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 2019-20, achievement was assessed for 68 indicators in the following groups (age groups specified where applicable):
The highest QOF recorded prevalence rates were for hypertension (14.1%), depression (11.6%) and obesity (10.5%).
Overall, the greatest change in QOF recorded prevalence was for depression, which increased from 10.8% in 2018-19 to 11.6% in 2019-20.
The QOF recorded prevalence of depression exhibits the greatest range by region, with the lowest rate in London (8.2%) and the highest rate in the North West (14.0 %).
Note: prevalence rates for 2018-19 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% 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 2019-20, overall achievement ranged from 88.0% for the cardiovascular disease - primary prevention indicator group, to 100.0% for the prescribing safety indicator group.
Note: achievement rates for 2018-19 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 2019-20 was 533.9, compared with 539.2 in 2018-19 (out of a maximum of 559 available points).
The proportion of practices achieving the maximum score of 559 points decreased to 7.3% in 2019-20, from 13.0% in 2018-19.
Personalised care adjustment (PCA) rates reflect the percentage of patients who are not included when determining QOF achievement. Examples of PCAs 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). PCAs supersede 'exceptions' which were recorded in previous years; exception reporting captured very similar information but was less detailed.
The cardiovascular disease - primary prevention indicator group had the highest overall PCA rate (31.4%), whilst the blood pressure indicator had the lowest overall PCA rate (0.7%).