More changes to parts of the QOF scheme were announced in December 2021, so GPs could focus on the Covid-19 booster campaign. QOF expert Dr Gavin Jamie provides a guide on which areas were suspended, which are intact and where points values have changed
For a third year running, QOF has been partly suspended due to the effects of Covid-19. Although some of the general principles are similar to the changes made last year, they have been implemented almost nine months into the QOF cycle, after practices had already done much of the work.
Data will still be collected in the normal way at the end of the year on all indicators – and this will continue to be made public, including to organisations such as the CQC.
As before, where indicators have been suspended points scores have been preserved. In most cases, the baseline for performance is the year 2018/19 meaning that payments made this summer could be based on activity levels from four years before.
The only indicators that are completely unchanged in terms of points value are for cervical cytology and immunisation. There are three indicators for infant vaccinations carrying 54 points in total. These remain tough to achieve but the reward is high – the cash value of vaccinations after hitting 90% uptake is several hundred pounds per child.
There is no exception reporting here but they should still be a high priority for practices.
There is a further indicator for the shingles vaccination among patients who turn 80 years old during the course of the QOF year.
The cervical cytology indicators continue as normal.
Most indicators are protected in their points value, as they have been for the last couple of years.
Indicators introduced after April 2020 have been excluded because of a lack of robust historical data to base past performance on (thus making it difficult to preserve points). These include:
All of these removed points have been transferred to the prescribing indicators.
Most of the remaining indicators will be paid based on performance levels achieved in 2018/19. Some indicators in diabetes and hypertension (see Table below) did not exist in 2018/19, so performance based on 2019/20 will be used instead. Of course, QOF was suspended at the very end of 2019/20, so there might not have been as much focus on maximising points as there would usually have been. While this might not seem entirely fair, it’s a situation that can’t be changed.
Meanwhile, the points allocated to the QI indicators will be awarded in full.
The points available from the removed indicators have been reallocated to indicators around prescribing. These have mostly doubled from their original point values although a couple have been given an additional point added to make the totals add up.
The new points values can be seen in Table 2 of the NHS England letter sent to practices on 7 December outlining the changes. (Do note, that an in initial version of the letter sent had errors in this section, which were later corrected).
Prescribing indicators look at prescriptions issued after 1 October in the QOF year, so will often look low on practice dashboards for a while but should be get up to full strength from January onwards.
Exception reporting can be essential here. ACE inhibitors and beta blockers can have significant contraindications and these should be recorded. The 12 extra points in the heart failure with left ventricular systolic dysfunction (LVSD) area make this particularly valuable. These two indicators (HF003 and HF006) now have 24 points between them. An average practice will only have around 27 patients with LVSD, so this represents a large number of points per patient.
The disease register indicators are still live although their main effect on income is through the disease prevalence adjustment, which will also continue this year. Adding patients to registers will still increase practice payments with the exception of the non-diabetic hyperglycaemia register.
Most practices usually achieve nearly all of the QOF points here. Any differences between practice incomes are mainly down to disease register size.
Practices should continue to add patients to disease registers. However, the effect of the points changes are also quite significant. For example, adding a patient to the LVSD register requires a heart failure code and a left ventricular systolic dysfunction code. Previously, if you achieved full points for the ACE and beta blocker prescribing indicators, adding a patient would have been worth around £85. This year that doubles to £170.
By contrast, adding a patient to the mental health register would previously have been worth £90 but this has now been cut to £43. This is still quite a reasonable sum but practices with a generally younger population may see a drop in QOF income as they tend to have proportionally less patients with cardiovascular disease but more mental health problems.
Other areas worth concentrating on include atrial fibrillation where the payment per patient rises from £30 to £45.
Dr Gavin Jamie is a GP partner in Swindon and runs the QOF Database website
[1]There actually is good historical data for the MH007 alcohol consumption indicator as it was not new, just taking a holiday. This seems to have been forgotten.
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