Changes to QOF from April will see an extra 8 points made available, with the total number of points increasing from 559 to 567.
In addition, 97 points are being recycled into 11 ‘more clinically appropriate’ indicators.
An additional £10m is being invested in QOF to bring about the changes.
A completely new indicator worth 18 points will incentivise yearly testing of HbA1c levels to detect non-diabetic hyperglycaemia.
This is to be supported by new investment and retirement of the CVD-PP001 indicator for statin treatment of patients newly diagnosed with hypertension.
Asthma
The asthma register will be expanded to include patients from age 6 upwards, in line with NICE guidance.
Practices will be expected to use a minimum of two diagnostic tests to confirm an asthma diagnosis – spirometry and one other. Tests are to be performed up to 3 months before and up to 6 months after any date of diagnosis. Newly registered patients with a historical record of asthma diagnosis will also need to undergo confirmatory tests if they have not already had them, within 6 months of registration.
The asthma review has been updated to include the recording of exacerbations, assessment of inhaler technique and provision of a written asthma plan.
Practices are to record exposure to smoking in those under 19, as well as personal smoking status.
COPD
To be included on the COPD register patients will need to have a clinical diagnosis plus a record of post bronchodilator spirometry FEV1/FVC ratio below 0.7, between 3 months before and 6 months after diagnosis.
Annual reviews will also include recording of exacerbations.
Heart failure
Any new diagnosis of heart failure will need to be confirmed by an echocardiogram or specialist assessment between 3 months before and six months after diagnosis.
In left ventricular systolic dysfunction (LVSD), treatment with beta blockers is now incentivised independently of treatment with ACE-I/ARB
And a new indicator will reward an annual review of patients with heart failure, to include functional assessment and potential up-titration of medication to address symptoms.
For new indicators these are based on NICE recommendations and previous practice performance. Points and payment thresholds for unchanged indicators will be held at 2019/20 levels for a further year.
The threshold setting methodology will be reviewed in 2020.
Payment thresholds for new and revised indicators are reproduced here and detailed in annex B of the GP contract document for 2020/21 – 2023/24.
In 2019/20 a new 74-point Quality Improvement (QI) domain was added, comprising two modules on prescribing safety and end of life care.
These modules have now been replaced, though NHS England encourages practices to continue to ‘consolidate and mainstream’ the improvements made in line with these.
The two new modules to be introduced from April are on learning disabilities and early cancer diagnosis.
Learning disabilities
The QI Care of People with a Learning Disability module promotes uptake of the annual health check, as well as medicines optimisation, making reasonable adjustments and social prescribing.
Early cancer diagnosis
The aims of the QI early cancer diagnosis module are to improve uptake of national screening programmes, and to improve referral and safety netting practices for patients suspected of having cancer. It will support the roll out of the Primary Care Network early cancer diagnosis service specification.
From April 2021, there will be a new QOF domain to incentivise vaccinations and immunisation programmes, while flu vaccinations look set to be dropped to be replaced with PCN level targets through the Impact and Investment Fund.
NHS England and the BMA GP committee have also agreed to an ongoing programme of indicator review in key priority areas, including mental health, in 2020/21.
The new QI domain is undergoing evaluation to determine how it is developed in future, but further modules are already in the pipeline, on CVD prevention and detection; shared decision making; anxiety and depression; antimicrobial resistance including antibiotic prescribing; wider primary prevention; and preventing prescription drug dependency.
Lastly, there is a long-term plan to introduce a QOF obesity indicator for referral to weight management services.
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