The Quality and Outcomes Framework (QOF) is a voluntary annual reward and incentive programme for all GP surgeries in England, detailing practice achievement results. It is not about performance management but resourcing and then rewarding good practice.
The QOF contains four main components, known as domains. The four domains are: Clinical Domain, Organisational Domain, Patient Experience Domain and Additional Services Domain. Each domain consists of a set of achievement measures, known as indicators, against which practices score points according to their level of achievement. The 2011/12 QOF measured achievement against 142 indicators; practices scored points on the basis of achievement against each indicator, up to a maximum of 1,000 points.
- clinical care: the domain consists of 87 indicators across 20 clinical areas (e.g. coronary heart disease, heart failure, hypertension) worth up to a maximum of 661 points.
- organisational: the domain consists of 45 indicators (worth up to 262 points) across six organisational areas – records and information; patient communication; education and training; quality and productivity; practice management and medicines management.
- patient experience: the domain consists of one indicator (worth up to 33 points) that relates to length of consultations.
- additional services: the domain consists of nine indicators (worth up to 44 points) across four service areas – cervical screening, child health surveillance, maternity service and contraceptive services.
The QOF gives an indication of the overall achievement of a surgery through a points system. Practices aim to deliver high quality care across a range of areas for which they score points. Put simply, the higher the score, the higher the financial reward for the practice. The final payment is adjusted to take account of surgery workload and the prevalence of chronic conditions in the practice's local area.
To report the latest annual QOF points, The Health and Social Care Information Centre (HSCIC) has developed this online database to allow patients and public easy access to this useful data that indicates how well their surgery is doing. The HSCIC is working to make information more relevant and accessible to the public, regulators, health and social care professionals and policy makers, leading to improvements in knowledge and efficiency.
Following a consultation exercise and discussions with key stakeholders at the Department of Health and British Medical Association, the online database includes a number of additional measures for the 2011/12 data. These additional measures are:
Exception rate
QOF includes the concept of exception reporting. This allow practices to pursue the quality improvement agenda and not be penalised, where, for example, patients do not attend for review, or where a medication cannot be prescribed due to a contraindication or side-effect. Exception rate is the number of recorded exceptions expressed as a percentage of the number of patients on a disease register who were qualified to be part of the indicator denominator.
Points Achieved as a per cent of QOF points available
Some practices cannot achieve the full 1,000 points available because they do not have patients pertinent to every indicator denominator (e.g. they might not have any patients with hypertension). Where this is the case for a practice, this measure is calculated presenting their points achievement as a percentage of the available points that they could be expected to achieve.
Percentage of patients receiving the intervention
This provides an alternative measure of achievement, which accounts for all patients covered by indicator - including “exceptions” (patients to whom the indicator applies, but who are not included in the indicator denominator according to agreed exception criteria). Percentage of patients receiving the intervention gives an indication of the rate of provision of interventions to all patients to whom the indicator applies. For this calculation the indicator numerator is divided by the sum of the indicator denominator and the indicator exceptions.
Browse the online database to find the results for your local surgery.
Other searches will compare your local GP practice against other GP practices in the local area and the national results across England.
The online database provides easy access to comprehensive information on the pattern of common chronic diseases such as asthma, diabetes and coronary heart disease. In terms of scale, the data for QOF is collected from over 8,000 GP practices with over 54 million registered patients in England.
The QOF helps practices compare the delivery and quality of care currently provided against the achievements of previous years. Ultimately, the aim is to improve standards of care by assessing and benchmarking the quality of care patients receive. The QOF has undergone some revisions since it was first introduced, with several changes in 2011/12 from 2010/11. Changes to the QOF at the start of 2011/12 included the introduction of new indicators in the epilepsy, learning disability and dementia clinical indicator sets; the introduction of a new set of indicators measuring quality and productivity, 12 indicators across a range of sets were retired, 22 indicators were replaced, either due to changes to indicator wording or coding/business logic changes, five indicators had changes to point values or thresholds. Overall, the maximum QOF score remained at 1,000 points. Changes are covered in detail via the following link to NHS Employers:
Summary of 2011/12 QOF indicator changes, points and thresholds
The sample of the output chart above shows the results for some of the clinical indicator groups for an individual GP practice.
As well as displaying the latest 2011/12 results, the chart also displays the current year's PCT (Primary Care Trust) and England averages.
Similar charts are available for the total achievement results, the four individual domain results and the underlying achievement details for the individual indicators within each indicator group.
You can use this specially designed website to make specific searches on achievement in the following ways:
- search for any GP practice in England
- find the overall achievement score for any practice
- breakdown the achievement by a series of clinical measures
- compare local surgery achievement with other surgeries and the local PCT and England averages
- discover explanations of the QOF clinical indicators
- export simple data tables of multiple practice results
- The QOF information is collected at an aggregate level for each general practice and does not refer to specific patients, hence QOF cannot show how well your surgery treats you.
- The QOF only reflects part of the work that a general practice is responsible for, as such The HSCIC does not recommend or endorse the use of QOF data to rank practices into league tables. A fuller explanation is available on the frequently asked questions page: