How practices can get the most out of QOF 2024/25

GP Dr Gavin Jamie analyses this year’s changes to QOF to help practices maximise income

The good news for busy practices this year is that there are no new indicators added to the Quality and Outcomes Framework (QOF).

Several of the existing indicators (32 to be precise) have been ‘income protected’ for this year, which is likely to reduce workload to some degree, although probably to a smaller extent than some of the coverage might have suggested.

Some of the key themes and points to consider for QOF activity this year include:

How does income protection actually work?

When it comes to indicator protection, please ignore the protection applied to indicators that define disease registers. This is meaningless and makes no difference at all to how practice income is calculated.

The sole exception would be in the rare case that a practice had no patients at all on a particular register in 2023/24. It would mean they would be unable to get any payment for that disease register in 2024/25.

Protection for other indicators works by fixing the number of points in the relevant indicator at the level that was earned in 2023/24. Practices cannot drop below that level but equally they cannot rise above it – even if achievement is greater this year than last. Practices do tend to score highly on most indicators, so this year may be a welcome reprieve in some areas.

There is a small potential catch, and this is to do with our inability to predict the future.

Currently, indicators are protected for one year. However, some of the indicators could appear in next year’s QOF (for 2025/26).

For instance, CAN004 says that a patient diagnosed with cancer this May would be expected to have had a review within 12 months. This would fall in the 2025/26 QOF year.

Nobody knows if the indicator will be included in next year’s QOF, or even whether QOF will survive at all. There will be a general election and a GMS contract review before then. It is something to bear in mind when approaching this year’s indicators.

Practices should remember that although the points will be protected that does not mean that the payment will be the same. The value of the points will continue to be adjusted by disease prevalence – which is why those disease registers will be as important as ever.

Which areas mean less work this year and which increase workload?

Much of the work associated with the QOF will need to continue but the protection of the Quality Improvement (QI) indicators do represent a real reduction in practice work. There will be no targets or indicators set for these indicators this year. Points will be preserved from 2023/24.

Other areas will have less effect. Smoking advice in chronic disease (SMOK005), including the recording of smoking in asthma (AST008) indicator are suspended, although it is expected that smoking data will continue to be collected and cessation advice given. Other smoking indicators such as recording of smoking data in patients with chronic disease and smoking advice in all patients carry on as usual.

Both of the cancer reviews have been suspended but as mentioned above their potential re-introduction could be messy. Similarly, reviews for depression within eight weeks of diagnosis (DEP004) are also not being assessed this year.

After only a year in QOF, the indicator MH021 concerning patients on the mental health register having all six physical checks (BMI, alcohol consumption etc) has been protected. This will make very little difference to practice workload as each check continues to have its own indicator.

The mental health guidance now includes more information from the NICE guideline and includes a larger number of physical checks than previously. Measurements such as waist circumference, prolactin, and nutritional status are not part of any indicator but are now included in the guidance.

Indicators have been modified to be more in line NICE guidance 

There have been tweaks to some of the other indicators, mainly to align them with current NICE guidelines.

This is most obvious in the cholesterol indicators. The indicator for statin prescriptions has been renumbered for no particular reason from CHOL001 to CHOL003.

What was formerly CHOL002 – and is now CHOL004 – has bigger changes. It will now look for LDL level first and, only if that is not present, will it check non-HDL cholesterol. This is the reverse of the situation from 2023/24.

The cholesterol levels have also been increased slightly, which should make things a little more achievable for practices. The LDL threshold has risen from 1.8 to 2mmol/L and the non-HDL threshold from 2.5 to 2.6mmol/L

Be aware of changes to the guidance accompanying the indicators

Other changes are simply to guidance, with no change to the indicators themselves.

For example, in relation to DM006 for diabetes, treatment of microalbuminuria has been updated to include reference to SGLT2 inhibitors, although the indicator itself still only mentions ACEI.

There have been similar small updates to guidance in asthma and depression. In asthma, there are additional links to resources to ensure the quality of annual asthma reviews. These are potentially useful but would represent quite a small change to how practices undertake these reviews.

There is a reminder now in the depression guidance that the single depression review required for the indicator is not the end of care of patients with depression. Hopefully most practices realised this already.

In all, this should be a quiet year for QOF. Changes to guidance have mostly been to try to bring it closer to the published NICE guidelines. We are likely to see bigger changes next year, although I am glad that there is no indicator for predicting the future – I would be unlikely to get any points all.

Further reading

• NHS England’s Quality and Outcomes Framework guidance for 2024/25
• GMS Medical Services Statement of Financial Entitlements Directions 2024

Dr Gavin Jamie is a GP in Swindon and runs the QOF database website