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Publication, Part of

Quality and Outcomes Framework, 2021-22

Official statistics

Integrated Care Boards

Integrated Care Boards (ICBs) were established as statutory bodies from 1st July 2022, consequently this publication no longer presents data at CCG and STP level. From July 2022 onwards, data will be aggregated to Sub ICB Location, and ICB level. For further information on these changes please see Related Links.


1 July 2022 00:00 AM

Indicator definition correction

The description for indicator CAN004 in the QOF 2021-22:Indicator definitions file has been updated to correspond to the Quality and Outcomes Framework Guidance for 2021/22.

12 October 2022 14:12 PM

Prevalence csv updated

The Prevalence csv file has been updated to include GP practices register count as zero where no register count was provided.

18 October 2022 11:02 AM

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 2021-22, 72 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
  • Vaccination and immunisation (0-2; 4-5; 79-80)

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 that year). Payment protection continues to be in place for QOF 2021-22. 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 (14.0%), depression (12.7%) and obesity (9.7%). 

Overall, the greatest change in QOF recorded prevalence was for obesity, which increased from 6.9% in 2020-21 to 9.7% in 2021-22. 

The increase in QOF recorded prevalence of obesity is likely to be due to the increase in face-to-face consultations after 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.

This increase in QOF recorded prevalence is demonstrated across all regions in England.

The QOF recorded prevalence of depression exhibits the greatest range by region, with the lowest rate in London (9.0%) and the highest rate in the North West (15.5%).

Note: prevalence rates for 2020-21 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.

In 2021-22, overall achievement ranged from 52.2% for the vaccination and immunisation indicator group, to 100.0% for the cancer, care of people with learning disabilities, early cancer diagnosis and obesity indicator groups.


**Non-diabetic hyperglycaemia (NDH) indicator group has a 0 (zero) points allocation which is reflected in the chart.

The average total achievement score for GP practices in 2021-22 was 582.4 (out of a maximum of 635).

The proportion of practices achieving the maximum score decreased to 1.5% in 2021-22, from 6.2% in 2020-21.

Personalised care adjustments

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).

The Depression indicator group had the highest PCA rate (18.9%), whilst the blood pressure indicator had the lowest (0.7%).

Last edited: 18 October 2022 11:05 am