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Publication, Part of

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

Official statistics

Main findings

Introduction to the QOF

The Quality and Outcomes Framework (QOF) was introduced as part of the General Medical Services (GMS) contract on 1 April 2004. The QOF is an incentive payment scheme (not a performance management tool) which aims to improve patient care by rewarding practices for the quality of care they provide. This quality is assessed using achievement against a range of indicators across a number of key areas in clinical care and public health. A key principle of the QOF is that indicators should be based on the best available research evidence.

In QOF 2018-19, achievement was assessed for 77 indicators in the following groups (age groups specified where applicable):

  • Asthma
  • Atrial fibrillation
  • Blood pressure
  • Cancer
  • Cardiovascular disease - primary prevention (30-74)
  • Cervical screening (25-64)
  • Chronic kidney disease (18+)
  • Chronic obstructive pulmonary disease
  • Contraception (<55)
  • Dementia
  • Depression (18+)
  • Diabetes mellitus (17+)
  • Epilepsy (18+)
  • Heart failure
  • Hypertension
  • Learning disabilities
  • Mental health
  • Obesity (18+)
  • Osteoporosis (50+)
  • Palliative care
  • Peripheral arterial disease
  • Rheumatoid arthritis (16+)
  • Secondary prevention of coronary heart disease
  • Smoking
  • Stroke and transient ischaemic attack

QOF recorded prevalence

The highest QOF recorded prevalence rates were for hypertension (14.0 per cent), depression (10.7 per cent) and obesity (10.1 per cent).

Overall, the greatest change in QOF recorded prevalence was for depression, which increased from 9.9 per cent in 2017-18 to 10.7 per cent in 2018-19.

All regions saw an increase in QOF recorded prevalence, but the range across regions exceeded 5 percentage points for the first time, with the lowest rate in London (7.7 per cent) and the highest rate in the North West (12.9 per cent).

Note: prevalence rates for 2017-18 have been recalculated using only those practices for which data are available for both reporting years.


QOF achievement refers to the percentage of available QOF points attained. Points are associated with each indicator, and each indicator specifies a level of clinical care. A threshold is set in respect of the provision of this clinical care to patients on the relevant QOF register - for many indicators, a practice must provide the specified clinical care to 90 per cent of patients on the relevant register in order to achieve the full points available for the indicator. Further details are available in the technical annex.

Achievement rates are generally high. In 2018-19, overall achievement ranged from 90.8 per cent for the cardiovascular disease - primary prevention indicator group, to 99.7 per cent for the obesity indicator group.

Note: achievement rates for 2017-18 have been recalculated using only those practices for which data are available for both reporting years.

The average total achievement score for GP practices in 2018-19 was 539.2, compared with 537.5 in 2017-18 (out of a maximum of 559 available points).

The proportion of practices achieving the maximum score of 559 points increased to 13.0 per cent in 2018-19, from 12.5 per cent in 2017-18.


Exception reporting rates reflect the percentage of patients who are not included when determining QOF achievement. Examples of exceptions include patient refusal of treatment, GP advice that two types of treatment should not be administered simultaneously, or a patient registration or diagnosis occurring within three months of the end of the reporting year (full details are available in the technical annex). 

The cardiovascular disease - primary prevention indicator group had the highest overall exception rate (32.7 per cent), whilst the blood pressure indicator had the lowest overall exception rate (0.6 per cent). 

Note: exception rates for 2017-18 have been recalculated using only those practices for which data are available for both reporting years.

The greatest changes in exception rates compared with 2017-18 were in the asthma, cancer, cardiovascular disease - primary prevention and osteoporosis indicator groups. The exception rate decreased by 0.7 percentage points for asthma, and increased by 0.7 percentage points for cancer, 1.2 percentage points for cardiovascular disease - primary prevention, and 2.9 percentage points for osteoporosis. 

The exception rate in the osteoporosis indicator group has increased every year since the indicators went live, and now stands at 22.2 per cent.

Last edited: 2 March 2022 1:27 pm