It’s that time of year again, when we start chasing those elusive last points – calling patients who haven’t responded to invitations or exploring exception reporting as a last resort. To help you along with achieving your maximum potential, here’s a useful little A-Z.
A – Administration: Having a robust call and recall process creates a solid foundation for running a proactive QOF programme. Most practices use birth months to call in patients, in the hope that eventually patients will call to arrange a review without being prompted.
B – Business rules: These pesky little articles are from NHS England, who are responsible for producing and maintaining the extraction specification (business rules) for QOF among other things.
C – Contractor Population Index (CPI): Getting to grips with this algorithm will help you understand why your QOF monetary values may not be quite as expected. QOF points are based (in 2023/24) on an average practice list size of 9,639 and an average QOF point value of £213.93. Adjustments are made through the CPI for practices with list sizes of less than or more than the average. QOF point values are also adjusted by prevalence (see ‘P’).
D – Disease registers: Maintenance is needed on all registers, not just those with indicators attached to them. For example, in QOF, having an Obesity register is all that’s required, but this also has relevance to various ES and some indicators (such as MH006 BMI recorded).
E – Episodicity: Super relevant to the Depression indicator, which asks for review 10 – 56 days after diagnosis. Only completely new diagnoses or episodes should be added as a new diagnosis – this then triggers the timescale-restricted indicator. If a patient has experienced recent episodes, be sure to amend the episodicity to ‘ongoing’, otherwise it will trigger the need for coded review. The distinction between a new episode vs. an ongoing episode is also relevant when coding heart conditions among others.
F – Funding: QOF is voluntary but with so much potential income attached to it, consider what other funding you might need if you were to choose not to participate.
G – Get going from day 1! Even though clinical systems are notoriously slow at updating QOF after the year end, don’t be lulled into a false sense of security. From 1st April, everything coded counts!
H – How am I driving? Well, after many years behind the wheel, I like to think I’m alright…. In QOF terms, though, this can be a helpful indicator of your achievement, if the date you looked at the data was year-end.
I – Indicators: There are three domains in which the indicators fall – Public Health, Clinical and Quality Improvement. Public Health covers cervical screening, vac and imms, and smoking. Clinical, long-term conditions and Quality Improvement subjects change annually. This year is capacity and access, and workforce health and wellbeing.
J – Justify: Most indicators are based on NICE guidelines so they can be justified as being part of QOF to evidence that the practice is giving good patient care and demonstrating best practice.
K – Keep your eye on the ball: Reviewing QOF stats quarterly is a good discipline to use; it highlights where things are going well, as well as areas that might need more attention.
L – Lighten the load: Delegate, delegate, delegate! You can’t do this alone. Your whole team needs to be involved, so share tasks among them.
M – Mad March rush: Despite all our best intentions, we still have an element of this. Hopefully some of these hints and tips will help to alleviate some of the panic.
N – New indicators: This year sees the introduction of the Cholesterol indicator. Hopefully you will be au fait with how to achieve it, but if not, basically CHOL001 can only be exception reported if the patient has declined a statin or had an adverse reaction to lipid-lowering therapy. For patients unable to tolerate it, check if an alternative lipid-lowering treatment may be suitable. CHOL002 doesn’t include patients with CKD. This cohort can only be excepted if they decline a cholesterol test or if they’re registered with the practice after July 2023.
O – Origins: QOF was originally introduced in 2004 after the election of a Labour Government and their revolution of the GMS contract. At this time, there were 76 clinical indicators and patients could be excepted for reasons such as clinical inappropriateness, e.g., intolerance of medication and patient dissent.
P – Prevalence: Monitoring registers closely will help with prevalence. If you have a higher-than-average number of patients on a register, then your QOF point value will increase to reflect the additional work you’re doing. If you have a lower-than-average number, then you’ll be penalised with a lesser amount. Ways of increasing prevalence include looking for hypertensive patients taking medication but not coded as actually having the condition. Also, for long-standing diabetic patients, check their diabetes code is a QOF code and not an old ‘C’ read code. Equally, you should be checking for patients on a disease register who no longer need to be there – asthmatics coded as children who no longer have regular inhalers could potentially be coded as ‘asthma resolved’.
Q – Quality improvement modules: These change annually, depending on current needs in primary care. They should also feature on PCN meeting agendas as peer review is often a requirement.
R – Read codes: When I first started in primary care way back when, it was mooted that read codes would soon be changing to SNOMED, in line with secondary care coding. Several decades later, we’re still not quite there. However, coding (in whichever format) is essential to achievement. When conducting a Depression review, there can be a beautifully detailed consultation within the patient’s record, but unless the actual review code is added, the patient will still show as missing.
S – Summarise: The QOF technical specs document is quite a weighty tome. From the beginning of April, watch out for summaries of changes on platforms like Practice Index and NHS Digital.
T – Thresholds: Each indicator has a lower threshold and an upper threshold. Achieving the minimum will put you on the points ladder, but meeting the upper threshold will gain you the maximum amount.
U – Updates: See ‘B’ – Business rules. These and other updates can catch you out, so monitor primary care bulletins for any changes.
V – Vac and imms: A recent addition to QOF and, frustratingly, there’s no way of exception reporting children whose parents don’t want them to be vaccinated. This particularly affects areas with diverse ethnicities and/or areas that are pro anti-vaccination. Since its introduction, there has been a change to the business rules, meaning that practices are no longer penalised where patients have registered after the vaccination timescale. We live in hope that the opportunity to exception code for patient dissent will also be added.
W – Window of opportunity: Make sure your team members know where to look for any outstanding QOF alerts in a patient’s record. During a phone call, for instance, a care navigator can ask a patient to have their blood pressure checked if there’s an alert. Clinicians (if time allows) can also opportunistically complete outstanding tasks.
X – Xception reporting: Personalised care adjustments should remove a patient from an indicator if they’re coded as having two invitations at least seven days apart. Exceptions are best left until the end of March, to allow the patient to attend. A word of caution: if you’re noted to have high exception-reporting rates, you should expect to be contacted by your ICB to justify that reporting has been appropriate.
Y – Your view: There is currently a consultation open about the role of incentive schemes in general practice. This consultation closes on 7th March.
Z – Zero points: The equivalent of Eurovision’s ‘nul points’! Zero points means no financial remuneration for any work completed. It may be that work has been done but just not coded correctly. A bit of retrospective work may soon rectify that.
(The views expressed in this blog are my own and not representative of any organisation in which I work.)
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