For cash-strapped practices feeling greater financial pressures than ever before, QOF points matter. The welcome additional income is, in an increasing number of cases, often the difference between success and failure.
It’s therefore unsurprising that a hot topic for practice managers is the QOF calculation – knowing what cash will be coming in down the line is important. And for the current contractual year, it appears this calculation is causing plenty of head scratching and confusion.
Before focusing on the calculation, it’s worth taking a moment to consider the changes to QOF made in this year’s GP Contract. The most recent QOF guidance document, updated at the end of April, details the new set-up, which has changed considerably from last year. Some of the key highlights include:
- The retirement of 28 indicators, totalling 175 points, which are either no longer in line with NICE guidance, have known measurement issues (usually because of low numbers at a practice level) or where the care described is now viewed as a core professional responsibility.
- The introduction of 15 new indicators, totalling 101 points, to bring QOF into closer alignment with NICE guidance and Screening Committee recommendations, mainly on diabetes, blood pressure control and cervical screening.
- Exception reporting has been replaced with a Personalised Care Adjustment to ‘better reflect individual clinical situations and patients’ wishes’.
Quality improvement domain
In addition to the above, there’s a new quality improvement domain, which includes two areas which will change annually.
Firstly, GP practices will need to participate in peer-review meetings within their primary care network. GPs will have to join a minimum of two peer review meetings on what they are doing to improve safe prescribing and two meetings to discuss how they are improving end-of-life care.
This year the domain will focus on prescribing safety and end-of-life care, and will equate to 74 points – 37 for each area.
As the guidance document states, prescribing safety will cover NSAIDs, lithium and valproate in women of child bearing age, while end-of-life care will focus on early identification and support for people with advanced progressive illness who might die within the next twelve months and their family/care-givers.
The new QOF guidance has said that for each section, practices can earn 27 points for showing ‘continuous quality improvement activity’ and ten points for participating in the network meetings where they will ‘regularly share and discuss learning from quality improvement activity’. In order to earn the points, practices will need to evaluate the current quality of their prescribing safety and end-of-life care and identify areas for improvement – this would usually include a baseline assessment of current prescribing and a retrospective death audit. Practices will also need to implement an improvement plan and complete a QI monitoring template.
Personalised care adjustment policy
Among the many changes to QOF for 2019/20, perhaps the most significant was the removal of Exception Reporting as we know it and its replacement by the new Personalised Care Adjustment. NHS England says that the change has been made because exception reporting did not provide any specific reasons and so was deemed to be a catchall that could potentially be abused. This followed an assessment by the regulatory authorities who stated in their findings that those practices that were higher exception reporters were often seen as those who provided a lesser quality of service. The new Personalised Care Adjustment enables practices to differentiate between five different reasons for removing a patient from an indicator. Practice Index PLUS members can access a handy resource that outlines the policy changes and how to implement them. Click here for more details.
With all of that out of the way, we can now turn our attention to the financial side. It’s worth pointing out here that the size of QOF remains unchanged for 2019/20 at 559 points, although the value of a QOF point in will increase from £179.26 in 2018/19 to £187.74, and the national average practice population figure will be 8,479.
While there is an increase in place, this doesn’t necessarily mean there’s more money for practices. As one poster points out on the Practice Index Forum, “whilst the actual value of the QOF point has increased, there will be no additional income as it is based on national average list size which has also increased.”
To calculate the actual value of a QOF point for a practice, it’s a case of following this calculation, because QOF points are adjusted for prevalence and patient population, based on national list size (8,479).
So, to work out your actual QOF value for your practice, you need to divide your population by 8,479 to derive a factor and multiply this to the QOF point value to derive the actual QOF value for your practice.
For example, if your practice has 4000 patients.
4000/8479 = 0.4717537
0.4717537 x £187.74 = £88.57 per QOF point.
Interestingly, a handy post on the Forum points out that this all equates to pretty much static funding for general practice (which could equate to a fall, once corrected for inflation). Assuming your list size is static, as is disease prevalence, what does the year on year increase in QOF point value mean for you. Again, assuming a list size of 4000 patients and total QOF points available as 545, the following applies:
These figures don’t include 2019/20 because 74 points are available via the new initiatives mentioned above. “How they’ll adjust the payment of this I don’t know…probably based only on capitation I’m guessing,” commented the author of these calculations on the Forum.
These figures also don’t take in to consideration prevalence, which starts getting much more complicated.
Disease prevalence further confusion seems to exist around disease prevalence within the new QOF set-up. Previously, if you wanted to increase QOF income, but didn’t want more patients or couldn’t get any, increasing disease prevalence would boost income. By coding better or diagnosing more, as well as weeding out ghost patients that dilute the prevalence, practices could get higher payments – if prevalence is above average, you get more money, if it’s less then you get less.
However, one practice manger we spoke to shed some doubt on this, based on their calculations and the fact QOF is moving towards average value points. They told us: “We’re in a retirement town with a very old population, on average, so we have a really high disease prevalence. With the new QOF system moving to average value points our QOF income is going to drop by at least £30,000. The indicators being withdrawn were weighted in our favour previously – I see this changing big time.” The PM outlined how six osteoporosis points, worth £9,000, were being replaced by six prescribing points worth £1,600, and how the system penalises practices with large disease registers, high prevalence, high frailty, and high complexity. “There will be winners and losers from the new system, that’s for sure, and it all comes down to a practice-by-practice calculation,” the PM added. “It’s worth doing the sums now to avoid nasty surprises further down the line.”
Other calculations we’ve completed with practices resulted in more positive outcomes – one suburban practice with a list size of 9,500 stood to receive an increased income of 2.9%, while an urban one with a similar list stood to gain by 0.89%, mainly due to the phasing out of MPIG and loss of the correction factor.
When you then take into account the issue of pay rises – a topic we discussed recently on the Blog – and indemnity changes, which could save practices money, it’s a complicated picture for practice manager to deal with. All we can safely say is that nobody in general practice is going to be wildly better off – but then you probably knew that already!
A handy tool
To help practices track and maximise QOF, Practice Index PLUS subscribers can download a handy QOF plotter. Currently compatible with SystmOne, the QOF plotter takes a snapshot of data from your end of year QOF report and translates it into a clear visual report on which areas to target
It helps you to identify the key areas to focus on, with some clever colour coding to really highlight the indicators worthy of your all-important time. We hope this clever little tool will give you a real boost as you keep a record of all your hard work!
How will the ‘new-look’ QOF impact you? Have you done the calculations? Let us know by commenting below or take it to the Practice Index Forum.