At first glance, you might assume that the not much has changed for QOF in 2022/23 in the contract update letter .To an extent, you’d be correct, though there are more changes than you might expect.

While updates are relatively minor, but we’ve summarised the changes here to give you a head start on QOF 2023/24.

In 2023/34 the value of a QOF point is £213.43.  There are 635 available QOF points available. The Contractor Population Index (CPI) is 9639, an increase of 265 from 9374 in 2022/23.

In order to provide some support for practices the disease registers set out below will be income protected for 2023/24.

Income protected disease registers

Disease registers for 2023/24 will be paid on the basis of 2022/23 achievement. The disease registers that will be paid on that basis are as follows:

Disease register                Title           Conditional Points

TOTAL                                                                          81 POINTS

Other changes

ATRIAL FIBRILATION

 REMOVED AF007 In those patients with atrial fibrillation with a record of a CHA2DS2-VASc score of 2 or more, the percentage of patients who are currently treated with anti-coagulation drug therapy

ADDED AF008 Percentage of patients on the QOF Atrial Fibrillation register and with a CHA2DS2- VASc score of 2 or more, who were prescribed a direct-acting oral anticoagulant(DOAC), or, where a DOAC was declined or clinically unsuitable, a Vitamin K antagonist.
12 POINTS.  70-95% THRESHOLDS

 CORONARY HEART DISEASE

 REMOVED CHD008. The percentage of patients aged 79 years or under with coronary heart disease in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less

REMOVED CHD009. The percentage of patients aged 80 years or over 5 with coronary heart disease in whom the last blood
pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less

ADDED CHD015 The percentage of patients aged 79 years or 12 under, with coronary heart disease, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less, (orequivalent home blood pressure reading).
12 POINTS 40-77% THRESHOLDS

ADDED CHD016 The percentage of patients aged 80 years or 5 over, with coronary heart disease, in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less, (or equivalent home blood pressure reading) 5 POINTS. 46-86% THRESHOLDS

HEART FAILURE

REMOVED HF005 The percentage of patients with a diagnosis of heart failure on or after 1 April 2021 which:

1. Has been confirmed by an echocardiogram or by specialist assessment between 3 months before and 6 months after entering on to the register; or
2. If newly registered in the preceding 12 months, with no record of the diagnosis originally being confirmed by echocardiogram or specialist assessment, a record of an echocardiogram or a specialist assessment within 6 months of the date of registration.

ADDED HF008 The percentage of patients with a diagnosis of heart failure on or after 1 April 2023 which:

1. Has been confirmed by an echocardiogram or by specialist assessment in the 6 months before entering on to the register; or
2. If registered at the practice after diagnosis,with no record of the diagnosis originally being confirmed either by echocardiogram or by specialist assessment, a record of an echocardiogram or a specialist assessment within 6 months of the date of registration.

6 POINTS.  40-80% THRESHOLDS

HYPERTENSION

REMOVED HYP003 The percentage of patients aged 79 years or 14 under with hypertension in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less

REMOVED HYP007 The percentage of patients aged 80 years and 5 over with hypertension in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less

ADDED HYP008 The percentage of patients aged 79 years or 14 under with hypertension in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90mmHg or less (or equivalent home blood pressure reading)
14 POINTS.  40-77% THRESHOLDS

ADDED HYP009 The percentage of patients aged 80 years or over, 5 with hypertension, in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less, (or equivalent home blood pressure reading)
5 POINTS.  40-80% THRESHOLDS

 STROKE AND TIA

REMOVED STIA010 The percentage of patients aged 79 years or 3 under with a history of stroke or TIA in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less

REMOVED STIA 011 The percentage of patients aged 80 years and 2 over with a history of stroke or TIA in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less

ADDED STIA014 The percentage of patients aged 79 years or 3 under, with a history of stroke or TIA, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less (or equivalent home blood pressure reading).
3 POINTS. 40-73% THRESHOLDS

ADDED STIA015 The percentage of patients aged 80 years or 2 over, with a history of stroke or TIA, in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less, (orequivalent home blood pressure reading).
2 POINTS 46-86% THRESHOLDS

DEMENTIA

REMOVED DM019 The percentage of patients with diabetes, on the register, without moderate or severe frailty in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less

ADDED DM033 The percentage of patients with diabetes, on the register, without moderate or severe frailty in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less (or equivalent home blood pressure reading)
10 POINTS. 38-78% THRESHOLDS

ASTHMA

REMOVED AST006 The percentage of patients with a diagnosis of asthma on or after 1 April 2021 with either:

1. A record of spirometry and one other objective test (FeNO or reversibility or variability) between 3 months before and 6 months after diagnosis; or
2. If newly registered in the preceding 12 months with a diagnosis of asthma recorded on or after 1 April 2021 but no record of objective tests being performed at the date of registration, with a record of spirometry and one other objective test (FeNO or reversibility or variability) recorded within 6 months of registration

ADDED AST011 The percentage of patients with a diagnosis of asthma on or after 1 April 2023 with either:

1. A record of quality assured spirometry and one other objective test (FeNO or, bronchodilator reversibility or peak flow variability) between 3 months before or 6 months after diagnosis; or
2. If newly registered in the preceding 12 months with a diagnosis of asthma recorded on or after 1 April 2023 but no record of objective tests being performed at the date of the registration, with a quality assured spirometry and one other objective test (FeNO or bronchodilator reversibility or peak flow variability) recorded within 6 months of the registration.

15 POINTS.  45-80% THRESHOLDS

COPD

REMOVED COPD008 The percentage of patients with COPD and Medical Research Council (MRC) dyspnoea scale ≥3 at any time in the preceding 12 months, with a subsequent record of an offer of referral to a pulmonary rehabilitation programme (excluding those who have previously attended a pulmonary rehabilitation programme)

ADDED COPD014 The percentage of patients with COPD and 2 Medical Research Council (MRC) dyspnoea scale ≥3 at any time in the preceding 12 months, with a subsequent record of referral to a pulmonary rehabilitation programme (excluding those who have previously attended a pulmonary rehabilitation programme)
2 POINTS. 40-90% THRESHOLDS

DEPRESSION (LIKELY CODING CHANGES)

REMOVED DEP003 The percentage of patients aged 18 or over with a new diagnosis of depression in the preceding 1 April to 31 March, who have been reviewed not earlier than 10 days after and not later than 56 days after the date of diagnosis

ADDED DEP004 The percentage of patients aged 18 or over with a new diagnosis of depression in the preceding 1 April to 31 March, who have been reviewed not earlier than 10 days after and not later than 56 days after the date of diagnosis
10 POINTS. 45-80% THRESHOLDS

MENTAL HEALTH

ADDED MH021 Percentage of patients with schizophrenia, bipolar affective disorder and other psychoses and those on lithium therapy, who received all six elements of the Physical Health Check for people with Severe Mental Illness
6 POINTS. 50-80% THRESHOLDS

RHEUMATOID ARTHRITIS

REMOVED RA002 The percentage of patients with rheumatoid arthritis, on the register, who have had a face-to-face review in the preceding 12 months

NON-DIABETIC HYPERGLYCAEMIA (LIKELY CODING CHANGES)

REMOVED NDH001 The percentage of patients with non-diabetic hyperglycaemia who have had an HbA1c or fasting blood glucose performed in the preceding 12 months

ADDED NDH002 The percentage of patients with non-diabetic hyperglycaemia who have had an HbA1c or fasting blood glucose performed in the preceding 12 months
18 POINTS. 50-90% THRESHOLDS

VACCINATION AND IMMUNISATION

Changes to the achievement thresholds with removal of the increased points achievement at the lower threshold.

Changes to the recording of overseas vaccinations to allow practices to use discretion and record qualifying overseas vaccination in such a way that it will qualify for QOF, but not the associated Item of Service (IoS) payments.

Quality Improvement Activity

Activity in the Quality Improvement domain will this year focus on workforce and well being and optimising demand and capacity.

Workforce and wellbeing (37 POINTS)

Improving wellbeing, resilience and risk of burnout

Practices need to undertake a review covering the current approach to workforce wellbeing and retention, including among other things: Access to flexible working, reasons for sickness absence, available support for new starters,  and the available support for various staff groups.

Optimising demand and capacity in General Practice (37 POINTS)

Optimising Access to General Practice

Practices need to assess demand and capacity over time, looking at variations in patterns and predictability.  Practices will need to count daily availability of available appointment modes and look to plot this on a run chart.  Using the capacity and demand data, practices should plan process improvements and use this as a basis for their quality improvement activity in this area

How do you feel about the latest changes? If you have any comments or questions, pop over to the Practice Index forum thread here.