Note that this is the 4th version, which updates the original contract and therefore the numbers are not sequential and there are some missing to reflect changes and to ensure that any comparative studies are clear what is being compared.

Quality and productivity

There is now a new section of QOF Quality and Productivity Indicators. Points have been released in the 2011 changes to be used for new quality and productivity indicators in QOF that aim to "secure more effective use of NHS resources, in particular through improvements in the quality of primary care that reduce hospital outpatient referrals, and emergency hospital admissions by providing care to patients through the use of alternative care pathways, and through more cost-efficient prescribing. " [Letter from General Practitioners Committee of the BMA 11 March 2011].

Extract of letter:
"The “Improving Quality and Productivity In the NHS” indicators in the QOF will assist in the review of current practice by GPs, both within the practice and with external peers, prompted by the analysis of practice specific data that looks to understand the reasons for and, if appropriate address, outlier performance by a practice in three areas:

•    emergency admissions
•    first outpatient referrals
•    prescribing drugs

The agreed activities involve reinvesting over £100m released from removed QOF indicators to support improved quality of general practice in areas where the evidence shows the strongest link between GP practice behaviours and levels of expenditure in secondary care. 

In England, the first two indicators will be based on the ‘Better Care, Better Value’ (BCBV) indicators developed by the NHS Institute for Improvement and Innovation that seem to build on their Opportunity Locator work.  They will cover the following areas:

•    reducing emergency hospital admissions associated with long term conditions where there is evidence that appropriate management of these conditions in primary care reduces emergency admissions;
•    reducing inappropriate outpatient referrals,

We have agreed that for the emergency admissions and outpatient referrals elements, practices will receive the full payments for these areas if, following internal and external practice reviews, they are implementing care pathways that are intended to have the effect of reducing unnecessary referrals and admissions. 

In Scotland and Wales, the indicators will be based on the equivalent of England’s BCBV indicators.


The third of these areas focuses on increasing cost-effective prescribing and will be based on a range of national and local indicators. Following internal and external practice reviews, payment will depend on the actual level of appropriate cost-effective prescribing achieved by the practice.

These quality and productivity incentives are for one year, from 1 April 2011 until 31 March 2012, with the possibility of being extended to a second year if significant progress has been made in achieving productivity savings at the mid-year point. "
 

 

Asthma

Indicator	Points	Payment stages
Records
ASTHMA 1. The practice can produce a register of patients with asthma, excluding patients with asthma who have been prescribed no asthma-related drugs in the previous twelve months	4
Initial Management
ASTHMA 8. The percentage of patients aged eight and over diagnosed as having asthma from 1 April 2006 with measures of variability or reversibility	15	40-80%
Ongoing management
ASTHMA 3. The percentage of patients with asthma between the ages of 14 and 19 in whom there is a record of smoking status in the previous 15 months	6	40-80%
ASTHMA 6. The percentage of patients with asthma who have had an asthma review in the previous 15 months	20	40-70%

 

 

Chronic Obstructive Pulmonary Disease

Indicator	Points	Payment Stages
Records
COPD 14. The practice can produce a register of patients with COPD (same as COPD1)	3
Initial diagnosis
COPD 15. The percentage of all patients with COPD diagnosed after 1 April 2011 in whom the diagnosis had been confirmed by post bronchodilator spirometry (was COPD 12 and the date was 2008)	5	40-80%
Ongoing management
COPD 10. The percentage of patients with COPD with a record of FeV1 in the previous 15 months	7	40-70%
COPD 13: Replaces COPD 11 The percentage of patients with COPD who have had a review, undertaken by a healthcare professional, including an assessment of breathlessness using the MRC dyspnoea score in the previous 15 months	9	50-90%
COPD 8. The percentage of patients with COPD who have had influenza immunisation in the preceding 1 September to 31 March	6	40-85%

 

 

Smoking Indicators

Indicator	Points	Payment Stages
Ongoing management
Smoking 3: The percentage of patients with any or any combination of the following conditions: coronary heart disease, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma,  schizophrenia, bipolar affective disorder or  other psychoses whose notes record smoking status in the previous 15 months.	30	40-90%
Smoking 4: The percentage of patients with any or any combination of the following conditions: coronary heart disease, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma,  schizophrenia, bipolar affective disorder or  other psychoses who smoke whose notes contain a record that smoking cessation advice or referral to a specialist service, where available, has been offered within the previous 15 months	30	40-90%

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