About the Quality and Outcomes Framework

The Quality and Outcomes Framework (QOF) is a system to remunerate general practices for providing good quality care to their patients, and to help fund work to further improve the quality of health care delivered. It is a fundamental part of the general medical services (GMS) contract, introduced on 1 April 2004.

The QOF contains groups of indicators, against which practices score points according to their level of achievement. QOF awards surgeries achievement points for
(i) managing chronic diseases;
(ii) providing services for cervical screening;
(iii) improving quality and productivity with regard to secondary care referrals; and
(iv) improving patient experience.

The overall structure of the Framework including number of indicators and maximum number of points available is illustrated in the table. The Framework consists of 4 domains (Clinical, Public Health, Records & Systems and Patient Experience) each containing a range of areas described by a total of 55 indicators. These indicators have points attached that are given to GP practices based on how they are performing against these measures. The maximum number of points achievable by a practice is 547. The QOF was substantially revised for 2022/23 with indicators removed, new indicators added and changes made to definitions and point allocation. A full detailed list of indicators is available in the QOF Indicators page in this dashboard.

Reprioritisation of Care (RoC)
During 2022/23, Reprioritising of Care (RoC) was introduced in recognition of issues and delays with regards to monitoring progress towards QOF targets and the pressures facing general practice/patient services. With this Reprioritising of Care, practices were required to contract to provide NI Local Enhanced Services (LES) in respect of Proactive GP Care for Nursing & Residential Homes and Managing Winter Pressures. As a result, QOF requirements were revised, with Practices who opted into RoC required to continue to report on a total of 7 non-clinical indicators only (all Quality Improvement indicators and selected indicators within the Records & Systems and Patient Experience domains). There would be no financial detriment to practices as a result of RoC and a replacement payment process was developed for all practices who chose to avail of this option. For those general practices who did not opt into RoC, revised QOF requirements did not apply and they were required to aspire to achieve all QOF indicator thresholds in order to generate reimbursement. Those non-clinical indicators that RoC practices were required to report on are highlighted in yellow in the table.

Whilst RoC practices were only required to report on the 7 non-clinical indicators, all RoC practices, actually aspired to achieve points across all areas in the Clinical Domain and the Public Health Domain (Cervical Screening). Additionally, a number of RoC practices aspired to achieve and report on the other 6 non-clinical indicators not required under the terms of the RoC. Due to the introduction of Reprioritisation of Care, care should be taken to note the number of practices reported in each area. Due to the differing number of practices reported across non-clinical indicators, the following are presented by individual indicator (rather than area).

• Asthma - AST006

• Palliative Care - PC002

• Records & Systems - R&S001, R&S002, R&S006, R&S004, R&S005

• Patient Experience - AC001, AC002, AC003.

Limitations on the use of QOF data
The data collected for the Quality & Outcomes Framework provides some useful information for researchers and public health officials regarding disease prevalence and care quality information about general practices. However, it is important to note the limitations of using QOF data to make further inferences and conclusions.

The following points should be noted:
• It may be inappropriate to use the data to make comparisons between practices in terms of the quality of care offered. For instance, the clinical disease areas chosen for the Quality & Outcomes Framework represent the minority of patients in Northern Ireland and therefore points achievement in these areas does not reflect the full workload of general practices.

• As the Quality & Outcomes Framework system takes into account practice list size and disease prevalence before calculating payment, comparing practices by isolating particular domain points achieved does not account for the full system of QOF.

• The achievement of each practice will be partly dependent on the number of points each practice aspired to, therefore not all practices will have commenced QOF from the same baseline and not all will have improved to the same extent. Standards of recording diagnoses and other administrative procedures may also differ between practices.

The Impact of the Covid-19 Pandemic
During 2021/22 due to the continuing Covid-19 pandemic, the DoH agreed with NIGPC and the HSCB to continue standing down elements of the GMS contract. The majority of QOF activity and reporting remained suspended in 2021/2022. Therefore, QOF data for 2021/2022 may have been impacted upon and it is recommended that the use of this data in publications or drawing conclusions from it includes appropriate caveats acknowledging the unprecedented impact of Covid-19.

Quality and Outcomes Framework - 2020/21