The current QOF system is to be reviewed during 2023/24 so it becomes more ‘streamlined and focused’, with an overhauled model being launched the following year, NHS England has announced in its GP contract letter.
Views from GPs, patients and ‘the broader system’ will be sought and taken into account ‘to determine the most appropriate form’ for QOF in 2024/25.
However, the 2023/24 QOF activity will be ‘streamlined’ too, under the changes to the contract.
All QOF income for ‘register indicators’ is to be protected, with funding paid to practices monthly based on their 2022/23 performance. This will ‘release £97m’, said NHS England.
It is unclear exactly what is meant by ‘register indicators’, but Dr Gavin Jamie, a GP partner in Swindon who also runs the QOF Database website, said it likely refers to the 19 indicators that require a register of patients to be held, such as with epilepsy, heart failure, chronic kidney disease and more.
The number of indicators in QOF will also be cut by a quarter, from 74 to 55. There will be ‘a number of other small changes to indicator wordings and value funding’, NHS England’s letter said.
Other revisions to QOF include:
- Atrial Fibrillation indicator AF007 will be retired and replaced with a new indicator, AF008 – the 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. This will carry 12 points, with a lower threshold target of 70% and upper threshold of 95%. This new indicator is similar to one from this year’s Investment and Impact Fund (IIF), CVD-05.
- Two new cholesterol indicators will be added to QOF worth 30 points, and £36m in funds.
- There will also be a new overarching mental health indicator.
- The above additions will be funded by retiring indicator RA002 (the percentage of patients with rheumatoid arthritis on the register, who have had a face-to-face review in the preceding 12 months) and reducing the value of DEM004 (annual dementia review).
- The mode of review of DEM004 will also be amended ‘to be determined through shared decision-making with the patient’.
The QOF QI modules next year will focus on workforce and wellbeing, and optimisation of demand and capacity management in general practice. This will include ‘an emphasis on using data to analyse potentially avoidable appointments and build on care navigation and use of wider workforce or local services to reduce pressure on general practice,’ said NHS England.
Dr Jamie said: ‘I think this “income protection” element is the biggest change to QOF, although without any details it’s confusing. NHS England said money will be “released” but that is generally NHSE code for “not paid to practices” and there is quite a bit of money involved.’
He warned that this change may also signal a ‘transition to none of the register indicators having points’ but that the timescales are not clear.
Dr Jamie also said the addition of an ‘overarching’ mental health indicator may pose problems. ‘As a general rule big “overarching” indicators are a complicated mess. Several simpler ones tend to be easier to manage’.
While cholesterol indicators have been in QOF before, he added, the retiring of Atrial Fibrillation indicator AF007, and inclusion of a similar indicator taken from the IIF instead ‘seems sensible.’
‘The criteria were different for IIF and QOF before. It felt as if they were written by different committees and someone seems to have read the whole thing now,’ he said.
