Maximising your QOF income: Chronic kidney disease

Updated November 2022

Summary – indicators and value

• Indicators: 1
• Points: 6
• Prevalence*: 3.2%
• £/patient on the register (estimated): £4

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

Indicator 1: maintain patient register (6 points)

Chronic kidney disease (CKD) has been part of the QOF for more than a decade and prevalence has been fairly stable for most of that time. There is no indicator requiring specific action by the practice, although the register is intended to promote specific care of diagnosed patients.

Entry to the register is with a code giving the diagnosis of CKD stages 3 to 5. Stage 3 has several sub-stages, which will all qualify. Patients can leave the register if their most recent CKD stage is 1 or 2. Alternatively, they may be coded as CKD resolved. As this is purely a register, there is no exception reporting (‘personalised care adjustment’).

Tips for gaining points

• The diagnosis is made following measurement of an estimated glomerular filtration rate (eGFR), but this is not automatic – you need to enter a specific diagnosis code. CKD stage 3 is identified by having an eGFR consistently below 60mmol/l in two readings at least three months apart.
• Patients must be over the age of 18 years and there is no upper age limit. Renal function naturally falls over time, so CKD rates are likely to be high in the elderly.
• It is relatively easy to search the computer for patients with low eGFR who have not already been diagnosed. This can be done either directly with a search on the practice computer, or using specific tools to find patients meeting the criteria for CKD.
• Blood tests taken in hospital can be useful, but patients do commonly have acute kidney injury when unwell so this is not an ideal time to measure long term renal function. The eGFR formula is not reliable in acute kidney injury. It is important that patients are followed up after renal disease is spotted to establish whether this was an acute change or an indication of CKD. This should be highlighted on the discharge summary.

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 indicator

Indicator 1: The contractor establishes and maintains a register of patients aged 18 or over with CKD with classification of categories G3a to G5 (previously stage 3 to 5) (CDK005)