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New QOF points added to contract backed by £10m funding envelope

The GP quality and outcomes framework (QOF) will be updated to include more points while asthma and chronic obstructive pulmonary disease (COPD) domains have been overhauled, under contractual changes. 

NHS England and the BMA have negotiated a new £10m funding pot for QOF, bringing the total points available to 567 in 2020/21 – up from 559 – while the value of a QOF point will increase from £187.74, to £194.83 in 2020/21.

The updated contract states that £10m of funding will be added to the QOF to support the introduction of a new indicator on non-diabetic hyperglycaemia, worth 18 points.

The agreement, which comes as part of the revised GP contract, also sees the recycling of 97 points covering asthma, COPD and heart failure domains into 11 ‘more clinically appropriate indicators’ from 2020/21.

In addition new incentive payments will be introduced to maximise vaccine coverage as part of QOF, replacing the current childhood immunisation DES.

The changes follow a review of the framework involving representatives from the BMA GP Committee, the RCGP, NICE, Public Health England, the Department of Health and Social Care, and NHS England. 

Under the changes, practices will be required to use at least two diagnostic tests to confirm an asthma diagnosis and keep a record of patients aged six years and over who were diagnosed with asthma.

Practices will need to amend any entries to the COPD register made after 1 April so that patients have a clinical diagnosis and a record of post bronchodilator spirometry FEV1/FVC ratio below 0.7. In addition, they will be asked to carry out an annual review to include the number of patients’ exacerbations in a bid to help avoid emergency admissions. 

Meanwhile, any patients diagnosed with heart failure after 1 April will be reviewed by an echocardiogram or specialist assessment between three and six months after diagnosis.

NHS England said the new modules will focus on improving the care of people with a learning disability and supporting early cancer diagnosis, with the aim to promote health checks and medicine optimisation and increase uptake in cancer screening programmes. 

Dr Gavin Jamie, Swindon GP and QOF expert, was cautiously optimistic about the changes. 

He said: ‘For the first time that I can remember, the number of points in QOF are expanding. It’s a matter of opinion whether QOF getting bigger is a good thing.

‘We’re paid on a lot of targets with these and the enhanced services, but more targets in general is more hassle for practices and PCNs. There’s likely to be a mixture of views there. If practices are fairly prepared, these are the sort of changes we used to see in QOF almost every year so it’s an update rather than anything radically new.’

He added: ‘It’s just going to be a little bit of adaptation to how things are done in surgeries from April onwards. I don’t see there being a huge difference in the number of points or amount of income from QOF that practices get. The extra 18 points [for hyperglycaemia] is going to be mostly about organisation and getting people in for blood tests rather than GP time.’

Further changes in ‘key priority areas’ for QOF, such as mental health, anti-microbial resistant including antibiotic prescribing and cardiovascular disease prevention and detection, will be implemented in 2020/21, the contract said.