Please note, following NHS England advice on 7 January 2021, practices are now guaranteed the full 74 points for the Quality Improvement domain for 2020/21 and will receive income protection for eight prescribing indicators worth 44 points, so that a total of 354 QOF points will be paid based on historical payments.
The update was part of a new set of measures to free up practices to deliver the Covid vaccination programme. Read the full details here.
GP and QOF expert Dr Gavin Jamie explains where practices may be able to boost income from the most profitable areas under the revised QOF for 2020/21.
See also this further detailed guide on how to boost income from revised QOF clinical areas in 2020/21.
QOF, like almost everything else in general practice, is a bit different this year.
Although many of the indicators have essentially been suspended, practices need to continue at least some work on 22 areas covering a total of 37 indicators, some of which have been allocated extra points that are recycled from other, inactive indicators.
In all, 257 points – over 45% of the total 567 points – are from actively reported indicators in the revised specification.
The indicators that count for this year are in five categories:
Importantly, the points for cervical cytology and flu indicators have been doubled. There have also been some changes to the way that the points are awarded.
The remaining 310 points are protected under an income guarantee scheme, although practices need to demonstrate they have a strategy for proactively identifying and prioritising their most vulnerable patients for review, such as those with uncontrolled diabetes, patients who fail to attend and those at higher risk of Covid-19.
Details for how the payment will work have not been released yet, although it is supposed to be based on historical payments. In addition, whilst these indicators will not be used for payment, the data will still be collected and it is expected that practices will still make reasonable efforts to provide the care to patients who are most in need.
Further guidance on this is due in November.
Seven clinical areas account for half of the points, and around two thirds of all the clinical points, in the active indicators.
These should be the top priority for your QOF arrangements this year.
These are:
See more details on the value of these and tips on each area in our separate guide here.
Each disease register attracts the usual number of points. However, practices do need to focus on keeping up diagnoses and coding accurately, because:
This will be easier in areas where patients stay on the register for some time and have a diagnosis after an acute event, such as heart disease or stroke.
It will be more challenging for areas where practices routinely make the diagnosis – for example, respiratory disease or diabetes. It is worth looking at how these patients are diagnosed – see more details below and here.
The following areas require practices to simply record patients with a diagnosis, with no other indicators to be reported:
Points / Value per patient (est.)
Some pointers here:
Asthma
Adding a patient to the register will pay about £1.30 per patient. Diagnosing asthma will be more difficult as testing lung function in surgery is limited. If asthma is suspected, then it may be useful to prescribe a peak flow meter on FP10 (or the electronic equivalent) for serial home testing. Tech minded patients may even be able to share their readings electronically.
Obesity
One area where keeping up the register will be particularly hard is obesity, where the register only picks up anyone with a BMI >30 recorded within the QOF year.
At my practice we have added a weight check to our flu vaccines clinic, which is easier to do under the Covid-19 measures, with regular appointment slots keeping a smooth flow of patients through the surgery.
Learning disabilities
Learning disabilities is one of those areas that is already only a register but is reasonably well paid, and with data sharing across services you can pick up cases simply via Local Authority records. Learning disabilities attracts about £16.50 per patient, and also makes the patient eligible for the LD health check DES – worth £140.
Osteoporosis
Osteoporosis is worth around £21 for each patient that you can navigate through the labyrinthine requirements around fractures, DEXA testing and osteoporosis diagnosis.
Depression
As there are no points attached to the disease register you won’t get any payment for simply recording diagnoses this year, although practices will still want to maintain this for when the full QOF resumes.
There are 74 QI points and they now represent over a quarter of the active QOF points. Work that the practice has already done will still count towards these but there are now nine specific requirements – four for cancer and five for the learning disability sections. The general principles are around the return of services to patients with a particular emphasis on the needs of more vulnerable patients. There is quite a lot to be done here and, as always, it much easier if you start as early as possible. Much of this is likely to overlap with cancer and other work that is part of the PCN DES.
Read our separate guide on fulfilling the revised QI requirements here.
Dr Gavin Jamie is a GP partner in Swindon and runs the QOF Database website
How to boost income from revised QOF clinical areas in 2020/21
How to fulfil the QOF Quality Improvement Covid-19 adjustments
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