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How we added nearly £20k in QOF income

David Cripps describes how a QOF health check helped boost practice income

The problem

I thought we were good with data – I spent 18 years in the IT industry so I know about data quality, and our QOF prevalence was fairly good. However, we could always do better, so we decided to have a company conduct a QOF health check.

What we did

We are the largest practice in Suffolk, with 23,000 patients, five surgeries in a single practice, seven partners, seven salaried GPs and many other clinical and non-clinical staff, so we booked the company for two days instead of the usual one. This cost £3,600: £3,000 for the health check and £600 for the second day.

The first stage of the process was for the consultancy to go through our patient list with its algorithm to identify patients not already coded whom we could add to our QOF registers and boost prevalence scores.

At the end of this we had a 160-page report, and someone from the consultancy came to our surgery for two days to go through it with us.

On these days we identified the registers that would be most productive and cost effective in terms of time spent, for example osteoporosis and dementia. Then, since individual staff are responsible for several registers, time was spent with each member of the four-person QOF team going through their list. This was an excellent learning opportunity and a chance to correct some beliefs, as some staff were operating under old guidance. Rules change, sometimes people forget, and sometimes they get contradictory instructions.

Patients who required a clinical decision were passed onto a clinician to review later.

Work continued throughout the next few months as we went through the rest of the report ourselves, splitting up decisions between non-clinicians and GPs to decide how to code patients.


The cost of the check was not too large for a practice of our size so we decided it was worth a gamble – and it more than paid off.

It needed ongoing work after the initial time spent with the consultants. However, this is now just ‘business as usual’ and incorporated into our routine work on QOF, so has not added to our workload. Our staff are all keen to hit QOF targets, and this exercise has been a massive help in keeping them motivated.

Information governance and confidentiality were a concern and we needed to be reassured that appropriate protections were in place.


I didn’t expect to be impressed by the outcome. As I said, we thought the quality of our coding was fairly good. But by the end of the two days our increase in prevalence was worth £8,800. This has doubled with the work we’ve done since. For example: we increased the number of patients on our dementia register from 241 to 290. And the number of people on the osteoporosis register increased from 1 to 121. On a wider level, it will help our CCG reach quality premium targets for diagnosis of dementia, which means £180,000 more for our local NHS. As a result, our CCG has commissioned the consultancy to help other practices identify patients with dementia.

The future

The positive effects will last for a few years as the patients we’ve added will stay on the register until they leave or die. However, we will probably do something similar again in two or three years. Some things will be miscoded, new patients will arrive and it should be routine to repeat quality audits.

David Cripps is practice manager at Hardwicke House Group Practice in Sudbury, Suffolk

This article was commissioned independently. Interface Clinical Services, the consultancy that provided the health check, had no input into the copy

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Readers' comments (10)

  • it's much easier to forget about qof and ditch the contract

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  • Unfortunately; 300 for you is not a cost but small Practices with constant underfunding struggle to find 3000 to spare.
    By the way anybody in the Practice works in CCG or LMC member?

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  • Yes, having no performance management, outcome indicators, &etc would be easier. But, if we are to be paid, we have to work within the parameters we are given. And we have a responsibility to know we are doing the best for our patients, not just say we are. Not every indicator in QOF is pointless (sorry, unintended pun).

    Yes, I was once a Governing Board member, but not at the time we undertook this work and not at the time our CCG asked practices to help improve diagnosis of dementia (yes, I know that's contentious too, but if brings extra cash into the NHS locally why wouldn't you want that?).

    When it comes to ICSs fees, I believe they are scaled according to list size. And the point is: it more than pays for itself. I've just had the analysis rerun. The additional income of patients added since we started is £19,764. Cost - £3,600.

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  • There are a few companies that offer QOF data checks like this. We ended up using a company called QOF Masters as they offer a free initial report and maximum fee of about £1,000 for the full report (they only support EMIS Web practices though). Ardens offer QOF data checks for SystmOne practices. Interface Clinical Services support all three clinical systems I think. I recommend you shop around before deciding on a particular company.

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  • £3600/2 days to a "QOF Consultant" -- says it all really. That is a lot more than a locum GP's pay with no risk whatsoever. No wonder clever people are voting with their feet

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  • 6:56@ Exactly! The system is made for 'our' people and 'they,' in small and medium size Practices, can get stuffed.
    Changes to QoF codes are made frequently so only the chosen few who can afford it maximize on profits. Corruptions and manipulation in UK beats third world countries but is done under the garb of 'effective management of resources' in white gloves.
    Why can't QoF codes and IT systems be transparent without having to divest valuable funds to private Consultants?

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  • @9:06 In fairness all of the QOF searches are transparent (at least on Emis) you only need to read the search definition. Any above average emis user with some knowledge of clinical terminology can generally improve income from QOF.

    Start by looking at your practices prevalence compared to your local area.

    Look at trends, are you well below the local average for COPD? Osteoporosis is always a winner as it is tricky to code and nationally under coded, start their.

    Also focus on small disease registers, you will not make money finding 20 uncoded asthmatics but find 5 with RA and you will.

    My final free tip, weight patients regularly. A patient is only on your obesity register for QOF if they have a BMI in that QOF year.

    I spend half my working day reminding clinical staff to code things properly, building templates and protocols to help them.

    The other half I spend correcting their coding when they ignore all my templates, protocols and massive pop-up windows pleading for them to take a patients BP.

    Yes it's all tedious work but it greatly improves your income.

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  • Where do we get the up-to-date prevalence from?
    Can anyone recommend a website?

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  • will give you up to 2015 data at the moment.

    If you want actual real-time prevalence I don't know any websites but it's pretty easy to figure out from your QOF searches.

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  • I would be happy to pay consultants.
    My accountant asked £330 for a half hour chat on the phone.
    It was about our earnings at £40 k per partner.
    Our neighbours at 80- 100 k per partner
    They earn twice per patient .
    David are you earning £320 per patient like some practices in Wessex

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