Once again GPs should be proud of their achievement in the QOF in 2015. The headline figure is 94.7% of all points, but the median is a little higher at 97%. This was a better proportion than the previous year although the actual number of points points available was around a third lower. A typical practice missed fewer than 17 points – although this could still be worth around £3,000 to an average sized practice.
The drastic reduction of the size of the QOF removed several unpopular indicators which may account for the increase in achievement. The transfer of cash to the global sum meant less of a QOF ‘bonus’ at the end of the year.
The toughest area for practices was diabetes which with coronary heart disease and osteoporosis made up most of the loss of points. Clinical targets around blood sugar control consistently were the most challenging for practices. As these carry a large number of points the effect on practice incomes is relatively large.
Small numbers of patients remain a difficulty in QOF. Many practices had no patients with a qualifying fracture to appear in the osteoporosis register. The three indicators carried three points each so the loss could be quite large. A third of practices have no suitable patients for at least one indicator.
There are three points for monitoring patients who are taking lithium but 600 practices had no suitable patients and missed out on these through no fault of their own.
Prevalence can have an effect as well. Whilst increasing prevalence can increase income for individual practices the overall effect is to dilute the value of points. We have continued to see an increase in diabetes prevalence which is now over twice the level when QOF was first introduced. This year has also seen a rise in coronary heart disease, bucking the long term downward trend.
Dr Gavin Jamie is a GP in Swindon and runs the QOF Database website