What changes have been made to QOF in 2019/20?

Female doctor writing prescription to her young patient.

The sprawling but informative document entitled 2019/20 General Medical Services (GMS) contract Quality and Outcomes Framework (QOF) can be time-consuming to navigate – so Practice Business has mined the gold for you and summarised the 2019/20 changes

In January 2019, NHS England reviewed QOF and agreed a new five-year framework for GP contract reform. They have outlined this in a comprehensive documented called the 2019/20 General Medical Services (GMS) contract Quality and Outcomes Framework (QOF): Guidance for GMS contract 2019/20 in England. The QOF topics discussed here are in line with the NHS Long Term Plan, and several changes have been suggested for the remainder of 2019/ 2020, including:

  • The retirement of 28 indicators, worth 175 points. These indicators have been retired due to no longer being in line with NICE guidelines, have known measurement issues, or the care outlined is now deemed core professional responsibility.
  • The introduction of 15 new indicators, worth 101 points. These bring QOF into closer alignment with NICE guidelines and Screening Committee recommendations. The new indicators are mainly on blood pressure control, cervical screening and diabetes.
  • Exception reporting has been replaced with a Personalised Care Adjustment which will better reflect individual clinical situations and patients’ wishes.
  • The introduction of a new QOF Quality Improvement (QI) domain (worth 74points). The first two modules will be prescribing safety and end-of-life care.

These changes were last updated at the end of April 2019, so we are aware that the revisions to QOF have been influencing practices for some time. They are continuing to shape the way services are being delivered, and it is therefore important to keep the revisions fresh in your mind and be able to refer back to them. The entire Guidance for GMS contract 2019/20 in England document is 134 pages long. We realise that most will not have time to read this in its entirety, so below we have summarised the retired indicators as well as the new ones.

We hope you can use this article as a quick resource to help you sustain your knowledge on the 2019/20 QOF changes.

The retirement of 28 indicators

From seizure-free epilepsy patients to cholesterol readings in schizophrenic patients, the ‘low value’ indicators that have been removed are linked to a wide range of long-term conditions. The retirement of 28 indicators totals 175 QOF points, 101 of which have been recycled into the 15 new indicators.

For a full list of the retired indicators, visit section 7 of the 2019/20 General Medical Services (GMS) contract Quality and Outcomes Framework (QOF), entitled Indicators no longer in QOF (INLIQ).

The introduction of 15 new indicators

New indicators have been introduced for type 2 diabetes. They ensure glucose targets are established for younger patients to avoid undertreatment and to aid in prevention efforts.

Hypertension indicators have also been reformed, with the HYP003 indicator reintroduced so that patients under 79 should be controlled to 140/90mmHg. These targets include patients with coronary heart disease and stroke/TIA.

Cervical screening QOF indicators reflect the National Screening Committee recommendations, with women receiving age-related advice and screening offers.

And indicators for offering pulmonary rehabilitation to patients with COPD have been introduced, along with a new indicator for a focus on weight management in patients with schizophrenia or other psychoses.

A complete list of the 15 new indicators can be found here:

  • CS005: Proportion of women eligible for cervical screening aged 25-49 years who have had a cervical screen test within the last three years and six months.
  • CS006: Proportion of women eligible for cervical screening aged 50-64 who have had a cervical screen test within the last five years and six months.
  • COPD008: The percentage of patients with COPD and MRC dyspnoea scale >3 in the last 12 months who have been offered a referral to pulmonary rehabilitation.
  • DM019 The percentage of patients with diabetes without moderate or severe frailty who have a blood pressure of 140/80 measured in the last 12 months.
  • DM020 The percentage of patients with diabetes without moderate or severe frailty who have a HbA1c level of 58mmol/mol measured in the last 12 months.
  • DM021 The percentage of patients with diabetes with moderate or severe frailty who have a HbA1c level of 75mmol/mol measured in the last 12 months.
  • DM022: The percentage of patients with diabetes aged 40 or over, with no history of CVD and without moderate or severe frailty, currently treated with a statin (not including patients with type 2 diabetes and a CVD risk score of <10% recorded in the last three years).
  • DM023: The percentage of patients with diabetes and a history of CVD (not including haemorrhagic stroke) who are currently treated with a statin.
  • HYP003: The percentage of patients aged 79 years or younger who have a blood pressure of 140/90mmHg or less measured in the last 12 months.
  • HYP007 The percentage of patients aged 80 years and over who have a blood pressure of 150/90mmHg or less measured in the last 12 months.
  • MH006: The percentage of patients with schizophrenia, bipolar disorder and other psychoses who have a record of BMI in the last 12 months.
  • CHD008: The percentage of patients aged 79 or under with CHD with a blood pressure of 140/90mmHg or less in the last 12 months.
  • CHD009: The percentage of patients aged 80 or over with CHD with a blood pressure of 150/90mmHg or less in the last 12 months.
  • STIA010: The percentage of patients aged 79 years or under with a history of stroke or TIA with a blood pressure of 140/90mmHg in the last 12 months.
  • STIA011: The percentage of patients aged 80 years or over with a history of stroke or TIA with a blood pressure of 150/90mmHg in the last 12 months.
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Personalised Care Adjustment

There has also been an overhaul in ‘exception reporting’, how a practice can appeal to remove a patient from one or more of its indicators due to being anomalous in some way. It is now termed personalised care adjustment, with practices allowed to select one of five reasons for removing a patient from an indicator. The new term reflects the patient-oriented purpose of such a reporting system.

The criteria are as follows:

  • treatment unsuitable for the patient,
  • patient chose not to have treatment following a conversation with the nurse,
  • the patient didn’t respond to offers of care,
  • service not available,
  • patient is newly diagnosed or newly registered.

Unlike exception reporting, these five specific reasons for making a personalised care adjustment help NHS England differentiate between practices using the system fairly and practices who may be abusing it. The regulatory authorities found that practices who were higher exception reporters were often giving a lesser quality of service. Exception reporting can no longer be used as a ‘catch-all’ to justify the exclusion of patients from the QOF assessment, making a practice seem more successful than it is.

We hope that this brief summary has helped solidify the QOF revisions and additions in your minds, so that you can keep striving for QOF excellence and bolster the service and funding of your practice.

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