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Publication, Part of

Quality and Outcomes Framework, 2020-21

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 2020-21, 68 indicators were included across the following groups (age groups specified where applicable):

  • Asthma (6+)
  • Atrial fibrillation
  • Blood pressure
  • Cancer
  • Care of people with learning disabilities
  • Cervical screening (25-64)
  • Chronic kidney disease (18+)
  • Chronic obstructive pulmonary disease
  • Dementia
  • Depression (18+)
  • Diabetes mellitus (17+)
  • Early cancer diagnosis
  • Epilepsy (18+)
  • Heart failure
  • Hypertension
  • Learning disabilities
  • Mental health
  • Non-diabetic hyperglycaemia (18+)
  • Obesity (18+)
  • Osteoporosis (50+)
  • Palliative care
  • Peripheral arterial disease
  • Rheumatoid arthritis (16+)
  • Secondary prevention of coronary heart disease
  • Smoking
  • Stroke and transient ischaemic attack

Due to the impact of the COVID-19 pandemic on activity in general practice, QOF implementation was changed for the 2020-21 reporting year; the majority of QOF indicators were income protected (i.e. payments were made to practices irrespective of activity recorded for indicators in 2020-21). Further information on the income protection measures applied to QOF can be found on the NHS England and Improvement website.

QOF recorded prevalence

The highest QOF recorded prevalence rates were for hypertension (13.9%), depression (12.3%) and diabetes mellitus (7.1%). 

Overall, the greatest change in QOF recorded prevalence was for obesity, which decreased from 10.5% in 2019-20 to 6.9% in 2020-21. 

The greatest increase in QOF recorded prevalence was for depression, which increased from 11.6% in 2019-20 to 12.3% in 2020-21.

Note: the definitions of the Asthma and Chronic Obstructive Pulmonary Disease (COPD) registers changed between 2019-20 and 2020-21. The 2019-20 data for these registers is therefore excluded from this chart as the prevalence data is not directly comparable.


The decrease in QOF recorded prevalence of obesity is likely to be due to the reduction in face-to-face consultations during the pandemic; in order to be included on the obesity register, a patient must have a BMI of 30 or more recorded in the 12 months up to and including the reporting period end date.

The QOF recorded prevalence of depression exhibits the greatest range by region, with the lowest rate in London (8.7%) and the highest rate in the North West (15.0%).

Note: prevalence rates for 2019-20 have been recalculated using only those practices for which data are available for both reporting years.

Last edited: 7 February 2022 11:55 am