The Quality and Outcomes Framework (QOF) is a voluntary annual reward and incentive programme for all GP surgeries in England and is part of the GP contract.
The QOF was introduced as part of the new General Medical Services (GMS) contract on 1 April 2004. Participation rates are very high, with most Personal Medical Services (PMS) practices also taking part. Practices score points on the basis of achievement against each indicator, up to a maximum of 1,000 points. Results of GP practices' achievement against the QOF are published each year.
The QOF is not about performance management, but incentivising and rewarding good practice. For 2011/12, 8,123 GP practices in England are included in the published results, covering almost 100 per cent of registered patients in England.
The QOF has four main components, known as domains. Each domain consists of a set of measures of achievement, known as indicators, against which practices score points according to their level of achievement.
- Clinical domain: 87 indicators across 20 clinical areas (e.g. coronary heart disease, heart failure, hypertension).
- Organisational domain: 45 indicators across six organisational areas - records and information; information for patients; education and training; practice management and medicines management.
- Patient care experience domain: one indicator relating to length of consultations.
- Additional services domain: nine indicators across four service areas (cervical screening, child health surveillance, maternity services and contraceptive services)
How is QOF achievement measured?
Achievement against the QOF is measured by the Quality Management Analysis System (QMAS), a national IT system developed by NHS Connecting for Health (CfH). QMAS ensures consistency in the calculation of quality achievement and disease prevalence, and is linked to payment systems. QOF information on QMAS is not a comprehensive source of data on quality of care in general practice, but it is potentially a rich and valuable source of such information, providing the limitations of the data are acknowledged.
The Prescribing and Primary Care team of The NHS Information Centre works on behalf of the Department of Health and in collaboration with CfH to obtain extracts from QMAS to support the publication of the QOF information.
Further details on how the QOF is measured (e.g. QMAS system; practice list size, patient exceptions etc) can be found in the QOF 2011/12 bulletin.