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Maximising your QOF income: Learning Disabilities

15 November 2023

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GP Dr Gavin Jamie looks at how practices can attain maximum points within the learning disabilities area of QOF’s clinical domain

Summary – indicators and values

  • Indicators: 1
  • Points: 4
  • Prevalence: 0.55% (this is an estimate based on latest available QOF data and current trends)
  • Estimated £/patient on the register: £16


The prevalence of learning disability has been going up in recent years, possibly because of better identification by practices and social services departments. The prevalence recorded by practices is still less than a third of the figures quoted by Mencap. There is only one indicator which is for maintaining the register, although this is generally also the basis for the learning disability enhanced service.

Indicator LD004: Maintain patient register (4 points)

The register will be the basis for the annual reviews described in the Learning Disability DES. However, as these are only for patients aged 14 and over, it is worth coding patients under the age of 14 too. Many codes will put a patient onto the register. One of the more useful is a code saying that the patient is on the learning disability register, as well as diagnostic codes for learning disability and mental retardation. Codes for learning difficulties will not put a patient on the register.

As learning disability is a long term condition the code needs only to be entered once. The patient will remain on the register and contribute to prevalence for each following year. There is no code to remove a patient from the register. As this is simply a register there is no exception reporting.

This register is likely to be used to assist with the enhanced service. It is worth comparing your register with the register held by your local social services department, to identify patients who may be missing from either list. This can both increase prevalence and ensure more joined-up care for patients.

Although the payment per patient is modest, the associated learning disabilities DES offers £140 for each patient who has a health check, making the register considerably more valuable. It is worth concentrating efforts on making sure that patients receive that review by sending invitations to patients or their carers as appropriate. After the check they must be appropriately coded to claim from the enhanced service.

Full indicator

The contractor establishes and maintains a register of patients with learning disabilities (LD004)

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

 Further reading/resources 

NHS England – Quality and Outcomes Framework guidance for 2023/24. Published 30 March 2023.