Quality and Outcomes Framework (QOF) and primary care business rules

NHS England are responsible for producing and maintaining the extraction specification (business rules) for Quality and Outcomes Framework (QOF), Enhanced Services (ES), Vaccinations and Immunisations V&I, certain elements of Core Contact (CC) and other services commissioned by the Department of Health and Social Care.

The Reference Set Portal is an interactive tool which allows users to see which SNOMED codes are included in the current version of a reference set (refset)/cluster as used by the business rules.

NHS England have released the business rules for the enhanced services (ES), Vaccinations and immunisations (V&I) and Core Contract components (CC). This page will be updated as further ES, V&I and CC business rules become available.

As part of the contractual agreement it was agreed to continue collecting information relating to indicators no longer in QOF (INLIQ). Indicators retired since 2014-2015 will continue to be collected under this extraction. The reporting is essential, as the Department of Health and Social Care, Public Health England and other healthcare groups have indicated that the information linked to these indicators is essential for their work and wider healthcare programmes.

These patient level data collections are in response to the intense demand for general practice data to be shared in support of vital pandemic planning and research for COVID-19 purposes. These collections include:

• GP Data for Pandemic Planning and Research (GDPPR)
• At Risk Patients
• Shielded Patient List (now retired)

Evidence shows that early identification and treatment of diabetic eye disease could reduce sight loss. The main treatment for diabetic retinopathy is laser surgery. This service looks to identify those at risk of developing diabetic retinopathy.

The Government's mandate to NHS England includes a task of working with NHS Digital and The Department of Health (DH) to provide GPs and general practices with information on the care provision for their patients.

The LDD aims to:

• make information about the health and healthcare for people with learning disabilities more readily available and understandable
• undertake detailed secondary analyses of existing datasets to identify important new lessons for service improvement and development
• share the learning by working to ensure that key messages about best practice in providing healthcare for people with learning disabilities are widely understood
• improve available information by surveying data gaps and working to fill them.

The ruleset lays out how General Practice systems should search for specific clinical information in patient records. Firstly, the searches look for patients who already have cardiovascular disease and then filter out those whose lipid control is good; they then find those who have had difficulties with or have not wanted lipid lowering therapy in the past so that clinicians can consider what next steps to take, including offering one of the newer therapies.

For the remaining patients, the searches then determine which of the available treatment options (several high intensity stain and other non-statin alternatives) may be suitable, taking into account relevant factors such as allergies, current lipid levels and kidney function. The end result is a list of patients for each group of possible treatment options which can be used by practices to review patient records and then call patients for review.

There are 2 sets of business rules included in the zip file below. The difference is in the way they are structured, with the ‘New Style’ ones reducing some of the duplication of logic needed by the usual style business rules. System suppliers have the choice of using whichever business rules suit their set up.

Unlike with other business rules, data relating to this service is not collected by NHS Digital.

NHS Digital, acting on behalf of Public Health England (PHE), will be collecting information about the numbers of people who are invited to an NHS Health Check and either attend or do not attend.

PHSMI data extract collects information detailed on GP records for patients with severe mental illness and not recorded as ‘in remission’.

This collection helps to ensure that people with severe mental illness have their physical health needs met by monitoring the delivery of comprehensive physical health check, collects information on relevant follow-up interventions and to understand their physical health outcomes.