An Introduction to The Quality and Outcomes Framework (QOF) for New Primary Care Network Leaders

If you are a new PCN Manager or Digital and Transformation Lead, depending on your experience, you may not have been directly involved in delivering on the QOF indicators before, but with QOF QI modules now part of the GP Contract, this is something you may have missed, as it's not written into the PCN DES.

It's my opinion that you do not need to know the detail of every QOF indicator, but it is important that you have an awareness of the work required, the income associated with the scheme and how this can help with workforce planning.

To support this blog, the NHSE Quality and Outcomes Framework guidance for 2023/24 can be found here. Within the document, you will find a complete list of the indicators with an accompanying definition.

Let's jump in!

In 2004, the UK National Health Service introduced the world's largest health-related, pay-for-performance scheme. This scheme was called the Quality and Outcomes Framework, otherwise known as QOF.

QOF is a voluntary annual reward and incentive programme for GP practices in England, Wales and Northern Ireland designed to help primary care practitioners measure their performance against national standards, identify areas for improvement, and ultimately deliver better patient outcomes.

The original scheme included:

QOF contains 3 domains

Within these 3 domains, there are now a total of 635 points in the 2023 /24 QOF guidance.

Whilst QOF is very much part of the fabric of general practice, depending on how your network operates and views its PCN, this year, where appropriate, there may be an opportunity for the network to help support the achievement of OQF more so than ever before due to the reduction in the Investment and Impact Fund indicators.

However, The future of QOF may look different, as indicated in The Hewitt Report published in April 2023. The report cited that:

"The Quality and Outcome Framework (QOF) points that were an important and useful innovation twenty years ago are now out of date and are seen by GPs as well as ICBs as an inflexible and bureaucratic framework.

This needs to be updated with a more holistic approach that allows for variation. The new approach must also recognize that, in order to allow primary care to refocus resources on prevention, outcomes rather than just activity need to be measured.

As mentioned, there are 635 total points in QOF for 2023/24. 81of these are subject to income protection which practices do not have to achieve certain targets; however, NHS England guidance has also indicated that practices will still be required to maintain these registers.

This year (2023/24 ), each QOF point is worth £213.43.

In 2019, the GP contract required practices to come together to start sharing their lessons learned underpinned by a quality improvement approach.

Below is a brief history of what practices and networks were asked to come together to share their learning on.

NHS England has introduced two new Quality Improvement modules in 2023/24, which are to be discussed in two PCN peer-reviewed meetings.

Ideally, one meeting to plan (this is what we will do). The second meeting; to share what we did, what worked, and the lessons learned.

The indicators are:

💢 Workforce and wellbeing

These indicators are designed to incentivise practices to “demonstrate continuous quality improvement activity, focused on workforce and wellbeing” and the participation in network activity to “regularly share and discuss learning” on this theme.

💢 Optimising demand and capacity in general practice.

Three indicators in this domain are focused on encouraging practices to understand, act on, and share insights relating to capacity. One indicator has been introduced to incentivise a reduction in avoidable appointments.

When it comes to the Optimising Access to the General Practice domain, this is an additional layer which relates to the GP contract that now requires practices to:

Along with the quality improvement peer review meetings to discuss and implement workforce and well-being and optimising access, I asked a practice manager in Cheshire and Merseyside what opportunities there were for some QOF activity to be delivered at PCN level.

She said that the collective view within their practice was that QOF should feed into EVERYONE's role, as it's part of general practice.

“ It shouldn't be an extra job to do, but I appreciate that every practice is organised differently”.

The same Practice Manager took some time out to outline the steps they are taking to embed their Health Inequalities Care Coordinator to support QOF.

The network purchased health kiosks for their seven practices and, this year, employed a Health Inequalities Care Coordinator to progress some of the work in this area.

Alongside achieving the QOF targets, this approach aims to:

A Self-Health Kiosk is a screening kiosk designed to give patients greater control of their own health. Patients registered to a GP surgery with a health kiosk can log in and take standard NHS health checks, take vital signs measurements and complete basic questionnaires/assessments for:

Results are saved to the patient record instantly, ready for a clinician to review and discuss at the patient’s next appointment.

The benefit of this approach is that, rather than waiting for a patient to be motivated to use the health kiosk, this can form part of the network's proactive and planned care strategy.

This network is also deploying care coordinators to support immunisations and vaccinations.

To get a better understanding of how your network reviews and approaches QOF:

✅ It's advisable that PCN Managers and Digital and Transformation leads regularly engage with Practice Managers, and attend Practice Manager meetings, to highlight the QOF QI, but this will very much depend on the dynamics of the relationships within the network, so ensure the Practice Managers guide you here.

✅ Make sure that QOF forms part of the training and induction of new PCN Staff, which includes guidance on the specific codes and templates they must use.

✅ If your PCN team is going to be involved in managing and supporting QOF, ensure PCN staff members are properly embedded in practice. This will ensure that everyone feels part of the team and is pulling in the same direction, with a clear outline of individual (and collective) roles and responsibilities.

✅ When it comes to monitoring targets, as with everything, there is variation across practices. Some practices work with strict daily, weekly, monthly and quarterly targets. For others, there is a rush at the end of the year to achieve the targets,

From a PCN perspective, you may want to check in with practices and see if any support is required around the six and nine-month marks.

You can run an audit to assess where you are and allocate your resource/s as required.

✅ If QOF is supported at the network level, the platform we would recommend to monitor progress is Ardens Manager, but other excellent tools are available. Through Ardens Manager, you can track the majority of your network's activity, removing the need for spreadsheets.

✅ Lastly, try to allocate time for a QOF QI peer review discussion within an existing network meeting and aim to get the first meeting in Q1.

💡 How does your current PCN workforce support the achievement of QOF

💡Do you feel there is more room to integrate the delivery of QOF at a network level?

💡 If PCN staff supported QOF last year, what worked well and what areas could be improved?

💡 How can you connect the QOF QI Optimising demand and capacity in general practice domain to the PCN access and capacity improvement plan and the latest GP update, which requires practices to ensure that patients should be offered an assessment of need or signposted to an appropriate service at the first contact with the practice?

Please note that I do not think there are wrong or right answers here. Every network is different. These questions are simply to guide a conversation in your network to ensure everyone is on the same page when it comes to utilising the network's workforce and resources to aid capacity in day-to-day practice.

We hope this helps!

I'm Tara; I am the founder of THC Primary Care, an award-winning healthcare consultancy specialising in Primary Care Network Management and the host of the Business of Healthcare Podcast, where we have now published over 290 episodes.

I have over 20 years of project management and business development experience across the private and public sectors, and I have supported over 80 PCNs by providing interim management, training and consultancy.

I have managed teams across multiple sites and countries; I have an MBA in Leadership and Management in Healthcare, I'm published in the London Journal of Primary Care, and I am the author of over 250 blogs.

I have 3 children. My eldest has Asthma, my middle child has a kidney condition called Nephrotic Syndrome, and my youngest daughter has Type 1 Diabetes, so outside of work, healthcare plays a huge role in my life.

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