remain eligible for the review indicator if the disease is in remission or has burnt out.

Tips:

• The diagnosis is usually made in secondary care so have a system for coding up from letters.
• Searching for immunosuppressant drugs may identify any patients who have missed a diagnosis

Indicator 2: annual face-to-face review (5 points)

There is a specific code for rheumatoid arthritis review and the full five points will be awarded if 90% of patients have had the review during the QOF year. The review should include recording symptoms, current treatments and the need for any further referrals.

There are specific codes for exception reporting (now termed ‘personalised care adjustment’) for informed dissent and unsuitable patients for the rheumatoid arthritis area, and the usual automatic exception for patients who have registered with the practice, or received their first diagnosis in the last three months of the QOF year.

Tips:

• It is not unusual for treatment to be largely in secondary care so inviting patients for review early in the year gives the best opportunity to ensure that the review takes place.
• If the patient does not attend after three invitations, they can be exception reported for informed dissent.
• The guidance does not state who should undertake the review but it should include the effects of the disease on their life and appropriate referral across the multidisciplinary team. In some areas this could be by a specialist rheumatoid team in either primary or secondary care.

Dr Gavin Jamie is a GP partner in Swindon and runs the QOF database website

Further reading/resources

• NHS England – Quality and Outcomes Framework guidance for 2022/23. Published 31 March 2022.

­­­­­­­­­­­­­­Full indicators

Indicator 1: The contractor establishes and maintains a register of patients aged 16 or over with rheumatoid arthritis (RA001; 1 point)

Indicator 2: The percentage of patients with rheumatoid arthritis, on the register, who have had a face-to-face review in the preceding 12 months (RA002; 5 points)