The Quality and Outcomes Framework (QOF) is a voluntary annual reward and incentive programme detailing GP practice achievement results. The QOF assesses surgeries across three domains. Each domain comprises a set of indicators against which practices score points depending on their level of performance. Achievement scores are primarily used to calculate the payment that a practice should receive based on the services delivered. Here we examine the QOF clinical domain.
Comparisons over time are difficult as QOF indicators are changed and redefined from year to year. It is clear, however, that the vast majority of England's GP practices are performing well across the clinical disease areas, with little variation in QOF achievement scores over the last ten years.
Between 2006/07 and 2016/17 the achievement rates for depression, mental health and palliative care indicators were relatively low compared to the other clinical indicators. Cardiovascular disease and osteoporosis indicators have also had lower achievement rates than other conditions since they were added as QOF clinical indicators. There was a noticeable drop in performance of the learning disabilities indicator, from 99.2% in 2010/11 to 83.5% in 2011/12, although this has since recovered to 99.0% in 2016/17.
In 2012/13, average QOF achievement across all indicators fell for the first time in three years with decreases reported across the majority of clinical indicator groups (data not shown). NHS Digital suggested this may have been partly due to the addition of two new disease areas (peripheral arterial disease and osteoporosis) to the clinical domain. The average achievement score across all practices in England fell again from 96.7% in 2012/13 to 92.4% in 2013/14, although achievement has since improved to 95.5% in 2016/17.
Achievement scores for the asthma indicator can be used as an exemplar for other indicators in the QOF clinical domain. As shown in the graph there has been high achievement with limited variation over time. In 2006/07 the QOF achievement score for asthma was 96.4%, and this increased to 98.7% in 2010/11. There was a slight decrease in achievement to 97.2% in 2012/13, and since then it has remained relatively steady, reaching 97.3% in 2016/17.