13
QOF = a system of incentive payments designed to improve quality and reduce variation by rewarding GP practices for achieving targets in important clinical and administrative areas (aka domains)
Introduced in 2004 as part of the new (nGMS) GP contract.
There are a set of clinical and other standards with points for achieving certain target thresholds.
The number of points achieved by a practice determines the sum paid.
| QOF Domains | Points 2011/12 |
|---|---|
| Clinical | 650 |
| Organisational | 167.5 |
| Additional Services | 36 |
| Patient Experience | 146.5 |
Clinical domains
21 Disease Areas (2011) each with a variable number of indicators with respect to:
- diagnosis
- registers
- records
- initial management
- ongoing management
| Clinical Domains | Points | Prevalence |
|---|---|---|
| Asthma | 45 | 5.7 |
| AF | 27 | 1.3 |
| CVS 1° Prevention | 13 | |
| CHD 2° Prevention | 76 | 3.5 |
| Cancer | 11 | 1.1 |
| CKD | 38 | 2.9 |
| COPD | 30 | 1.5 |
| Contraception | 10 | additional services |
| Dementia | 26 | 0.4 |
| Depression | 31 | |
| Diabetes | 92 | 3.9 |
| Epilepsy | 14 | 0.6 |
| Heart Failure | 29 | 0.8 |
| Hypertension | 79 | 12.8 |
| Hypothyroidism | 7 | 2.7 |
| Learning Disabilities | 7 | 0.3 |
| Mental health | 40 | 0.7 |
| Obesity | 8 | 7.6 |
| Palliative Care | 6 | 0.1 |
| Smoking | 60 | |
| Stroke & TIA | 22 | 1.6 |
QOF payments
Average practice £130.51 per points achieved 2011/12
1000 points available ie £130,510 for average practice
- Actual amount received per point depends on:
- list size (or for additional services target population size)
- disease prevalence factor (clinical indicators only)
- number of registered patients
Individual indicators are either absolute / all or nothing or scaled dependant on how close to a specified max percent
| List size adjustment |
|---|
| Payment is adjusted according to national average practice list sizes approx 5891 (2008/9) for England different figures for Scotland Wales and NI -divide practice list size by average national list size (contractor population index CPI) |
| Adjusted disease prevalence factor ADPF |
|---|
| Achievement payments in clinical domains are adjusted by an adjusted disease prevalence factor (ADPF) to reflect the practice’s actual disease prevalence compared to the national average. An ADPF of 1.0 indicates that prevalence is the same as the national average, so payment is £130.51 per point achieved.An ADPF of 1.2 indicates above average prevalence, so payment is £130.51 x 1.2 = £156.61 per point achieved. |
| Points Achieved |
|---|
| (% achieved – min target %)/(max target % – min target %) x points available |
| Achievement Payments |
|---|
| (points achieved x amount per point x list size x ADPF) / average list size |
| Aspiration Payments |
|---|
| 70% of last years achievement / 12 – paid monthly |
| Surplus of total achievement payments over aspiration payments already made is paid by the end of the first quarter of the next financial year |
QOF 2012/13 2013/14
- QOF Guidance BMA
- eGuidelines QOF Tables 2011/12
- PCT guidance on QOF quality and productivity indicators
- QOF 2012/2013 BMA
- NICE consultation on potential new QOF indicators
- Summary of 2012-2013 QOF indicator changes
- QOF articles pulsetoday.co.uk
- www.poplarssurgery.co.uk/upload/qof
Episode coding
QOF reference dates
In each QOF year the reference date is 31 Mar of that year – targets will have a 6 12 or 15 month window preceding that date qualify in that year.
Numerator/denominator
Performance in the clinical domains is automatically measured by software which interrogates the clinical record.
Certain disease and drug codes trigger the patient to be included in the denominator or target population for a particular QOF indicator.
Other codes must then be entered to demonstrate/record performance of necessary activities/targets for those patients (the numerator) within the required time window.
For administrative domains there are clear guidelines how the practice can demonstrate its performance against the targets again via data collected by the computer systems or demonstration of production and adherence to systems within the practice as preparation for the annual QOF visit.
Changes in the QOF Business Rules are agreed between GPC and NHS employers each year
www.primarycarecontracting.nhs.uk/145.php
| Exception reporting QOF 2010/11 Exception Reporting NHS Information Centre | |
|---|---|
| Max Tolerated Dose | for lipids 8BL1 antihypertensives 8BL0 DM 8BL2 epilepsy 8BL3Where a patient is recorded as receiving the maximum tolerated dose of a specific drug, then they can be excluded from the relevant indicator for 15 months. |
| Informed Dissent | eg 9h51patient does not agree with the recommended treatment or investigation and has said ‘no’ either verbally or in writing- patient has not responded to recall invitations- a patient has not attended three appointments.This must be recorded in the records.This exception code will only remove the patient from the denominator and numerator population of the clinical area specified for 15 months if that specific indicator is not achieved. |
| Patient Unsuitable | eg 9h52It is left to the GP’s discretion to record that a patient is unsuitable to receive treatment or attend an annual review.This must be recorded in the records with the reasons for deciding that a patient is unsuitable.This exception code will only remove the patient from the denominator and numerator population of the clinical area specified for 15 months if that specific indicator is not achieved.Single Indicator exception e.g. Warfarin not tolerated 8I71 This refers to a monitoring point within a clinical area, e.g. where justification exists for not prescribing a particular medication. This will only exclude patients from the relevant indicator if that indicator target is not met and will not exclude them from the remaining indicators in that disease area.The following criteria have been agreed for single exception reporting:Patients for whom prescribing a medication is not clinically appropriate, e.g. those who have an allergy, another contraindication or who have experienced an adverse reaction. These exceptions are generally permanent.Where a patient has not tolerated medication. This exception only lasts 15 monthsWhere the patient has a supervening condition which makes treatment of their condition inappropriate, e.g. cholesterol reduction where the patient has liver disease. This exception only lasts 15 months |
| Newly Registered | New patients should have their conditions recorded and be reviewed within three months of joining the practice. Monitoring targets e.g. blood pressure should be reached within nine months. Exclusion will only occur if a patient does not achieve a specific indicator. |
| Persisting and Expiring codes. | Expiring codes lapse each QOF year, needing to be re-added if appropriate.Persisting codes will permanently exempt the patient from the indicator concernedThere are sometimes both a temporary AND a persisting code which could be justified for the same situation eg if intolerant of Beta blockers one could use .8I73 & have to re-add it annually, or .U60B7 which would exempt the patient permanently. |
| Multiple Exceptions needed | eg antiplatelets/anticoagulants in CHD & Stroke each drug needs to be individually excepted |
QOF verification visits
| QOF primary prevention CHD | ||
|---|---|---|
| PP1 | % patients aged 30 to 74 having face to face CVS risk assessment within 3m of diagnosis using an agreed risk assessment toolnot if preexisting CHD DM CVA TIA PVD FH CKD 3-5JBS 662k-n QRISK 38DF | 8 45-70% |
| PP2 | lifestyle advice re exercise, smoking, alcohol & diet within 15m 67H | 5 40% |
| QOF secondary prevention CHD | ||
|---|---|---|
| CHD1 | CHD register | 4 |
| CHD6 | % patients with CHD in whom the last blood pressure reading (measured in the previous 15 months) is <150/90 mmHg | 17 45–71% |
| CHD8 | % patients with CHD whose last measured total cholesterol (measured in the previous 15 months) is ?5 mmol/l | 17 45–70% |
| CHD9 | % patients with CHD with a record in the previous 15 months that aspirin, an alternative antiplatelet therapy, or an anticoagulant is being taken | 7 50–90% |
| CHD10 | patients currently treated with a beta blocker (unless a contraindication or side-effects are recorded) | 7 50–60% |
| CHD14 | % patients with a history of myocardial infarction (from 1 April 2011) currently treated with an ACE inhibitor (or ARB if ACE intolerant), aspirin or an alternative anti-platelet therapy, beta blocker and statin | 10 45–80% |
| CHD12 | flu vaccination in the preceding 1 September to 31 March | 7 50-90% |
| QOF hypertension | ||
|---|---|---|
| BP1 | hypertension register | 6 |
| BP4 | bp check since last Jul 1st 246% |
8 50-90% |
| BP5 | target 150/90 reached 8BLO |
55 45-70% |
| QOF heart failure | ||
|---|---|---|
| HF1 | Heart Failure Register | |
| HF3 | LVF only % on ACE/ARB in last 6mException report annually | 10 45-80% |
| HF4 | LVD only % of patients on ACE/ARB also on HF beta blocker | 9 40-60% |
| QOF atrial fibrillation | ||
|---|---|---|
| AF1 | AF register G573.% excludes atrial flutter G5731 |
5 |
| AF6 | % of patients with latest CHADS=1 (in last 15m) on anticoagulant or antiplatelet treatment | 6 50-90% |
| AF7 | % of patients with latest CHADS=2 on current anticoagulants | 15 40-70% |
| QOF stroke TIA | ||
|---|---|---|
| Stroke1 | Stroke/TIA register (Specify) Haemorrhagic .G61 Ischaemic .G64 Unspecified .G66TIA .G65SAH excluded Am Fug = TIA |
2 |
| Stroke13 | New CVA/TIAs must be scanned/referred Scan must be documented 3m b4 to 1/12 after episode date |
2 45-80% |
| Stroke6 | Last BP in last 15m <150/90 .8BL1 |
5 45-71% |
| Stroke7 | Cholesterol checked in last 15m .44P% |
2 50-90% |
| Stroke8 | Last Cholesterol in last 15m was <5.0 mmol/l or exception report yearly if on max tolerated Rx |
5 40-60% |
| Stroke12 | On anteplatelet/anticoagulant last 15m or ER (annually all 4 drugs) Asp Advised/OTC is OK |
4 50-90% |
| Stroke10 | Flu Vacc last Sept – March or exception report |
2 45-85% |
| Codes | Refer CVA Clinic 8HTQ Refer CT 8HQ4 CT NAD 5C00 CT abnormal 567C MRI NAD 567F MRI abnormal 5694 |
|
| QOF PAD | ||
|---|---|---|
| PAD1 | PAD register | 2 |
| PAD2 | aspirin or alternative last 15m | 2 40-90% |
| PAD3 | BP reading <150/90 last 15 m | 2 40-90% |
| PAD4 | cholesterol <5.0mmol/l last 15m | 3 40-90% |
| QOF asthma | |||
|---|---|---|---|
| Asthma1 | Asthma Register H33% Repeat Rx in last 12m excludes H333 & H33z1 |
4 | |
| Asthma8 | Diagnosis by spirometry or PFR variability/reversibility 339A / 339B > 8yrs |
15 45-80% |
|
| Asthma10 | Smoking status in last 15m in ages 14-19 | 6 45-80% |
|
| Asthma6 | face to face review in last 15m to include 3 RCP questions 66YJ |
20 45-70% |
|
Record smoking status if >14 years.
Confirm diagnosis if> 8 years.
In children (< 6 yrs), where PFR not feasible, diagnosis relies on the presence of key features (audible wheeze, symptoms related to exercise, nocturnal symptoms etc), chronicity of symptoms (cough or wheeze) or response to trials of treatment – always question the diagnosis if Rx ineffective.
Do not add children to the asthma register unless you are confident of the diagnosis.
Diagnosis – spirometry +/- variability
objective tests should be used to support the diagnosis but this is not mandatory in patients deemed to be high probability of having asthma (BTS 2008)
PFR based diagnosis is the most useful test in a Primary Care setting >20% / 400mls diurnal variation in recorded EU Peak Flow Rate (am and pm prior to any Beta agonists!) on 3 or more days each week for 2 weeks
Variation % = (maximum PFR – minimum PFR)/maximum PFR x 100
Spirometry may be falsely negative in a patient who is well at time of assessment
Fev1/FVC < 70% = an obstructive picture (Asthma or COPD) but in asthma there is reversibility in the lung function.
>15% or > 200mls improvement in FEV1 after 400mcg (4 puffs via an MDI) of salbutamol via a volumatic.
>15% or > 200mls deterioration in FEV1 after 15mins of exercise.
Annual review
Patient understanding of ‘preventers’ and ‘relievers’ and their appropriate usage, also ask about any side effects.
Check inhaler technique.
Compliance as per computer and patient history – number of salbutamol MDIs used.
Smoking status and cessation advice.
Any exacerbations, hospital admissions or oral steroid use since last review.
| RCP 3 Questions |
|---|
| 1 Has your asthma interfered with your usual activities (e.g. housework, work, school, hobbies etc)? |
| 2 Have you had difficulties sleeping because of your asthma symptoms (including cough)? |
| 3 Have you had your usual asthma symptoms during the day (cough, wheeze, chest tightness or breathlessness?) |
Having to use a reliever more than 3 x per week?
The need to step up or step down treatment ? change self management plan.
Osteoporosis risk
Remember adults who have used oral steroids for > 3 months or have had 3 or more courses of oral steroids in a life time need a DEXA scan and consideration for osteoporosis prophylaxis e.g. biphosphonates. Furthermore, patients on beclomethasone doses greater than 800mcg a day should be considered for osteoporosis prevention lifestyle advice +/Calcichew D3 forte.
Stepping down Rx
If symptoms control excellent over a period of at least three months then consider dropping the inhaled steroid dose by 25 to 50% and review after another three months.
Structure of the asthma service
All patients with proven asthma will be tagged with the H33 Read code, as this is required for Read code QOF based recall which identifies patients who have not had a formal asthma review (questionnaire or face to face) in the last 15 months.
At repeat medication re-authorisation doctors must look at:
Beta 2 agonist over usage – arrange asthma clinic review?
Oral steroid/high dose inhaled steroid usage and need for osteoporosis prophylaxis.
Correct Read H33 Read coding & is it in the Problem page?
On the asthma register?
Recall in place?
| Asthma steps Read codes | ||
|---|---|---|
| Step1 | Relief bronchodilators as required | |
| Step2 | Step 1 + regular inhaled steroids | |
| Step3 | inhaled steroid + LABA or LRTA | |
| Step4 | inhaled steroid + LABA + trial of other bronchodilators | |
| Step5 | Step 4 + regular oral steroid | |
| Step6 | Step down after 3-6m stability | |
| QOF COPD | ||
|---|---|---|
| COPD14 | COPD register H3, H31%, H32%, H36-H3z – excluding H3101 H31y0 H3122 3 | 3 |
| COPD15 | % diagnosed with spirometry and reversibility testing 33H% or *HRC | 5 40-80% |
| COPD10 | % who have had an FEV1 in the last 15 months 339O | 7 45-70% |
| COPD13 | % who have had review including MRC scoring and COPD review within the last 15 monthsMRC dyspnoea score codes = 173H-L.
COPD review code = 66YM |
3 50-90% |
| COPD8 | % of patient who have had a flu vaccination in previous Sept – March | 6 45-85% |
Code as COPD (H3) after the diagnosis is confirmed at spirometry with reversibility testing.
Code mild moderate severe as H36-38
Pulse Oct 2011– COPD severity coding
| QOF smoking | ||
|---|---|---|
| Smoking5 | Smoking status for CHD / DM / CVA / BP / COPD / Asthma / PAD /Psychosis / CKD in last 15m | 25 |
| Smoking6 | Offer of Smoking cessation referral/treatment for the above within last 15m | 25 |
| Smoking7 | % patients aged 15yr + with record of smoking status in the preceding 27 months | x 40-90% |
| Smoking8 | % current smokers 15+ with record of offer support/treatment in last 27m | 12 40-90% |
| QOF obesity | |||
|---|---|---|---|
| OB1 | Obesity Register | Patients aged 16 and over with BMI >30 in previous 15 months | 8 |
| QOF diabetes | ||
|---|---|---|
| DM32 | diabetes register 17+ specifying type C10E% or F% |
6 |
| DM2 | BMI in last 15m 22K% | 1 50-90% |
| DM26 | Last HbA1c in last 15m < 59 mmol/mol (7.5%) | 17 40-50% |
| DM27 | Last HbA1c in last 15m < 64 (8.0%) | 8 45-70% |
| DM28 | Last HbA1c in last 15m is <7.5Or add “Max tolerated Rx” annually 8BL2. | 1050-90% |
| DM21 | Retinal screening in last 15m68A7/9NNC/9N2U/9N2V/9N2e/9N2f retinal Screener/Optometrist |
5 50-90% |
| DM29 | % patients with foot examination and risk assessment within last 15m RL 24E1 – 24ED LL 24F1 – 24FD or 9NND under care of foot screener 4 1) low risk (normal sensation, palpable pulses) 2) increased risk (neuropathy or absent pulses) 3) high risk (neuropathy or absent pulses plus deformity or skin changes or previous ulcer) 4) ulcerated foot |
x 50-90% |
| DM10 | Neuropathy testing last 15m 66Ac. 9NND |
3 50-90% |
| DM30 | last BP < 150/90 in last 15m Or add max tolerated Rx annually |
8 45-71% |
| DM13 | Microalbumin test in last 15m 46W% Permanently exclude if Proteinuric (R110.etc) |
3 50-90% |
| DM22 | Creatinine or eGFR documented in last 15m 44J3% (Creat) 451E (eGFR) 451F(GFR) 451G (eGFR, AfoAm) |
1 50-90% |
| DM15 | On ACE/A2 in last 6m (if Microalb +ve or Proteinuria) ( or ER for both ACE’s AND A2RB’s, Yrly.) | 3 45-80% |
| DM17 | Last Cholesterol in last 15m <5mmol/l (or ER eg.Max tolerated Lipid Rx annually) |
6 45-70% |
| DM18 | Flu Vaccination in previous Sep–Mar (or exception code) | |
| QOF hypothyroidism | ||
|---|---|---|
| Thyroid1 | Thyroid Register 442% Acquired hypothyroid CO4% Congenital Hypothyroidism CO3% |
1 |
| Thyroid2 | TFT recorded last 6/12 ??? | 1 |
| QOF CKD | ||
|---|---|---|
| CKD1 | register of patients 18+ yrs with CKD, stages 3-5 1Z12 to 1Z1L |
point ??? |
| CKD2 | BP checked in last 15m before Reference date | 4 50-90% |
| CKD3 | last BP in last 15m <140/85 | 6 45-70% |
| CKD5 | hypertensives with proteinuria treated with ACE/ARB in last 6m (unless C/I) | 11 |
| CKD6 | UACR / PCR checked last 15m 46TC |
6 45-80% |
points need revision
| QOF epilepsy | ||
|---|---|---|
| EP5 | epilepsy register 18 years+ on Rx in last 6m F25% F1321 SC200 |
1 |
| EP6 | Fit frequency recorded in last 15m 6675. or 667F or use max tolerated Rx code 8BL3 |
4 50-90% |
| EP8 | Seizure free previous 12m 667F (ignore Epilepsy 6) |
6 45-70% |
In order to be awarded maximum quality points, practices must achieve the following standards:
There must be a register of all patients who are receiving antiepileptic medication.
90% of patients aged 16 or over on drug treatment for epilepsy should have had a record of seizure frequency done in the past 15 months.
90% of patients aged 16 or over on treatment for epilepsy must have had a medication review done in the past 15 months.
70% of patients aged 16 or over on anti-epileptic medication should have been seizure-free for at least 12 months; this should have beenrecorded within the past 15 months.
| QOF depression | ||
|---|---|---|
| DEP1 | Depression Screen for patients with CHD or DM (17yrs+) using 2 question screen in last 15m 6896 |
6 50-90% |
| DEP6 |
|
17 50-90% |
| DEP7 | Depression score review percentage of patients who have had a further assessment of severity 2-12 weeks (inclusive) after the initial recording of the assessment of severity | 8 50-90% |
| Depression Codes |
|
|
| QOF mental health | ||
|---|---|---|
| MH8 | mental health register schizophrenia, psychosis, bipolar, on Li within last 6m d6% |
4 |
| MH11 | alcohol consumption recorded within last 15m |
4 50-90% |
| MH17 | Creatinine and Li measured for patients on Li within last 9m 44J3% 442A% |
1 50-90% |
| MH18 | last Li within normal range(0.4–1.0 mmol/l) last 4m 44W80 |
2 50-90% |
| MH10 | comprehensive care plan documented #8CR76A6 Mental Health Services |
6 25-50% |
| MH19 | % pts over 40 with record of TC:HDL ratio | 5 45-80% |
| MH20 | record of BS or HbA1c in last 15m | 5 45-80% |
Mental Health and Dementia Reviews
Mental health plan should be agreed between individuals, their family and/or carers as appropriate and should include social support of individual, occupation, early warning signs and patients preferred course of action if relapse.
Contact may be through telephone contact or visit where appropriate. If the person is in contact with secondary care, it will be appropriate to contact their key worker to discuss any concerns. Evidence will be required as to how this contact has been made. These Patients should in most cases be under care of MHSS or Psychogeriatric teams. Ensure that these teams have reviewed patient within last 15m.6A6 code can be entered when patient reviewed by psychiatry or Psychogeriatric teams
- Personal health assessment and plan.
- BMI
- BP
- Smoking history
- Review who is looking after mental health issues
- Review medication
- Address any recognised ongoing medical problems
- Basic lifestyle advice appropriate to individual, such as smoking cessation / diet / exercise.
- Consider blood testing such as Cholesterol and fasting glucose (esp. in pts on antipsychotics)
- Review social situation w.r.t. accommodation and identify carers
- Also add codes for carer information
- Add mental health review code if not been entered and recent letter is available
- Ensure follow up is chased up if it has been missed
- CROP
- Carers needs and issues
- Rx issues if relevant
- OPD / Ongoing secondary care issues
- Physical health issues identified
| QOF dementia | ||
|---|---|---|
| DEM1 | dementia register E000.Eu00z MIDEUo11F110 F112 F116 |
5 |
| DEM2 | annual health review (15m window) including face to face review focussing on support needs of pt’ & carer & to include physical/mental health R/V of pt, carer’s need for informatio impact of caring on the carer & coordination with 2° care if applicable 6AB.. |
15 25–60% |
| DEM4 | bloods for newly diagnosed – since Apr that QOF year FBC, Ca, glucose, RFTs LFTs, TFTs, B12, folate recorded 6m before or after entering on to the register |
6 45-80% |
| QOF learning difficulties | ||
|---|---|---|
| LD2 | TSH for Downs patients within last 15m excluding those on the thyroid register |
3 40-70% |
| QOF cancer | ||
|---|---|---|
| Cancer1 | register of all patients with cancer diagnosis Non-melanotic skin cancers excluded B0… – B32z plus B34.. – B6z0. Byu.. – Byu41 & Byu5. – ByuE0 “not BCC/SCC, (B33 chapter) and not B7% (Benign skin lesions nor BB% codes which are Cancer Histology codes |
5 |
| Cancer3 | cancer review within 6m diagnosis being coded | 6 50-90% |
| QOF palliative care | ||
|---|---|---|
| PC3 | register of all patients in need of palliative care/support irrespective of age | 3 |
| PC2 | 3-monthly MDT palliative care review meetings to discuss all patients on register | 3 |
| Read Codes |
|
|
| QOF Osteoporosis | ||
|---|---|---|
| OST1 | osteoporosis register1 aged 50-74 with record of FF post April 2012 confirmed by DEXA scan2 aged 75 + with record of FF post April 2012 | 3 |
| OST2 | % pts 50-74 with DXA confirmed osteoporosis with current Rx bone sparing agent | 3 30-60% |
| OST3 | % pts 75+ with FF with current Rx bone sparing agent | 3 30-60% |
| QOF non-clinical domains | |
|---|---|
| organisational | recordsinformation for patientseducation and trainingpractice managementmedicines managementquality and productivity |
| patient experience |
PE1 |
| additional services | contraceptionmaternitycervical screening |
| QOF organisational – records and information | ||
|---|---|---|
| Records3 | The practice has a system for transferring and acting on information about patients seen by other doctors out of hours | 1 |
| Records8 | There is a designated place for the recording of drug allergies and adverse reactions in the notes and these are clearly recorded | 1 |
| Records9 | For repeat medicines, an indication for the drug can be identified in the records (for drugs added to the repeat prescription with effect from 1 April 2004)Minimum Standard 80% | 4 |
| Records11 | The blood pressure of patients aged 45 years and over is recorded in the preceding 5 years for at least 65% of patientsThe blood pressure of patients aged 45 years and over is recorded in the preceding 5 years for at least 80% of patients | 10 |
| Records13 | There is a system to alert the out of hours service or duty doctor to patients dying at home | 2 |
| Records15 | The practice has up to date clinical summaries in at least 60% of patient records | 25 |
| Records17 | The blood pressure of patients aged 45 years and over is recorded in the preceding 5 years for at least 80% of patients | 5 |
| Records18 | The practice has up to date clinical summaries in at least 80% of patient records | 8 |
| Records19 | 80% of newly registered patients have had their notes summarised within 8 weeks of receipt by the practice | 7 |
| Records20 | The practice has up to date clinical summaries in at least 70% of patient records | 12 |
| QOF organisational – information for patients | ||
|---|---|---|
| Information5 | Supports smokers stopping via strategy including literature and therapy | 2points |
| QOF organisational – education and training | ||
|---|---|---|
| Education11 | There is a record of all practice-employed clinical staff ad clinical partnershaving attended training/updating in basic life support skills in the preceding 18 months | 4 |
| Education5 | There is a record of all practice-employed staff having attended training/updating in basic life support skills in the preceding 36 months | 3 |
| Education6 | The practice conducts an annual review of patient complaints and suggestions to ascertain general learning points which are shared with the team | 3 |
| Education7 | The practice has undertaken a minimum of 12 significant event reviews in the past 3 years which could include:• Any death occurring in the practice premises• New cancer diagnoses• Deaths where terminal care has taken place at home • Any suicides• Admissions under the Mental Health Act• Child protection cases• Medication errors• A significant event occurring when a patient may have been subjected to harm, had the circumstance/outcome been different (near miss) | 4 |
| Education8 | All practice employed nurses have personal learning plans which have been reviewed at annual appraisal | 5 |
| Education9 | All practice-employed non-clinical team members have an annual appraisal | ?3 |
| Education10 | The practice has undertaken a minimum of 3 significant event reviews within the last year | |
| QOF organisational – practice management | ||
|---|---|---|
| Management1 | QOF organisational – medicines managementQOF organisational – practice managementManagement 1Individual healthcare professionals have access to information on local procedures relating to Child Protection | 1 |
| Management2 | There are clearly defined arrangements for backing up computer data, back-up verification, safe storage of back- up tapes and authorisation for loading programmes where a computer is used | 1 |
| Management3 | The Hepatitis B status of all doctors and relevant practice- employed staff is recorded and immunisation recommended if required in accordance with national guidance | 0.5 |
| Management5 | The practice offers a range of appointment times to patients, which as a minimum should include morning and afternoon appointments 5 mornings and 5 afternoons per week, except where agreed with the PCO | 3 |
| Management7 | The practice has systems in place to ensure regular and appropriate inspection, calibration, maintenance and replacement of equipment including:• A defined responsible person• Clear recording• Systematic pre-planned schedules • Reporting of faults | 7 |
| Management9 | The practice has a protocol for the identification of carers and a mechanism for the referral of carers for social services assessment | 3 |
| Management10 | There is a written procedures manual that includes staff employment policies including equal opportunities, bullying and harassment and sickness absence (including illegal drugs, alcohol and stress), to which staff have access | |
| QOF organisational – medicines management | ||
|---|---|---|
| Medicines2 | The practice possesses the equipment and in-date emergency drugs to treat anaphylaxis | 2 |
| Medicines3 | There is a system for checking the expiry dates of emergency drugs on at least an annual basis | 2 |
| Medicines4 | The number of hours from requesting a prescription to availability for collection by the patient is 72 hours or less (excluding weekends and bank/local holidays) | 3 |
| Medicines6 | The practice meets the PCO prescribing adviser at least annually and agrees up to 3 actions related to prescribing | 4 |
| Medicines8 | The number of hours from requesting a prescription to availability for collection by the patient is 48 hours or less (excluding weekends and bank/local holidays) | 6 |
| Medicines10 | The practice meets the PCO prescribing adviser at least annually, has agreed up to three actions related to prescribing and subsequently provided evidence of change | 4 |
| Medicines11 | A medication review is recorded in the notes in the preceding 15 months for all patients being prescribed 4 or more repeat medicinesStandard 80% | 7 |
| Medicines12 | A medication review is recorded in the notes in the preceding 15 months for all patients being prescribed repeat medicinesStandard 80% | |
| QOF organisational – quality and productivity | ||
|---|---|---|
| QP6 | The practice meets internally to review the data on secondary care outpatient referrals provided by the PCO | 5 |
| QP7 | The practice participates in an external peer review with a group of practices to compare its secondary care outpatient referral data either with practices in the group of practices or with practices in the PCO area and proposes areas for commissioning or service design improvements to the PCO | ? |
| QP8 | The practice engages with the development of and follows 3 agreed care pathways for improving the management of patients in the primary care setting (unless in individual cases they justify clinical reasons for not doing this) to avoid inappropriate outpatient referrals and produces a report of the action taken to the PCO no later than 31 March 2012 | 11 |
| QP9 | The practice meets internally to review the data on emergency admissions provided by the PCO | 5 |
| QP10 | The practice participates in an external peer review with a group of practices to compare its data on emergency admissions either with practices in the group of practices or practices in the PCO area and proposes areas for commissioning or service design improvements to the PCO | 15 |
| QP11 | The practice engages with the development of and follows 3 agreed care pathways (unless in individual cases they justify clinical reasons for not doing this) in the management and treatment of patients in aiming to avoid emergency admissions and produces a report of the action taken to the PCO no later than 31 March 2012 27.5 | 27.5 |
| QP12 | practice meets to review A&E data provided by PCO by 31 Jul 2012 | 7 |
| QP13 | practice participates in external peer review and agrees improvement plan by 30 Sept 2012 | 9 |
| QP14 | practice implements the improvement paln to reduce avoidable attendances and produces a report by £! March 2013 | 15 |
| QOF patient experience | ||
|---|---|---|
| PE1 | Length of consultationsThe length of routine booked appointments with the doctors in the practice is not less than 10 minutes.If the practice routinely sees extras during booked surgeries, then the average booked consultation length should allow for the average number of extras seen in a surgery session.If the extras are seen at the end, then it is not necessary to make this adjustmentFor practices with only an open surgery system, the average face to face time spent by the GP with the patient is at least 8 minutes.Practices that routinely operate a mixed economy of booked and open surgeries should report on both criteria | 33 |
| QOF additional services |
|---|
| Cervical Screening (CS) |
| Child Health Surveillance (CHS) |
| Maternity Services (MAT) |
| Contraception (SH) |
| QOF additional services – Cervical Screening | ||
|---|---|---|
| CS1 | The percentage of patients ( 25 to 64 in England) whose notes record that a cervical smear has been performed in the preceding 5 years | 1140–80% |
| CS5 | The practice has a system for informing all women of the results of cervical smears | 2 |
| CS6 | The practice has a policy for auditing its cervical screening service, and performs an audit of inadequate cervical smears in relation to individual smear-takers at least every 2 years | 2 |
| CS7 | The practice has a protocol that is in line with national guidance and practice for the management of cervical screening, which includes staff training, management of patient call/recall, exception reporting and the regular monitoring of inadequate smear rates | 2 |
| Exceptions | women having had a hysterectomy including the cervix women who have given a single written confirmation that they refuse a smear are also removed from the catchment group for 5 years |
|
| QOF additional services – child health surveillance | ||
|---|---|---|
| CHS1 | Child development checks offered in line with national guidelines and policy | 6 points |
| QOF additional services – maternity (MAT) | ||
|---|---|---|
| MAT1 | Ante-natal care and screening are offered according to current local guidelines | |
| QOF additional services – Contraception | ||
|---|---|---|
| SH1 | Register of women prescribed any contraception in last 12m (or other appropriate interval e.g. 5 years for IUS) |
4 |
| SH2 | % women prescribed OCP or patch in last 15m given LARCS information 8CAw |
3 40–90% |
| SH3 | % women prescribed EHC in last 12m given information about LARCS at time of or within 1 m of Rx 8CEG. / 8CAw |
3 40–90% |
| QOF Ethnicity |
|---|
| A White British |
| B White Irish |
| C Any other White background |
| D White and Black Caribbean |
| E White and Black African |
| F White and Asian |
| G Any other mixed background |
| H Indian |
| J Pakistani |
| K Bangladeshi |
| L Any other Asian background |
| M Black Caribbean |
| N Black African |
| P Any other black background |
| R Chinese |
| S Any other ethnic group |
| Z Not stated |
| DES LES |
|---|
| Direct Enhanced Services and Local Enhanced Services |
| Payments for additional services ouside QOF or GMS DES nationally directed often becoming part of QOF LES locally agreed according to local needs |
| Drug Misuse |
| Extended Hours |
| Minor Surgery |
| Osteoporosis |
| CVS screening |
| IUCD |
| HPV vaccination |
| Flu vaccination |
| Pneumococcal vaccination |
| Alcohol Misuse |
| Ethnicity and First Language |
| Choose and Book |
| Care of the homeless |
| Intrapartum care |
| Immediate care/First response care |
| Minor injury services |
| MS |
| Patients with depression |
| Sexual health services |
| Childhood immunisations |
| violent patients |
| H1N1 |
| Enhanced Services BMABMA Patient participation DES – FAQs Jun 2011download |