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Changes to QOF made as part of new GP contract agreement

Fifteen new QOF indicators, covering five areas of care, will be introduced from April 2019 as part of the new GP contract agreed between the British Medical Association and NHS England.

As previously report by Nursing in Practice, new indicators will be introduced for type 2 diabetes that will see glucose targets set for younger patients to avoid undertreatment.

Meanwhile, older patients will no longer require intensive glucose-lowering therapy, with clinical judgement used to ascertain their required level of therapy.

Hypertension will also see changes, with the HYP003 indicator will be reintroduced that sees patients under 79 controlled to 140/90mmHg, and targets extended to patients with coronary heart disease and stroke/TIA.

Cervical screening QOF indicators will be aligned with the National Screening Committee recommendations, with women receiving age-appropriate advice and screening offers.

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

All the stories from the new GP contract in England

In addition to the 15 new indicators, 28 existing indicators will be retired, worth a total of 175 points. Of these, 101 points will be recycled into the 15 new indicators. The remaining 74 will be used to create two ‘quality improvement’ modules for 2019/20.

The two modules will cover prescribing safety and end-of-life care, and will sit within a new quality improvement domain.

The alterations to QOF will also see exception reporting undergo an overhaul, called the personalised care adjustment, with practices able to differentiate between five different reasons for removing a patients from an indicator.

Practices will be able to choose from one of the following:

  • 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.

The changes in full

New indicators

Indicator ID Indicator wording Points
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 7
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 4
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 2
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 10
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 17
DM021 The percentage of patients with diabetes with moderate or severe frailty who have a HbA1c levvel of 75mmol/mol measured in the last 12 months 10
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) 4
DM023 The percentage of patients with diabetes and a history of CVD (not including haemorrhagic stroke) who are currently treated with a statin 2
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 14
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 5
MH006 The percentage of patients with schizophrenia, bipolar disorder and other psychoses who have a record of BMI in the last 12 months 4
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 12
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 5
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 3
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 2
     

Indicators to be retired

Indicator ID Indicator wording Points
CHD002 The percentage of patients with CHD with a blood pressure reading of 150/90mmHg or less in the last 12 months 17
CON001 A register of women aged 54 or under who have been prescribed any method of contraception at least once in the last year, or other appropriate interval, is established and maintained 4
CON003 The percentage of women prescribed emergency hormonal contraception at least once during the last 12 months, who have then received information about LARC at the time or within one month of emergency contraception prescription 3
COPD004 The percentage of patients with COPD with a record of FEV1 over the last 12 months 7
COPD005 The percentage of patients with COPD and MRC dyspnoea scale >3 in the last 12 months with a record of oxygen saturation value over the same time period 5
CS001 A protocol is in place, in line with national guidance, for the management of cervical screening. It should include staff training, management of patient call/recall, exception reporting and the regular monitoring of inadequate sample rates 7
CS002 The percentage of women aged 25 or over, and under 65, who have had a cervical screening test in the last five years 11
CS004 A policy for auditing the cervical screening service, with audits performed of inadequate cervical screening tests every two years 2
DEM005 The percentage of patients with a new diagnosis of dementia recorded in the year running 1 April-31 March, with FBC, calcium, glucose, renal and liver function, TFTs, serum vitamin B12 and folate levels recorded either 12 months before, or six months after, the patient enters the register 6
DM002 The percentage of patients with diabetes with a blood pressure reading of 150/90mmHg in the last 12 months 8
DM003 The percentage of patients with diabetes with a blood pressure reading of 140/80mmHg in the last 12 months 10
DM004 The percentage of patients with diabetes with a last measured total cholesterol of 5mmol/l or less within the last 12 months 6
DM007 The percentage of patients with diabetes with a HbA1c of 59mmol/mol or less in the last 12 months 17
DM008 The percentage of patients with diabetes with a HbA1c of 64mmol/mol or less in the last 12 months 8
DM009 The percentage of patients with diabetes with a HbA1c of 75mmol/mol or less in the last 12 months 10
HYP006 The percentage of patients with hypertension with a blood pressure of 150/90mmHg or less in the last 12 months 20
MH007 The percentage of patients with schizophrenia, bipolar disorder and other psychoses with a record of alcohol consumption in the last 12 months 4
MH008 The percentage of women aged 25 or over, and under 65, with schizophrenia, bipolar disorder and other psychoses who have had a cervical screening test in the last five years 5
MH009 The percentage of patients on lithium with a record of serum creatinine and TSH in the last nine months 1
MH010 The percentage of patients on lithium with lithium levels in the therapeutic range in the last four months 2
OST002 The percentage of patients aged 50 or over, and under 75, with a fragility fracture on or after 1 April 2012, in whom osteoporosis is confirmed on DXA, who are being treated with an appropriate bone-sparing agent 3
OST005 The percentage of patients aged 75 or over with a record of fragility fracture on or after 1 April 2014 and a diagnosis of osteoporosis, who are currently treated with a bone-sparing agent 3
PAD002 The percentage of patients with PAD with a blood pressure reading of 150/90mmHg or less in the last 12 months 2
PAD003 The percentage of patients with PAD with a record in the last 12 months of aspirin or alternative antiplatelet being taken 2
PC002 Three monthly multidisciplinary case review meetings where all patients on the palliative register are discussed 3
SMOK003 Support is offered to patients who smoke in stopping smoking, with a strategy that includes providing literature and offering appropriate therapy 2
STIA003 The percentage of patients with a history of stroke or TIA with a blood pressure of 150/90mmHg in the last 12 months 5
STIA008 The percentage of patients with a stroke or TIA, diagnosed on or after 1 April 2014, who have a record of a referral for further investigation between three months before or one month after the date of the latest recorded stroke or the first TIA 2