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QOF: understanding the public health domain

8 March 2023

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Practice manager Dr Jolande Bennekers offers tips on achieving QOF targets in areas including blood pressure, cervical screening and vaccination and immunisations.  

The Public health domain of QOF comprises five areas. These are:

  • Blood Pressure
  • Cervical Screening
  • Obesity
  • Smoking
  • Vaccination and immunisations. (This was added as a new area last year).

So, what do the indicators involve?

Blood Pressure

This area has one indicator currently: BP002.

It relates to the percentage of patients aged 45 or over who have had their blood pressure recorded in the last five years. The lower threshold target for this indicator is 50% and the higher threshold is 90%.

This indicator aims to find those people who live with raised blood pressure and diagnose and treat them appropriately. By identifying these patients, their risk of heart attacks, strokes, and kidney failure can be reduced.

This indicator is relatively easy to achieve, provided you encourage your clinicians to measure and record the blood pressure of everyone that walks through the door. In our practice, using this approach means we have usually already reached the end-of-year target at the start of the new QOF year.

When we recall patients for the NHS Health Check, which targets patients from the age of 40, this catches the same cohort of patients. Anyone we don’t catch this way are invited separately.

The only way to exemption report on this indicator is when a patient declines to accept offered care.

Cervical screening

This has two indicators within it, CS005 and CS006.

CS005 relates to the proportion of women aged 25 to 49 years who have received cervical screening in the previous 3 years and 6 months. Recall for cervical screening is central, but we still need to prompt our patients when they are overdue for their screening to hit the 80% target for full achievement.

CS006 looks at the proportion of women aged 50 to 64 years who had cervical screening within the previous five years and six months. These women are also recalled centrally, and we again need to prompt where they don’t respond. Again, the target is 80% for full achievement.

Even though the story of TV personality Jade Goody and other women with cervical cancer prompted an increase in cervical screening, many women are still reluctant to come forward.

I have seen a significant increase in women  taking up the offer of screening since we started using texting with a self-book link. Patients no longer need to telephone the surgery, but can instead book the appointment in a more convenient way and more easily find a slot that suits them best.

If patients have not responded to three or more invites, they can be excluded from this indicator.


This is currently purely a register indicator which carries no further action than adding patients to the register.

OB002 asks that we establish and maintain a register of patients 18 and over with a BMI that is 30 or above in the preceding 12 months. The aim of having a register is to set us up to providing patients with health promotion advice. Obesity carries many risks, including cancer, heart disease, diabetes, and strokes.

The register also links in with the weight management enhanced service.


This has three indicators: SMOK002, SMOK004, and SMOK005.

SMOK002 relates to patients on specific chronic disease registers who had their smoking status recorded in the last 12 months. The target for achieving full points is 90%.

SMOK004 looks at the percentage of smokers aged 15 or above, where an offer of support and treatment within the last 24 months was recorded. The target for full achievement is 90%.

SMOK005 relates to the percentage of patients on specific chronic disease registers who are current smokers and have received an offer of support and treatment within the last 12 months. There is a target of 96% for full achievement on this indicator.

We aim to reduce the risk that smoking poses to the health of the nation and premature death by including these indicators in QOF.

These are indicators that lend themselves to achievement early in the QOF year through batch texting and batch questionnaires to the patients in these groups.

Vaccination and immunisations

There are four indicators in this area: VI001, VI002, VI003, and VI004. It is worth noting that the vaccination and immunisations area doesn’t show in the public health domain on Emis but it is a part of this domain.

The first three target childhood immunisations, whereas the last one involves shingles vaccinations.

VI001 looks at the percentage of babies who reached eight months in the last year who received at least three doses of diphtheria, tetanus, and pertussis-containing vaccines before age eight months. To achieve this fully, we need to reach 95%.

VI002 involves the percentage of children who reached 18 months in the last year who received at least one dose of MMR vaccine between the age of 12 and 18 months. We need to hit the 95% target for full achievement.

VI003 relates to the percentage of children who became five in the last year and received their preschool booster and at least 2 doses of MMR between the ages of one and five years. We reach full achievement at 95%.

VI004 looks at the percentage of patients who reached 80 years old in the last year who received the shingles vaccine between the ages of 70 and 79 years. We achieve fully if we reach 60%.

Some targets can be difficult to hit, and we noticed non-achievement on the VI003 indicator was often due to incorrect coding of the vaccinations given. Fortunately, Ardens, and other similar resources, can help to identify those patients where coding issues exist.

The public health domain has several health promotional areas. When we achieve well on these, this will bring us income, but also helps prevent clinical problems, and may improve quality of life.

The indicators can be achieved through proactive actions. Texting tools and searches can help us, too.

Good luck!