What changes have been made to QOF in 2023/24?

The Quality and Outcomes Framework (QOF) is a voluntary annual reward and incentive programme for GP practices – here’s what changes have been made for 2023/24

CREDIT: This is an edited version of an article that originally appeared on BMA

Changes to the QOF framework for 2023/24 were imposed by NHS England, following GPC England’s rejection of the contract offer for that year. 

GPC England argued for the removal of all QOF targets and for the associated monies to be reallocated to core practice funding, to allow practices to focus on providing patient care rather than “chasing targets”. 

This proposal was in line with several recent reports, including The Future of General Practice published by the Health and Social Care Committee, but was not accepted.

NHS England has committed to a review of QOF with a view to making it more streamlined and focussed. The profession, patients and the wider system will be consulted on this in due course.

There are still 635 total points in QOF for 2023/24, with 81 of these subject to income protection. The value of a QOF point in 2023/24 is £213.43, and the national average practice population figure is 9,639.

 Income protection for disease register indicators (81 points)

NHS England has provided income protection for all register indicators, worth £97m. These will be paid to all practices based on 2022/23 performance once the outturn is finalised.

However, NHS England guidance has also indicated that practices will still be required to maintain these registers. Disease registers will still be used for the purpose of calculating disease prevalence. 

It is important that practices are aware that the £/point value for each clinical area is impacted by the adjusted practice disease factor (APDF), which is calculated using the disease registers; therefore, failing to maintain the registers could result in a reduction in QOF income.

GPC England disagrees with NHS England about the extent to which these measures amount to a meaningful reduction in bureaucratic tasks that practices are required to undertake.

New indicators

Two new cholesterol indicators have been added (CHOL001 and CHOL002), worth 30 points. There is also a new overarching mental health indicator (MH021) achieved based on the percentage of patients with serious mental illness who have received all six elements of the Physical Health Check.

These have been funded via a retirement a rheumatoid arthritis indicator (RA002) and the reduction of the value of the annual dementia review indicator (DEM004).

Atrial fibrillation indicator AF007 has been replaced with ex-IIF indicator CVD-05 (now designated AF008), relating to the prescription of a direct-acting oral anticoagulant or where declined/clinically unsuitable, a Vitamin K antagonist.

The Rheumatoid Arthritis face-to-face review has been retired, and the Dementia indicator can be done remotely or face to face.

Quality Improvement (QI) Modules

NHS England has introduced two new QI modules in 2023/24.

• Workforce and wellbeing – two new indicators (QI013, QI014) have been introduced, designed to incentivise practices to “demonstrate continuous quality improvement activity focussed on workforce and wellbeing” and the participation in network activity to “regularly share and discuss learning” on this theme. These are worth 36 points together.
• Optimising demand and capacity in general practice – four new indicators have been introduced. Three (QI016-QI018) are focussed on encouraging practices to understand, act on, and share insights relating to capacity. QI019 has been introduced to incentivise a reduction in avoidable appointments.

Childhood vaccinations

GPC England secured some minor concessions on the thresholds for these indicators, which have been widely criticised for being unachievable; the lower thresholds are now 89% for VI001, 86% for VI002, and 81% VI003, but the upper thresholds have been raised to 96%.

NHS England has agreed to introduce provisions so that patients vaccinated overseas in accordance with the UK national schedule can be coded as a success for the purposes of QOF achievement. 

It has also agreed to make allowances for patients who have registered with a practice too late (either in age, or in terms of the financial year) to be vaccinated in line with the UK national schedule.