Quality and Outcomes Framework, Achievement, prevalence and exceptions data 2018-19 [PAS]

The Quality and Outcomes Framework (QOF) covers 19 clinical and six public health aspects of GP practice activity, and it represents one of the richest sources of information from primary care. QOF data are collected primarily to support payments to GP practices. QOF information is valuable for many secondary uses.

Some aspects of the NHS Digital published QOF information are also presented by the Care Quality Commission, NHS.UK, and other information dissemination routes.

The accuracy of QOF information depends on:

• Clinical case finding by GPs; for example, information from QOF diabetes registers or about QOF diabetes indicators depends on people with diabetes being diagnosed
• Clinical coding; for example, when patients are diagnosed with diabetes, the quality of QOF data about people with diabetes depends on the GP practice maintaining accurate and coded clinical records

Several practices are shown to have very small list sizes; this is because patient list sizes as at 1 April 2019 are used for the QOF publication, and practices may have participated in QOF during the reporting year but closed at or towards the end of the reporting year. This should be borne in mind when analysing disease prevalence.

A number of practices in Kernow CCG and Devon CCG have been excluded from the publication following guidance received during the validation exercise, which identified issues in the data extracted from CQRS which rendered it misleading. A description of this issue, and a list of the practices excluded from the publication on this basis, is provided in the 'QOF 2018-19: Practice validation comments' file, which is available on the publication homepage. This should be taken into consideration when interpreting the 2018-19 QOF data.

QOF data are used to calculate annual payments to GP practices. GPs are therefore incentivised to maintain accurate and up to date patient records in respect of QOF information. Considering this, GP practices’ clinical information system suppliers deliver systems to maximise recording and quality of coding for information relating to the QOF.

NHS Digital uses a snapshot of QOF data as available via CQRS some months after the financial year-end as the basis for QOF publications; for 2018-19, this extraction was made on 2 July. Practices were advised to sign-off QOF achievement before midnight on the 31 March 2019.

Prior to publication, NHS Digital invites regional local offices to view the total QOF points for each of their practices, as held on CQRS at the point of extract for the QOF publication. Regional local offices are asked to advise NHS Digital of:

• Any practices whose final points total is subject to sign-off
• Any subsequent changes to QOF achievement (where known)
• Any practices missing from the extract
• Any practices that should not be included in the publication (for example services not receiving QOF payments due to practice closure or mergers)
• Notes on any practices whose QOF achievement should be viewed in a particular context – for example practices whose lists are specialised, and where not all QOF points can be achieved (e.g. university practices, asylum seeker services, services for the homeless, etc.)

In the 2018-19 validation exercise, 32 practices were not explicitly commented on during the validation process; these practices were listed as closed or dormant at the end of the reporting year and scored either zero or 14 points and were removed on advice of the Responsible Statistician. A further 262 practices were removed at the request of the validators. All comments made during the validation exercise are available to view in the file QOF 2018-19: Practice validation comments file, which can be accessed on the publication homepage.

QOF information relates to achievement over a financial year. QOF achievement can take some months after financial year-end to be agreed between practices and NHS England. The extract of QOF data for this publication was made from CQRS on 2 July 2019. This delay after the financial year-end maximises the number of practices whose achievement is signed-off, whilst still allowing publication in October.

There was no delay to the preannounced publication date of 24 October 2019.

This QOF release is available on the NHS Digital website. 

Included in this release is a summary of the main findings, a technical annex, an FAQ annex and this data quality annex. Information at practice, CCG, STP, regional local office, regional and national levels are presented in Excel workbooks, and the underlying (‘raw’) data are available in .csv files - these can be found on the publication homepage.

We provide an online database which allows users to view detailed information about practices in a more visual format.

Where NHS Digital data are reused, NHS Digital should be clearly acknowledged as the data source. Please see our terms and conditions for further information.

QOF information is collected primarily to support QOF payment calculations under GMS contracts, and this data collection is (for clinical information) based on detailed coded business rules. QOF clinical registers may not match disease definitions used by epidemiologists and may not cover all ages. As a result, QOF indicators may not be defined in the same way as similar measures from other sources.

It is important to take account of QOF definitions (including coding contained in QOF business rules) before comparing QOF information with other data sources, for example comparing QOF disease prevalence with expected prevalence rates based on public health models.

Individual QOF indicators or the business rules associated with them can change from year to year. Levels of achievement and exceptions rates therefore may not be directly comparable each year. 

Specific issues and caveats concerning the interpretation of QOF data are covered in the technical annex.

During each publication cycle, data quality is assessed by the NHS Digital collection and publication teams, and where queries arise, data suppliers are contacted to validate and confirm data submissions.

The content of QOF is changing in 2019-20, and we will be making changes to the QOF publication at the same time. Answer the 5 short questions in our QOF publication survey and give us your views on how the publication could be improved:

Comments can also be received via:

email: [email protected]

telephone: 0300 303 5678

The QOF data downloaded from CQRS by NHS Digital are a secondary use of the data.

The primary use of the QOF data is to support QOF payments to GP practices. The sub-region validation exercise, which allows NHS England sub-region teams to confirm practice data ahead of the publication, does place some burden on participants. Participation in this validation exercise is voluntary and we estimate that validation takes less than 1.5 person-days to complete for each sub-region.

Published QOF information is derived from the data available via CQRS. Users of CQRS (appropriate individuals from practices, CCGs and sub-regions) can monitor their own QOF information on a continuous basis throughout the year; they also have access to reports which provide the same level of information as that which is published by NHS Digital.

QOF publications are subject to risk assessments concerning disclosure. No personal identifiable data have been identified in this year’s QOF. Standard NHS Digital protocols around information governance are followed in the production of QOF publications.

The data contained in this publication are Official Statistics. The code of practice is adhered to from extraction of the data to publication: 

Please see links below to the relevant NHS Digital policies:

Statistical Governance Policy [Archive Content]

Freedom of Information