QOF

QOF changes for 2021/22 –what practices need to prepare for

GP partner and QOF expert Dr Gavin Jamie explores the key changes to QOF this year and what practices need to focus on when the Framework resumes from April

While the updates to QOF for this year were billed as ‘minor changes’, there are some fairly big changes in terms of vaccinations indicators.

Practices will also need to get up to speed with some indicators that were newly introduced last year, but were effectively shelved due to the pandemic.

The new mental health and cancer indicators, while involving more familiar work, will also require some planning.

Vaccination and immunisations – out with the old, in with the new

Flu vaccination indicators retired

Updates to the GP contract for 2021/22 announced earlier this month revealed that all four flu vaccination indicators are being retired from QOF this year, with a resulting loss of 18 points.

Vaccination of these target groups – patients with diabetes, stroke/TIA, coronary heart disease and COPD – are set to be incentivised instead through the new PCN DES Investment and Impact Fund (IIF). This could have an effect on practice profits especially given points for flu vaccinations were doubled in 2020/21. Furthermore, IIF must be used to pay for new services through the PCN, while QOF is paid in cash to practices. A practice’s IIF may also be reduced if their PCN’s overall performance is lower, and they will receive nothing at all if they are not part of a PCN.

New vaccinations and immunisations domain

As planned in the 2020/21-2023/24 updates to the GP contract, a separate new QOF domain on vaccinations and immunisations will come into effect this year. This is part of a major overhaul of the vaccination payments systems, which also sees all of the programmes except flu vaccinations becoming essential services.

The new QOF domain includes four new indicators, three on routine childhood immunisations and one on shingles vaccination, worth a total of 64 points. 

How these will impact on practices is difficult to predict, but the QOF element for the childhood immunisations payments looks to be generous for high achieving practices. By contrast, practices that struggle with low uptake will find it hard to earn points as the minimum threshold is 87%-90% uptake and exception reporting will only apply in very rare situations. Read more details on that and how the changes could affect your income in our detailed analysis of the childhood vaccinations payments overhaul.

Indicator changes from last year kick in

Meanwhile, there were some significant changes last year to QOF that may have passed practices by, due to the repurposing of QOF work to allow practices to focus on the pandemic.

Diagnostic criteria changes – asthma, COPD and heart failure

Practices should make sure that they are up to date with the asthma, COPD and heart failure indicators that were introduced in April 2020, but were suspended along with most of the rest of QOF later that year.

Certain key changes relate to diagnosis – the asthma and COPD disease areas included new criteria for diagnosis with respiratory testing, heart failure for echocardiography. Originally this would have applied to all patients diagnosed after April 2020. Because of the suspension of QOF over the last year this has been updated so only patients receiving their diagnosis after April 2021 will be eligible.

More specifically, asthma diagnosis now requires confirmation with at least two objective tests including spirometry. For COPD, the register and diagnosis indicators were effectively merged, and patients now require confirmation by spirometry within a shorter time frame (between 3 and 6 months). However, due to the pandemic, spirometry will have been impossible for many practices due to Covid safety measures.

With heart failure, there is now a shorter window for a new diagnosis to be confirmed by echocardiography or specialist assessment, which must be done within 6 rather than 12 months after diagnosis. Again due to Covid, practices may not have been able to access the necessary confirmatory tests in good time.

There were also several newly introduced indicators in each of these areas – regarding annual reviews, recording of smoking status and prescribing – that were all ultimately suspended completely in 2020/21, so practices may need to familiarise themselves with these new requirements.


You can read more detailed guidance on these new indicators in each of our specific guides for the asthma, COPD and heart failure areas.

New ‘pre-diabetes’ indicator

A new disease area for non-diabetic hyperglycaemia (NDHG) was also introduced in 2020/21, only to be suspended (with points were reallocated to deliver extra funding for flu / cervical screening indicators).

This indicator requires practices to measure blood glucose levels each year in patients with a history of NDHG. Read more details in our dedicated guide here.

Quality Improvement modules

On the plus side, the QI modules introduced in 2020/21 on cancer care and learning disabilities are carried forward to 2021/22 and have the same requirements. As these modules were only fully suspended in January this year, practices should already have a lot of the processes to complete this work.

Other new indicators this year

Serious mental illness

There are three new indicators for mental health this year, although they may all feel quite familiar.

All patients on the register should have alcohol consumption recorded each year. This indicator was removed two years ago but has returned unchanged. This is not an especially difficult indicator if patients are having an annual review, and carries four points. It does not need to be a face-to-face review – it could be by phone or electronic questionnaire. The most important thing is that it is part of your templates from the start of the year to ensure that the information is efficiently recorded.

The other two new indicators in mental health require blood tests. Past indicators for blood tests in patients on the mental health register had a lower age cut-off at 40. The new indicators have no age limits, although patients on the mental health register tend to be adults.

All patients on the register should have an annual HbA1c or blood glucose measurement and there are 8 points for getting to 90% of patients.

The second indicator requires an annual cholesterol check for patients who are:

  • Currently taking antipsychotic medication or
  • Have pre-existing cardiovascular disease or
  • Are overweight (no details but this would suggest BMI > 25) or
  • Smoke.

If there are patients who do not fit into the above groups they can have a cholesterol check every two years. Practically it would seem simplest to check them all annually at the same time as the HbA1c check.

Again there are 8 points for getting to 90% of patients. As most of the actual work is taking the blood these indicators should be looked at together. Being careful to request the blood tests accurately can effectively make these into a combined indicator worth 16 points.

These twenty additional points more than double the total points in the mental health area making each diagnosis potentially more valuable to the practice – probably worth over £80 per patient.

In full: new SMI indicators:

  1. SMI MH007 The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of alcohol consumption in the preceding 12 months. (Points: 4; Thresholds: 50-90%)
  2. NEW The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of a lipid profile in the preceding 12 months (in those patients currently prescribed antipsychotics, and/or have pre-existing cardiovascular conditions, and/or smoke, and/or are overweight) or preceding 24 months for all other patients. (Points: 8; Thresholds: 50-90%)
  3. NEW The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of blood glucose or HbA1c in the preceding 12 months. (Points: 8; 50-90%).

Cancer

Cancer reviews have been shaken up this year, with a new indicator for review within three months of diagnosis, and amendments to the timeframe and requirements for the cancer care review indicator. As cancer remains the subject of the QI section of QOF this year, these could be tackled together.

The first review must be within three months of the cancer diagnosis and should offer information about the support available from primary care. There is no requirement for this to be a face to face review or to be carried out by a GP. This can often be a busy time for patients, so flexibility in approach may be appreciated. All patients diagnosed after the 1st of April 2021 will be included in this indicator and there are two points for getting to 90% of patients.

The second review should be within a year of the diagnosis (previously six months) and use a structured template. This carries the same six points as the pre 2021 indicator, but the template is a new aspect.

It is nearly impossible to produce a single template that covers everything from terminal ovarian cancer to a squamous carcinoma excision, but MacMillan has had a go and this is the template that should be used. You can download the template here. It is already available on practice computer systems. Personally, I find it rather rigid and it can be difficult and unhelpful to keep patients on track.

This will only apply to patients who have their latest diagnosis from January 2021, so will apply to some patients diagnosed before the start of the QOF year. Note that this date is different to the first review indicator above.

In full: new Cancer indicators

  1. NEW The percentage of patients with cancer, diagnosed within the preceding 12 months, who have had the opportunity for a discussion and informed of the support available from primary care, within 3 months of diagnosis. (Points: 2; Thresholds: 70-90%).
  2. CAN003 The percentage of patients with cancer, diagnosed within the preceding 24 months, who have a patient Cancer Care Review using a structured template within 12 months of diagnosis. (Points: 6; Thresholds: 50 90%).

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

Guide URL:
https://pulse-intelligence.co.uk/guide/how-will-qof-changes-for-2021-22-impact-on-practices/
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