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 and/or the business rules associated with them can change from year to year. Levels of achievement and personalised care adjustments (formerly exceptions) rates therefore may not be directly comparable each year.
Overview of year on year changes are:
2004-05 and 2005-06
QOF was introduced in 2004-05, the same indicator set was used in 2005-06. In 2004-05 and 2005-06 GP practices were able to achieve a maximum QOF score of 1,050 points.
2006-07 and 2007-08
From April 2006 a revised QOF was introduced, including new clinical areas, and revising some clinical indicators. The revised QOF continued to measure achievement against a set of evidence-based indicators but allowed a maximum possible QOF score of 1,000 points.
2008-09
Changes were made at the start of 2008-09.
- The introduction of two new indicators in the Patient Experience domain. The new indicators, PE7 and PE8, were derived from the results of the national GP Patient Survey, and rewarded GP practices for providing 48-hour appointments (PE7) and advanced booking (PE8). These two new indicators were worth a total of 58.5 QOF points, and their introduction coincided with the removal of some indicators (or points associated with indicators)
Maximum possible QOF score remained at 1,000 points.
2009-10 and 2010-11
Changes made at the start of 2009-10 and remained in force for 2010-11 included:
- The introduction of new indicators in the existing heart failure, chronic kidney disease, depression, and diabetes clinical indicator sets
- The introduction of two new indicators under a new cardiovascular disease (primary prevention) clinical indicator set
- The removal of some patient experience indicators; changes to contraception indicators within the Additional Services domain of the QOF
- Various changes to the points values of some QOF indicators
Maximum possible QOF score remained at 1,000 points.
2011-12
Changes at the start of 2011-12 included:
- The introduction of new indicators in the epilepsy, learning disability and dementia clinical indicator sets
- The introduction of a new set of indicators measuring quality and productivity.
- Twelve indicators were retired across a range of sets
- Twenty-two indicators were replaced, either due to changes to indicator wording or coding/business logic changes
- Five indicators had changes to point values or thresholds.
Maximum possible QOF score remained at 1,000 points
2012-13
Changes at the start of 2012-13 included:
- The retirement of seven indicators (including five from the Quality and Productivity area), releasing 45 points to fund new and replacement indicators.
- Nine new NICE recommended clinical indicators introduced, including two new clinical areas (Peripheral arterial disease and Osteoporosis) and additional smoking indicators.
- Three new organisational indicators for improving Quality and Productivity which focused on accident and emergency attendances.
- Sixteen other indicators were replaced, either due to changes to indicator wording or coding/business logic changes or to changes to point values or thresholds.
Maximum possible QOF score remained at 1,000 points.
2013-14
Changes at the start of 2013-14 included:
- The indicator codes have all been reset and re-ordered, starting with 001 for each set of indicators to reflect the flow of processes.
- Thirty-eight indicators were retired which included the organisational domain
- A new public health domain was introduced (including a subset of additional services indicators), with some existing indicators reallocated to this new domain.
- Twelve new indicators were introduced which included a new public health measure: blood pressure and a new clinical condition: rheumatoid arthritis.
- Thirteen indicators have been replaced along with changes to the wording where necessary, which was mainly changing 'GP practice' to 'contractor'.
- There was of the end-of-year overlap for most indicators by changing the indicator time-frame from 15 to 12 months or 27 to 24 months.
Maximum possible QOF score available changed to 900.
2014-15
Changes at the start of 2014-15 included:
- Two domains retired: the quality and productivity domain and the patient experience domain.
- Three indicator group retired: hypothyroidism, child health surveillance and maternity.
- Twenty-six individual indicators retired, from within conditions that are still measured in QOF.
- No new indicators or indicator groups have been added this year.
- Minor changes to indicators have resulted in new indicator numbering. Epilepsy now has only one indicator (the presence of a register). Learning disability has had the age restriction removed and is no longer for those aged 18 or over. Blood Pressure has also changed its age restriction from age 40 or over to age 45 or over.
Maximum possible QOF score available remained at 900.
2015-16
Changes at the start of 2015-16 included:
- Total number of indicators fell from 81 to 77 with some indicators being retired or replaced.
- The number of points assigned to some indicators has been changed but the number of points available in each domain has remained the same.
- No changes to the number of indicator groups
- Minor changes to indicators’ wording, time-frame or maximum available points have resulted in new indicator numbering. This affects the dementia; chronic kidney disease and obesity indicator groups as follows:
- DEM002 and DEM003 are now numbered DEM004 and DEM005 respectively, due to changes in the wording and points for DEM002, and changes in the time-frame for DEM003.
- CKD001 is now numbered CKD005 following a change in wording
- OB001 is now numbered OB002 following a change in the age group to which the indicator applies
Maximum possible QOF score available changed to 559 points
2016-17-18
- No changes to the number of points available, or the number or definition of indicators for 2016-17 or 2017-18, as compared to 2015-16.
Maximum possible QOF score available remained at 559 points
2018-19
Changes at the start of 2018-19 included:
- Clinical codes used to define the learning disabilities register changed meaning the register (and associated recorded disease prevalence) is not comparable with previous years. The indicator ID has changed from LD003 to LD004 as a result, although the description remains the same.
Maximum possible QOF score available remained at 559 points
2019-20
Changes at the start of 2019-20 included:
- A new quality improvement domain (worth 74 points) was introduced, broken down to indicator groups prescribing safety and end of life care
- Nineteen new indicators were introduced 15 within existing conditions (worth 101 points) and 4 in new domain
- One indicator group retired: contraception.
- Twenty-eight individual indicators retired (worth 175 points), from within conditions that are still measured in QOF.
- Personalised care adjustments (PCAs) replaced exceptions more information can be found in the technical annex.
Maximum possible QOF score available remained at 559 points
Specific issues and caveats concerning the interpretation of QOF data are covered in the technical annex.