QOF Enhanced Services

How to prioritise your work alongside Covid vaccinations

GP partner and PCN co-lead Dr David Coleman offers advice on how to manage workload priorities alongside the major Covid vaccination programme in keeping with current guidance

General practice’s continued commitment to managing the COVID-19 pandemic, particularly the profession’s major role in the vaccination campaign, has once again led NHS England to recommend a pragmatic approach to workload prioritisation and the assessment of QOF achievements this year. 

This article will dissect the recommendations and offer advice on how to apply the guidance in the coming quarter.

QOF changes – use freed up time to plan ahead

This month’s letter from NHS England about workload prioritisation1 confirmed that ‘the Quality Improvement domain within QOF will be protected in full at 74 points per practice until March 2021’. This follows earlier advice to reduce the requirements of the QI domain.

I would still recommend completing the reporting templates and submitting them, as they are light touch and a lot of this work will have already been completed. However, I would not recommend organizing any further meetings to address the QI domains if these haven’t yet occurred.

All other QOF indicators are income protected, with the notable exception of ‘those related to flu vaccination and cervical screening, and register maintenance’. 2

This makes sense; practices should still be attempting to maximise uptake of flu vaccine – there is obviously a major public health reason, not to mention additional non-QOF income attached to this too.  In addition, cancer screening remains critical, especially in light of data showing that cancer referral rates have dropped during the pandemic.

As was the case last year, practices are to be paid based on historical achievement for the majority of indicators. Unlike last year, payments will be adjusted for 2020/21 list size.

If you can, use some of the breathing space to look ahead to next year’s QOF. Although we are extremely busy at the moment, it may be possible to find a session or two to reflect on what has worked this year in terms of remote consulting, SMS messaging and digital booking, with a view to revamping your recall systems for the post-Covid age. 

For example, our practice has decided we will be integrating more AccuRx questionnaires and trialling online videos to offer some of our more generic advice digitally – for example, dietary advice and statin discussions for patients with QRISK between 10-20%.

Make use of the LES / DES changes where possible

The priority is Covid vaccination and services directly related. Local commissioners have been asked to suspend enhanced services not related to this priority area; if a service in your area hasn’t been paused, or if you haven’t had written confirmation, please speak to your commissioners for clarification and seek support from your LMC if needed.

The minor surgery DES will be income protected for the final quarter of the financial year (January to March inclusive).  We have taken a decision to continue to offer joint injections for symptomatic relief, but have paused all other procedures.

Follow BMA/RCGP workload prioritisation advice

A joint document from the BMA and RCGP3 has drilled down a little further to offer practical advice on what to prioritise and where time savings can be made.  As GPs, we often bemoan a lack of specifics in guidance from above, so this is very welcome.   

The document applies a traffic light system, with green indicating work that should continue regardless of Covid, and red indicating workload areas that are lower priority and could be adjusted or stopped.

This is summarized as follows and offers a good framework for you to adjust priorities according to your local demands:

Green (High Priority work)

  • Urgent care / acute illness
  • Chronic disease management – particularly diabetes (HbA1c >75), mental health, poorly controlled COPD/asthma
  • Cancer care and screening
  • Wound management
  • Essential blood tests (eg, INR for warfarin, shared care bloods)
  • Vaccinations
  • Baby and post-natal checks
  • Essential injections

Amber (Medium priority work)

  • Complaints – consider a standard response with a formal response to follow post-Covid
  • Contraception – consider POP instead of depot/LARC; consider extending pill review periods
  • B12 injection for post-bariatric surgery patients

Red (Low priority work)

  • Coil checks/change – consider POP instead
  • Non-urgent checks/screening – eg, new patient medical, NHS health checks
  • Minor surgery
  • Ring pessaries
  • Ear syringing
  • Routine investigations that won’t impact treatment e.g. annual ECG, spirometry
  • Vitamin B12 injection – consider conversion to oral therapy or self-administration

However, you may find offloading some work only creates more problems. At our practice, we reduced B12 injections in the first wave and found it even more time consuming managing the fallout. As a compromise, we bought a gazebo and now administer these outside in short B12 clinics. We will continue to do this as it is slick, efficient, low-risk and well received by patients.


  1. https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C1026_Freeing-up-GP-practices-letter_070121.pdf
  2. https://www.bma.org.uk/advice-and-support/covid-19/gp-practices/covid-19-toolkit-for-gps-and-gp-practices/service-provision
  3. https://www.bma.org.uk/media/3654/bma-rcgp-covid-workload-prioritisation-nov-2020.pdf
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