FAQs

The NHS Information Centre publishes information each year on QOF achievement and on prevalence from the QOF.
The NHS Information Centre is not responsible for determining the nature of the QOF, including its revisions and its use in practice payments.
The NHS Information Centre does not publish QOF information relating to practice payments.

For this information you will need to see the web site of NHS Employers. There you will find all relevant information about QOF revisions, including changes for 2009/10 and work in progress around the development of the QOF:

http://www.nhsemployers.org/pay-conditions/primary-890.cfm

You may also find the web site of the Department of Health (DH) useful in relation to QOF and the Statement of Financial Entitlements for general medical services:

Based on the questions we are asked the most, we compiled these FAQs.

What is QOF?
Where does the data come from. What is QMAS?
How does QMAS, QOF data relate to GP practice payments?
Where is QOF data for previous years?
How is 2007/08 QOF different from other years?
What is in QOF? What are domains?
Does the NHS Information Centre have access to QMAS?
What is in the 2007/08 QOF publication?
Where can I find information on QOF exception reporting?
How many practices are in the QOF achievement data? Are all practices included?
Are Personal Medical Services (PMS) practices in the QOF dataset?
Do QOF achievement scores shown for Personal Medical Services (PMS) practices incorporate a PMS deduction?
What does 100 per cent achievement mean? What is underlying achievement?
Are all practices supposed to reach, or try to reach, 100 per cent QOF achievement?
What QOF prevalence information is available?
What prevalence figures are shown and how are they calculated?
Are there any warnings about the use of QOF prevalence figures?
Do prevalence figures differ from prevalence figures published elsewhere?
What practice list sizes are used in calculating prevalence rates?
Where can I find information about individual patients? How do I find out about patients with more than one disease?
Why are there fewer PCTs in the 2006/07 and 2007/08 datasets, compared with earlier years?
How do I know if practices or PCTs had special circumstances that affected QOF achievement for 2007/08?
Are there issues with prevalence for specific clinical areas?
Should I make a league table to show which practices or PCTs provide the best care or the worst?
Can I re-use or publish the QOF data?
Where can I find information on QOF for Scotland, Wales and Northern Ireland?

1. What is QOF?

The national Quality and Outcomes Framework (QOF) was introduced as part of the new General Medical Services (GMS) contract on 1 April 2004.

Participation by practices in the QOF is voluntary, though participation rates are very high, with most Personal Medical Services (PMS) practices also taking part. Details of the GMS contract can be found on the Department of Health website:

2. Where does the data come from. What is QMAS?

The published QOF information was derived from the Quality Management Analysis System (QMAS), a national system developed by NHS Connecting for Health.

QMAS uses data from general practices to calculate individual practices' QOF achievement. QMAS is a national IT system developed by NHS Connecting for Health to support the QOF.

The system calculates practice achievement against national targets. It gives general practices, primary care trusts (PCTs) and strategic health authorities (SHAs) objective evidence and feedback on the quality of care delivered to patients.

3. How does QMAS or QOF data relate to GP practice payments?

Through the QOF, general practices are rewarded financially for aspects of the quality of care they provide. QMAS ensures consistency in the calculation of quality achievement and disease prevalence, and is linked to payment systems.

This means that payment rules underpinning the new GMS contract are implemented consistently across all systems and all practices in England. Users of data derived from Quality Management Analysis System (QMAS) should recognise that QMAS was established as a mechanism to support the calculation of practice QOF payments.

It 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.

4. Where is QOF data for previous years?

On this website you can find QOF information for 2004/05, 2005/06 and 2006/07.

5. How is 2007/08 QOF different from other years?

The QOF was introduced in 2004/05, with an indicator set that that remained the same in 2005/06. In 2004/05 and 2005/06 practices were able to achieve a maximum QOF score of 1,050 points.

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 possible maximum score of 1,000 points.

The reduction from the previous maximum of 1,050 points was due to the reallocation of resources associated with the 'access bonus' (previously 50 QOF points) to become part of an 'access direct enhanced service'.

The 2006/07 QOF remained unchanged in 2007/08, and is the basis for the 2007/08 publication of QOF data. The 2007/08 QOF measured achievement against 135 indicators and one measure of depth of care, known as holistic care. Practices scored points on the basis of achievement against each indicator, up to a maximum of 1,000 points.

For 2008/09 there have been some modifications to the QOF. These are not part of the 2007/08 QOF publication. Full details of the various revisions to the QOF are available from the NHS Employers' web site.

6. What is in QOF? What are domains?

The QOF contains 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. The following is a summary of the QOF domains during 2006/07 and 2007/08:

the Clinical Domain consisted of 80 indicators across 19 clinical areas: - Coronary heart disease (10 indicators) - Heart failure (3) - Stroke and transient ischaemic attack (8) - Hypertension (3) - Diabetes mellitus (16) - Chronic obstructive pulmonary disease (5) - Epilepsy (4) - Hypothyroidism (2) - Cancer (2) - Palliative care (2) - Mental Health (6) - Asthma (4) - Dementia (2) - Depression (2) - Chronic kidney disease (4) - Atrial fibrillation (3) - Obesity (1) - Learning disabilities (1) - Smoking (2) Indicators in the clinical domain were worth up to a maximum of 655 points (65.5 per cent of the total)
the Organisational Domain consisted of 43 indicators across five organisational areas: - Records and information (12 indicators) - Information for patients (4) - Education and training (8) - Practice management (10) - Medicines management (9) Indicators in the organisational domain were worth up to 181 points (18.1 per cent of the total)
the Patient Experience Domain consisted of four indicators that related to length of consultations and to patient surveys. These indicators were worth up to 108 points (10.8 per cent of the total)
the Additional Services Domain consisted of eight indicators across four service areas: - Cervical screening (4 indicators) - Child health surveillance (1) - Maternity services (1) - Contraceptive services (2) Additional services indicators were worth up 36 points (3.6 per cent of the total).

The QOF also rewarded practices with a holistic care payment, based on achievement across the clinical domain. This was worth up to 20 points (2 per cent of the total).

7. Does the NHS Information Centre have access to QMAS?

No. The Prescribing Support Unit (PSU), part of the NHS Information Centre, has worked on behalf of the Department of Health and in collaboration with NHS Connecting for Health to obtain extracts from Quality Management Analysis System (QMAS) to support the publication of QOF information.

8. What is in the 2007/08 QOF publication?

The information published by the NHS Information Centre relates to general practices in England. The publication of 2007/08 QOF information is based on data for the period April 2007 to March 2008.

The data were extracted from the national QMAS system at the end of June 2008 in order to include adjustments agreed between practices and PCTs up to the end of June 2008.

This publication covers two types of data for England: data relating to QOF achievement and disease prevalence information. The 2007/08 QOF publication consists of:

a statistical bulletin
a set of spreadsheets of QOF data at England, SHA, PCT and practice level
an online database that allows searches for individual practices, and which presents QOF results graphically.

9. Where can I find information on QOF exception reporting?

Exception reporting refers to the potential exclusion of individual patients from calculations of practice achievement for specific clinical indicators.

Practices may exclude specific patients from data collected to calculate QOF achievement scores within clinical areas.

For example, patients on a specific clinical register can be excluded from individual QOF indicators if a patient is unsuitable for treatment, is newly registered with the practice, is newly diagnosed with a condition, or in the event of informed dissent.

The General Medical Services contract sets out valid exception reporting criteria. View Exception reporting information and more detailed FAQs.

10. How many practices are in the QOF achievement data? Are all practices included?

QOF achievement for 2007/08 is presented for 8,294 general practices in England. These practices made an end-of-year submission to Quality Management Analysis System (QMAS).

QOF achievement figures include data automatically extracted from general practice systems by the QMAS system in March 2008, and data adjustments for the year 2007/08 submitted between April and June 2008.

The sum of the practice list sizes for the 8,294 practices included in the 2007/08 QOF publication is 54,009,831. This represents 99.8 per cent of registered patients in England (based on registration data from the ePACT system of the Prescription Pricing Division of the NHS Business Services Authority, January to March 2008).

11. Are Personal Medical Services (PMS) practices in the QOF dataset?

Personal Medical Services (PMS) practices are able to negotiate local contracts with their PCTs for the provision of all services. PMS practices may also participate in the QOF, and they may either follow the national QOF framework or enter into local QOF arrangements.

PMS practices with local contractual arrangements are included in the published 2007/08 QOF information.

12. Do QOF achievement scores shown for Personal Medical Services (PMS) practices incorporate a PMS deduction?

where PMS practices use the national QOF, their 2007/08 achievement (in terms of the 1,000 QOF points available) is subject to a deduction of approximately 109 points before QOF points are turned into QOF payments.

This is because many PMS practices already have a chronic disease management allowance, a sustained quality allowance and a cervical cytology payment included in their baseline payments. (General Medical Services GMS practices do not receive such payments, but receive similar payments through the QOF).

To ensure comparability between GMS and PMS practices, the QOF deduction for PMS practices ensures that they do not receive the same payments twice. Because this publication covers QOF achievement and not payments, all QOF achievement shown is based on QOF points prior to PMS deductions.

This is to allow comparability in levels of achievement so that where GMS and PMS practices have maximum QOF achievement, both are shown as having achieved the maximum 1,000 points.

13. What does 100 per cent achievement mean? What is underlying achievement?

Reference to 100 per cent achievement usually refers to the percentage of available QOF points achieved. So if a practice achieves the full 1,000 QOF points it has achieved 100 per cent of the points available and may be said to have 100 per cent achievement across the whole QOF.

The level of achievement for certain elements of the QOF can be expressed in the same way. A practice achieving all 655 clinical QOF points available, can be said to have 100 per cent clinical achievement even though it may not have 100 per cent achievement overall.

Practices achieve the maximum QOF points for most indicators (especially clinical indicators) when they have delivered the maximum threshold to achieve the points available.

For many indicators a practice must provide a certain level of clinical care to 90 per cent of patients on a particular clinical register to achieve the maximum points. It can therefore deliver the required care to fewer than 100 per cent of its patients (90 per cent in this case) to achieve the full (100 per cent) points available.

Therefore there is an important distinction between percentage achievement in terms of QOF points available, and the underlying achievement for specific indicators the latter representing the indicator numerator as a percentage of the denominator.

14. Are all practices supposed to reach, or try to reach, 100 per cent QOF achievement?

Not necessarily. The achievement of full points may not be possible or desirable for some practices. Participation in the QOF is voluntary, and practices may aspire to achieve all, some, or none of the points available.

It is important to note that for some practices it may be impossible to achieve all of the points available in the QOF. For example, some clinical indicators relate to specific subgroups of patients, and if the practice does not have any such patients it cannot score points against the relevant indicators.

A practice that exclusively serves a student population, for instance, may not have patients on some of the clinical registers that are covered by the QOF, and although its QOF points total would be less than 1,000 (or 100 per cent), it may be providing all the appropriate care in respect of the clinical registers that it does hold.

In addition, practices with personal medical services contracts may include quality and outcomes as part of their locally negotiated agreements, and in may opt to use part or all of the new General Medical Services QOF as a measurement tool. This is an extremely important consideration when undertaking any comparative analysis of QOF achievement.

15. What QOF prevalence information is available?

Prevalence information for 2007/08 is presented in this publication for the 8,294 practices that were in the QOF achievement dataset. For 17 of the 19 areas of the clinical domain, Quality Management Analysis System captures the number of patients on the clinical register for each practice. (The other two clinical areas, depression and smoking indicators, are based on subsets of other clinical registers.)

The number of patients on the clinical registers can be used to calculate measures of disease prevalence, expressing the number of patients on each register as a percentage of the number of patients on practices' lists.

16. What prevalence figures are shown and how are they calculated?

The clinical registers used to calculate prevalence were those submitted to Quality Management Analysis System (QMAS) at the same time as achievement submissions (i.e. end of year submissions).

These are not national prevalence day' (14 February 2008) submissions. Year-end register submissions were used to achieve greater consistency between prevalence and achievement datasets.

Whereas QMAS uses disease prevalence to perform an adjustment in calculating practices' QOF payments. For national reporting of QOF information, the NHS Information Centre has presented only raw (unadjusted) clinical prevalence as recorded by the practices at year-end.

Raw prevalence = (number on clinical register / number on practice list) * 100.

17. Are there any warnings about the use of QOF prevalence figures?

QOF registers do not necessarily equate to prevalence, as may be defined by epidemiologists. For example, prevalence figures based on QOF registers (eg obesity) may differ from prevalence figures from other sources because of coding or definitional issues. QOF registers are constructed to underpin indicators on quality of care.

Quality Management Analysis System only uses read codes that are common to all three versions (version 2, version 3 and CVT). It is difficult to interpret year-on-year changes in the size of QOF registers, for example a gradual rise in QOF prevalence could be due partly to epidemiological factors (such as an ageing population) or due partly to increased case finding.

Five clinical areas within the QOF (diabetes, epilepsy, chronic kidney disease, obesity and learning disabilities) are based on clinical registers that relate to specific age groups. Diabetes registers are based on patients aged 17 and over; epilepsy, chronic kidney disease and learning disabilities registers are based on patients aged 18 and over; and obesity registers are based on patients aged 16 and over.

Except where specifically noted, prevalence rates shown in this publication for these five clinical areas are based on whole practice list sizes (all ages) as the denominator. The NHS Information Centre has produced prevalence rates for these five conditions, based on appropriate age-banded list size information, to researchers or information users who require more precise prevalence rates for these five clinical areas.

18. Do prevalence figures differ from prevalence figures published elsewhere?

Differences may occur because QOF registers do not necessarily equate to prevalence, as may be defined by epidemiologists.

For example, prevalence figures based on QOF registers may differ from prevalence figures from other sources because of coding or definitional issues.

For example, to be on the QOF obesity register, patients need to be aged 16 or over, and have a body mass index greater than or equal to 30 recorded in the previous 15 months.

19. What practice list sizes are used in calculating prevalence rates?

The 2007/08 QOF information published by the NHS Information Centre includes practice list sizes supplied to Quality Management Analysis System (QMAS), from National Health Applications and Infrastructure Services (NHAIS), the national general practice payments system, as at 1 January 2008.

These figures are used in QMAS for list size adjustments in QOF payment calculations. In the context of this publication, these list sizes are used as the basis for the calculation of raw clinical prevalence.

20. Where can I find information about individual patients? How do I find out about patients with more than one disease?

There is no patient-specific data in Quality Management Analysis System (QMAS) because this is not required to support the QOF.

For example, QMAS captures aggregate information for each practice on patients with coronary heart disease and on patients with diabetes, but it is not possible to identify or analyse information on individual patients. It is not possible, for example, to identify the number of patients with both of these diseases.

21. Why are there fewer PCTs in the 2006/07 and 2007/08 datasets, compared with earlier years?

QOF information is presented at strategic health authority and primary care trust level, as well as for practices.

The information presented for 2006/07 and 2007/08 refers to the NHS organisational structure as at 31 March in those years, when there were 10 strategic health authorities and 152 primary care trusts following organisational change during 2006/07.

22. How do I know if practices or PCTs had special circumstances that affected QOF achievement for 2007/08?

During August 2008, the NHS Information Centre consulted with PCTs on the local QOF achievement information contained in the end of June 2008 extract of 2007/08 QMAS data. PCTs were asked to confirm that the extract contained all their practices.

PCTs were also invited to provide commentary on their practices' overall QOF achievement, as contained in the Quality Management Analysis System (QMAS) extract. Such commentary was invited because QOF achievement for some practices had not been approved for payment (ie was still subject to local sign-off) at the time of the QMAS extract (end of June 2008).

For some practices in England data annotations were provided by PCTs to support the published QOF achievement information. Such notes generally referred to:

adjustments to QOF achievement that were agreed locally after the date of the QMAS extract for publication (ie after the end of June 2008).
notes on practices where QOF achievement remained subject to local review or appeal.
notes on practices providing specialist services, such as practices that served university populations or asylum seeker populations.

All notes on practice achievement provided by PCTs are presented alongside practice-level QOF achievement data on the 2007/08 online database, and a summary spreadsheet is also provided alongside practice level spreadsheets of 2007/08 QOF achievement.

In addition, all PCTs wished to emphasise that for Personal Medical Services (PMS) practices the published QOF achievement figures refer to QOF points achieved prior to the application of PMS deductions.

This is because the published information covers QOF achievement, not QOF payments, and therefore it was decided that where General Medical Services and PMS practices have maximum QOF achievement (for example) , both will be shown as having achieved 1,000 QOF points.

A number of PCT-specific notes were also received about practice codes that are not included in the QOF publication, for example about practices that participated in the QOF but did not use QMAS, or practice codes that did not participate in QOF.

23. Are there issues with prevalence for specific clinical areas?

Other factors in interpreting information on specific registers include:

some clinical areas have 'resolution codes' to reflect the nature of diseases. Others, such as the cancer register, do not. - to be on the asthma register, patients need a diagnosis of asthma and a prescription for an asthma drug within the year.
five clinical areas within the QOF (diabetes, epilepsy, chronic kidney disease, obesity and learning disabilities) are based on clinical registers that relate to specific age groups. Diabetes registers are based on patients aged 17 and over; epilepsy, chronic kidney disease and learning disabilities registers are based on patients aged 18 and over; and obesity registers are based on patients aged 16 and over.

Except where specifically noted, prevalence rates shown in this publication for these five clinical areas are based on whole practice list sizes (all ages) as the denominator.

The NHS Information Centre has published additional analysis, based on appropriate age-banded list size information to researchers or information users who require more precise prevalence rates for these five clinical areas.

Many patients are likely to suffer from co-morbidity, ie diagnosed with more than one of the clinical conditions included in the QOF clinical domain.

Robust analysis of co-morbidity is not possible using QOF data because QOF information is collected at an aggregate level for each practice; there is no patient-specific data within QMAS. For example, QMAS captures aggregated information for each practice on patients with coronary heart disease and on patients with diabetes, but it is not possible to identify or analyse patients with both of these diseases.

The qualification to this statement is that from 2006/07 the QOF clinical domain included depression and smoking indicators that are based on some patients who are on the CHD and/or diabetes registers (depression) and some patients who are on any (or any combination of) the CHD, stroke, hypertension, diabetes, COPD and asthma registers (smoking indicators).

24. Should I make a league table to show which practices or PCTs provide the best care or the worst?

Levels of QOF achievement will be related to a variety of local circumstances, and should be interpreted in the context of those circumstances. Users of the published QOF data should be particularly careful in undertaking comparative analysis.

The following points have been raised by local healthcare organisations in consultation with the NHS Information Centre:

the ranking of practices on the basis of QOF points achieved, either overall or with respect to areas within the QOF, may be inappropriate. QOF points do not reflect practice workload issues (for example around list sizes and disease prevalence) that is why practices QOF payments include adjustments for such factors
comparative analysis of practice-level or PCT-level QOF achievement, or prevalence, may also be inappropriate without taking account of the underlying social and demographic characteristics of the populations concerned. The delivery of services may be related, for example, to population age/sex, ethnicity or deprivation characteristics that are not included in QOF data collection processes
information on QOF achievement, as represented by QOF points, should also be interpreted with respect to local circumstances around general practice infrastructure. In undertaking comparative or explanatory analysis, users of the data should be aware of any effect of the numbers of partners (including single handers), local recruitment and staffing issues, issues around practice premises, and local IT issues
users of the data should be aware that different types of practice may serve different communities. Comparative analysis should therefore take account of local circumstances, such as numbers on practice lists of student populations, drug users, homeless populations and asylum seekers
robust analysis of co-morbidity (patients with more than one disease) is not possible using QOF data. QOF information is collected at an aggregate level for each practice. There is no patient-specific data within Quality Management Analysis System (QMAS). For example, QMAS captures aggregated information for each practice on patients with coronary heart disease and on patients with asthma, but it is not possible to identify or analyse patients with both of these diseases
underlying all this is the fact that the information held within QMAS, and the source for the published tables, is dependent on diagnosis and recording within practices using practices' clinical information systems.

25. Can I re-use or publish the QOF data?

This data has been produced by The NHS Information Centre. If you wish to re-use and/or publish this data independently, please contact us on 08453 006016 or enquires@ic.nhs.uk

26. Where can I find information on QOF for Scotland, Wales and Northern Ireland?

Scotland: (www.isdscotland.org)
Wales: (www.wales.nhs.uk)
Northern Ireland: (www.dhsspsni.gov.uk).

Related information

QOF 2007/08 press release

NHS - The Information Centre