Quality and Outcomes Framework (QOF) 2015-2016

752 Users are discussing this topic

PatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

The following Quality and Outcomes Framework (QOF) indicators only apply to England. The indicators for Scotland, Wales and Northern Ireland are released separately.[1] 

The General Practitioners Committee (GPC) and NHS Employers (on behalf of NHS England) have agreed changes to the QOF for 2015-2016. The threshold changes planned for 1 April 2015 have been deferred for one year to 1 April 2016.[1] 

Atrial fibrillation

  • Establish and maintain a register of patients with atrial fibrillation.
  • The percentage of patients with atrial fibrillation in whom stroke risk has been assessed using the CHA2DS2-VASc score risk stratification scoring system in the preceding 12 months (excluding those patients with a previous CHADS2 or CHA2DS2-VASc score of 2 or more); (thresholds 40-90%).[3] 
  • In those patients with atrial fibrillation with a record of a CHA2DS2-VASc score of 2 or more, the percentage of patients who are currently treated with anticoagulation drug therapy (thresholds 40-70%).

NEW - log your activity

  • Notes
    Add notes to any clinical page and create a reflective diary
  • Track
    Automatically track and log every page you have viewed
  • Print
    Print and export a summary to use in your appraisal
Click to find out more »

Secondary prevention of coronary heart disease

  • Establish and maintain a register of patients with coronary heart disease.
  • Percentage of patients with coronary heart disease in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mm Hg or less (thresholds 53-93%).
  • Percentage of patients with coronary heart disease who have had influenza immunisation in the preceding 1 August to 31 March (thresholds 56-96%).
  • Percentage of patients with coronary heart disease with a record in the preceding 12 months that aspirin, an alternative antiplatelet therapy, or an anticoagulant is being taken (thresholds 56-96%).

Heart failure

  • Establish and maintain a register of patients with heart failure.
  • Percentage of patients with a diagnosis of heart failure (diagnosed on or after 1 April 2006) which has been confirmed by an echocardiogram or by specialist assessment 3 months before or 12 months after entering on to the register (thresholds 50-90%).
  • In those patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction, the percentage of patients who are currently treated with an angiotensin-converting enzyme (ACE) inhibitor (or angiotensin II receptor antagonist - AIIRA) - (thresholds 60-100%).
  • In those patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction who are currently treated with an ACE inhibitor or AIIRA, the percentage of patients who are additionally currently treated with a beta-blocker licensed for heart failure (thresholds 40-65%).

Hypertension

  • Establish and maintain a register of patients with established hypertension.
  • Percentage of patients with hypertension in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mm Hg or less (thresholds 45-80%).

Peripheral arterial disease

  • Establish and maintain a register of patients with peripheral arterial disease.
  • Percentage of patients with peripheral arterial disease in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mm Hg or less (thresholds 40-90%).
  • Percentage of patients with peripheral arterial disease with a record in the preceding 12 months that aspirin or an alternative antiplatelet is being taken (thresholds 40-90%).

Stroke and transient ischaemic attack (TIA)

  • Establish and maintain a register of patients with stroke or TIA.
  • Percentage of patients with a stroke or TIA (diagnosed on or after 1 April 2014) who have a record of a referral for further investigation between 3 months before or 1 month after the date of the latest recorded stroke or the first TIA (thresholds 45-80%).
  • Percentage of patients with a history of stroke or TIA in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mm Hg or less (thresholds 40-75%).
  • Percentage of patients with stroke or TIA who have had influenza immunisation in the preceding 1 August to 31 March (thresholds 55-95%).
  • Percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record in the preceding 12 months that an antiplatelet agent or an anticoagulant is being taken (thresholds 57-97%).

Diabetes mellitus

  • Establish and maintain a register of all patients aged 17 or over with diabetes mellitus, which specifies the type of diabetes where a diagnosis has been confirmed.
  • Blood pressure:
    • Percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mm Hg or less (thresholds 53-93%).
    • Percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mm Hg or less (thresholds 38-78%).
  • Cholesterol:
    • Percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) is 5 mmol/L or less (thresholds 40-75%).
  • Nephropathy:
    • Percentage of patients with diabetes, on the register, with a diagnosis of nephropathy (clinical proteinuria) or micro-albuminuria who are currently treated with an ACE inhibitor (or AIIRA) - (thresholds 57-97%).
  • Glucose control:
    • Percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 59 mmol/mol or less in the preceding 12 months (thresholds 35-75%).
    • Percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 64 mmol/mol or less in the preceding 12 months (thresholds 43-83%).
    • Percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 75 mmol/mol or less in the preceding 12 months (thresholds 52-92%).
  • Percentage of patients with diabetes, on the register, who have had influenza immunisation in the preceding 1 August to 31 March (thresholds 55-95%).
  • Percentage of patients with diabetes, on the register, with a record of a foot examination and risk classification (thresholds 50-90%):
    1. Low risk (normal sensation, palpable pulses).
    2. Increased risk (neuropathy or absent pulses).
    3. High risk (neuropathy or absent pulses plus deformity or skin changes in a previous ulcer); or
    4. Ulcerated foot within the preceding 12 months.
  • Percentage of patients newly diagnosed with diabetes, on the register, in the preceding 1 April to 31 March who have a record of being referred to a structured education programme within 9 months after entry on to the diabetes register (thresholds 40-90%).

Asthma

  • Establish and maintain a register of patients with asthma, excluding patients with asthma who have been prescribed no asthma-related drugs in the preceding 12 months.
  • Percentage of patients aged 8 or over with asthma (diagnosed on or after 1 April 2006), on the register, with measures of variability or reversibility recorded between 3 months before or anytime after diagnosis (thresholds 45-80%).
  • Percentage of patients with asthma, on the register, who have had an asthma review in the preceding 12 months that includes an assessment of asthma control using the 3 Royal College of Physicians (RCP) questions (thresholds 45-70%).
  • Percentage of patients with asthma aged 14 or over and who have not attained the age of 20, on the register, in whom there is a record of smoking status in the preceding 12 months (thresholds 45-80%).

Chronic obstructive pulmonary disease (COPD)

  • Establish and maintain a register of patients with COPD.
  • Percentage of patients with COPD (diagnosed on or after 1 April 2011) in whom the diagnosis has been confirmed by post-bronchodilator spirometry between 3 months before and 12 months after entering on to the register (thresholds 45-80%).
  • Percentage of patients with COPD who have had a review, undertaken by a healthcare professional, including an assessment of breathlessness using the Medical Research Council dyspnoea scale in the preceding 12 months (thresholds 55-90%).
  • Percentage of patients with COPD with a record of forced expiratory volume in one second (FEV1) in the preceding 12 months (thresholds 40-75%).
  • Percentage of patients with COPD and Medical Research Council dyspnoea grade ≥3 at any time in the preceding 12 months, with a record of oxygen saturation value within the preceding 12 months (thresholds 40-90%).
  • Percentage of patients with COPD who have had influenza immunisation in the preceding 1 August to 31 March (thresholds 57-97%).

Dementia

  • Establish and maintain a register of patients diagnosed with dementia.
  • Percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months (thresholds 35-70%).
  • Percentage of patients with a new diagnosis of dementia recorded in the preceding 1 April to 31 March with a record of FBC, calcium, glucose, renal and liver function, TFTs, serum vitamin B12 and folate levels recorded between 12 months before or 6 months after entering on to the register (thresholds 45-80%).

Depression

  • Percentage of patients aged 18 or over with a new diagnosis of depression in the preceding 1 April to 31 March, who have been reviewed not earlier than 10 days after and not later than 56 days after the date of diagnosis (thresholds 45-80%).

The disease register for the depression indicators is defined as all patients aged 18 or over, diagnosed on or after 1 April 2006, who have an unresolved record of depression in their patient record. 

Mental health

  • Establish and maintain a register of patients with schizophrenia, bipolar affective disorder and other psychoses and other patients on lithium therapy.
  • Percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive care plan documented in the record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate (thresholds 40-90%).
  • Percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of blood pressure in the preceding 12 months (thresholds 50-90%).
  • Percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of alcohol consumption in the preceding 12 months (thresholds 50-90%).
  • Percentage of women aged 25 or over and who have not attained the age of 65 with schizophrenia, bipolar affective disorder and other psychoses whose notes record that a cervical screening test has been performed in the preceding 5 years (thresholds 45-80%).
  • Percentage of patients on lithium therapy with a record of serum creatinine and TSH in the preceding 9 months (thresholds 50-90%).
  • Percentage of patients on lithium therapy with a record of lithium levels in the therapeutic range in the preceding 4 months (thresholds 50-90%).

Remission from serious mental illness

  • Making an accurate diagnosis of remission can be challenging. In the absence of strong evidence of what constitutes 'remission' from serious mental illness, clinicians should only consider using the remission codes if the patient has been in remission for at least five years - that is where there is:
    • No record of antipsychotic medication.
    • No mental health inpatient episodes; and
    • No secondary or community care mental health follow-up for at least 5 years.
  • Where a patient is recorded as being 'in remission' they remain on the register (in case their condition relapses at a later date) but they are excluded from the denominator for mental health indicators.
  • The accuracy of this coding should be reviewed on an annual basis by a clinician. Should a patient who has been coded as 'in remission' experience a relapse then this should be recorded as such in their patient record.
  • In the event that a patient experiences a relapse and is coded as such, they will once again be included in all the associated indicators for schizophrenia, bipolar affective disorder and other psychoses.
  • Where a patient has relapsed after being recorded as being in remission, their care plan should be updated subsequent to the relapse. Care plans dated prior to the date of the relapse will not be acceptable for QOF purposes.

Cancer

  • Establish and maintain a register of all cancer patients defined as a 'register of patients with a diagnosis of cancer excluding non-melanotic skin cancers diagnosed on or after 1 April 2003'.
  • Percentage of patients with cancer, diagnosed within the preceding 15 months, who have a patient review recorded as occurring within 6 months of the date of diagnosis (thresholds 50-90%).

Chronic kidney disease (CKD)

  • Establish and maintain a register of patients aged 18 or over with CKD - with classification of categories G3a to G5.

Epilepsy

  • Establish and maintain a register of patients aged 18 or over receiving drug treatment for epilepsy

Learning disability

Osteoporosis: secondary prevention of fragility fractures

  • Establish and maintain a register of patients:
    • Aged 50 or over and who have not attained the age of 75 with a record of a fragility fracture on or after 1 April 2012 and a diagnosis of osteoporosis  confirmed on DXA scan; and
    • Aged 75 or over with a record of a fragility fracture on or after 1 April 2014 and a diagnosis of osteoporosis.
  • Percentage of patients aged 50 or over and who have not attained the age of 75, with a fragility fracture on or after 1 April 2012, in whom osteoporosis is confirmed on DXA scan, who are currently treated with an appropriate bone-sparing agent (thresholds 30-60%).
  • Percentage of patients aged 75 or over with a record of a fragility fracture on or after 1 April 2014, who are currently treated with an appropriate bone-sparing agent (thresholds 30-60%).

Rheumatoid arthritis

  • Establish and maintain a register of patients aged 16 or over with rheumatoid arthritis.
  • Percentage of patients with rheumatoid arthritis, on the register, who have had a face-to-face review in the preceding 12 months (thresholds 40-90%).

Palliative care

  • Establish and maintain a register of all patients in need of palliative care/support irrespective of age.
  • Regular (at least 3-monthly) multidisciplinary case review meetings where all patients on the palliative care register are discussed.

Further reading & references

  1. BMA Contracts; QOF Guidance
  2. Changes to QOF 2015/16; NHS Employers
  3. CHADS2 Score - Stroke Risk in Atrial Fibrillation; MDCalc Online Calculator

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

Original Author:
Dr Colin Tidy
Current Version:
Peer Reviewer:
Prof Cathy Jackson
Document ID:
28601 (v3)
Last Checked:
29/05/2015
Next Review:
27/05/2020

Did you find this health information useful?

Yes No

Thank you for your feedback!

Subcribe to the Patient newsletter for healthcare and news updates.

We would love to hear your feedback!

 
 
Patient Access app - find out more Patient facebook page - Like our page