Smash QOF in Ten Months the Easy Way: Part 1
The month of April in general practice is bittersweet. On one hand is the relief that usually comes from a lull in the pressure on targets. On the other is the realisation that the whole race to meet QOF targets is starting again. This means that it also happens to be the perfect time to plan for the year ahead. Our goal is to help you smash QOF in ten months the easy way.
The case for forward planning
“To fail to prepare is to prepare to fail.”
H.K. Williams
Among the advantages of planning the workload this early are the following:
- Enhance Recall Success: Enough time to schedule recalls and enhance the chances that most of your target population will be seen by the end of the financial year.
- Enhance Colleague Job Satisfaction: Reduce the stress on colleagues that comes from the pressure to meet rushed targets in the last few months of the year.
- Enhance Quality Outputs: Ensure high quality work throughout the year as it is not done in a rush.
- Enhance Emergency Preparedness: Early planning places you in a good position to handle “shocks” to the system, such as unexpected staff departures or sicknesses.
- Enhance Training and Development: It is easier to schedule training clinics and shadowing sessions if preplanned in recognition of the resources, support and workload available.
- Enhance Achievement of Time-dependent Indicators: Some indicators take time to achieve. For instance, CHOL004, which relates to lipid lowering therapy for secondary prevention, requires intensification of standard lipid lowering therapy before the use of injectable therapies such as inclisiran or PKSK9i. This might take anything from 6 to 9 months to achieve, hence it is advisable to start sooner rather than later.
Understanding the Goals
If you don’t know where you’re going, you’ll end up somewhere else.
Yogi Berra
This brings us nicely to the fact that, in order to execute the plan effectively, you need to know what you are working towards. In particular, you need to know the indicators associated with each domain, the income protected indicators, the performance thresholds and the value of the price (the points available for each indicator). This is normally a nice way to sharpen your priorities. Thankfully, we’ve got you covered in that space. The table below gives a summary of all the above points.
| Domain | Indicator | Points | Thresholds |
| AF | AF 001 – AF register | 5 | Income Protected |
| AF006 – % pts who have had stroke risk assessment with CHA2DS2VASc score | 12 | 40-90% | |
| AF008 – % pts with CHA2DS2VASc score ≥2 on DOAC or Vit K antagonist | 12 | 70-95% | |
| CHD | CHD001 – register of pts with CHD | 4 | Income Protected |
| CHD005 – % pts on aspirin or alternative antiplatelet, or anticoagulant | 7 | 56-96% | |
| CHD015 – % pts aged ≤79 yrs with BP ≤140/90 (or equivalent HBPM) | 12 | 40-77% | |
| CHD016 – % pts aged ≥80 yrs with BP ≤150/90 (or equivalent HBPM) | 5 | 46-86% | |
| Heart Failure | HF001 – register of pts with heart failure | 4 | Income Protected |
| HF008 – % pts with HF diagnosed after 1/4/23 confirmed by echo or specialist assessment within 6 months before entry onto register | 6 | 50-90% | |
| HF003 – % pts with HFrEF (or HF with LVSD) on ACEI or ARB | 6 | 60-92% | |
| HF006 – % pts with HFrEF (or HF with LVSD) on beta blocker | 6 | 60-92% | |
| HF007 – % pts with HF who have had annual review inc. functional capacity & medication review to ensure meds at max tolerated doses | 7 | 50-90% | |
| Hypertension | HYP001 – register of pts with hypertension | 6 | Income Protected |
| HYP008 – % pts aged ≤79 yrs with BP ≤140/90 (or equivalent HBPM) | 14 | 40-77% | |
| HYP009 – % pts aged ≥80 yrs with BP ≤150/90 (or equivalent HBPM) | 5 | 40-80% | |
| PAD | PAD001 – register of pts with peripheral arterial disease | 2 | Income Protected |
| Stroke/TIA | STIA001 – register of pts with stroke or TIA | 2 | Income Protected |
| STIA007 – % pts with non-haemorrhagic stroke/TIA on antiplatelet/anticoagulant | 4 | 57-97% | |
| STIA014 – % pts aged ≤79 yrs with BP ≤140/90 (or equivalent HBPM) | 3 | 40-74% | |
| STIA015 – % pts aged ≥80 yrs with BP ≤150/90 (or equivalent HBPM) | 2 | 46-86% | |
| Cholesterol | CHOL003 – % pts with CHD, PAD, stroke/TIA or CKD on statin (or alternative lipid lowering therapy) | 14 | 70-95% |
| CHOL004 – % pts with CHD, PAD or stroke/TIA with LDL ≤2.0 mmol/L (or if LDL not recorded non-HDL ≤2.6 mmol/L) | 16 | 20-35% | |
| Diabetes | DM017 – register of pts aged ≥17 yrs with diabetes and type confirmed | 6 | Income Protected |
| DM006 – % pts with nephropathy or micro-albuminuria on ACEI (or ARB) | 3 | 57-97% | |
| DM012 – % pts with recorded foot exam and risk classification | 4 | 50-90% | |
| DM014 – % pts newly diagnosed referred to structured education programme within 9 months of addition to the register | 11 | 40-90% | |
| DM020 – % pts without moderate/severe frailty with HbA1c ≤ 58 mmol/mol | 17 | 35-75% | |
| DM021 – % pts with moderate/severe frailty with HbA1c ≤ 75 mmol/mol | 10 | 52-92% | |
| DM022 – % pts aged ≥40 yrs (without moderate/severe frailty or known CVD) with CVD risk score ≥10% on statin | 4 | 50-90% | |
| DM023 – % pts with known CVD (not haemorrhagic stroke) on statin | 2 | 50-90% | |
| DM033 – % pts without mod/severe frailty with BP ≤140/90 (or equivalent HBPM) | 10 | 38-78% | |
| Asthma | AST005 – register of pts aged ≥ 6 yrs with asthma (excludes those who have been prescribed no asthma drugs in the preceding 12 months) | 4 | Income Protected |
| AST011 – % pts with asthma diagnosis (after 1/4/23) with spirometry and one other objective test (FeNO, bronchodilator reversibility, peak flow variability) between 3m before to 6m after diagnosis | 15 | 45-80% | |
| AST007 – % pts with annual review inc. asthma control, no. exacerbations, inhaler technique & personalised action plan | 20 | 45-70% | |
| AST008 – % pts aged ≤19 yrs with smoking record or 2nd hand smoke exposure | 6 | 45-80% | |
| COPD | COPD015 – register of pts with COPD (if after 1/4/23 diagnosis confirmed with post-bronchodilator spirometry FEV1/FVC ratio <0.7, between 3 months before to 6 months after diagnosis) | 8 | Income Protected |
| COPD010 – % pts with annual review inc. no. exacerbations & MRC breathlessness score | 9 | 50-90% | |
| COPD014 – % pts with MRC score ≥3 referred to pulmonary rehab | 2 | 40-90% | |
| Dementia | DEM001 – register of pts with dementia | 5 | Income Protected |
| DEM004 – % pts with annual review of care plan | 14 | 35-70% | |
| Depression | DEP004 – % pts aged ≥18 yrs with new diagnosis reviewed 10-56 days after diagnosis | 10 | 45-80% |
| Mental Health | MH001 – register of pts with schizophrenia/psychosis, bipolar disorder or on lithium | 4 | Income Protected |
| MH002 – % pts with annual care plan agreed between individuals, family and/or carers | 5 | 40-90% | |
| MH003 – % pts with BP recorded | 3 | 50-90% | |
| MH006 – % pts with BMI recorded | 3 | 50-90% | |
| MH007 – % pts with alcohol consumption recorded | 3 | 50-90% | |
| MH011 – % pts with lipid profile recorded (NB for some lower risk pts can be within 24 months rather than 12 months) | 7 | 50-90% | |
| MH012 – % pts with HbA1c or blood glucose recorded | 7 | 50-90% | |
| MH021 – % pts who have received all 6 elements of SMI check | 6 | 50-80% | |
| Cancer | CAN001 – register of pts with cancer (excluding non-melanotic skin cancer) after 1/4/03 | 5 | Income Protected |
| CAN004 – % pts with cancer diagnosed in last 24 months with cancer care review | 6 | 50-90% | |
| CAN005 – % pts with cancer that have had discussion and support from 10 care within 3 months of diagnosis | 2 | 70-90% | |
| CKD | CKD005 – register of pts aged ≥18 yrs with CKD stages G3a-G5 | 6 | Income Protected |
| Epilepsy | EP001 – register of pts aged ≥18 yrs receiving drug therapy for epilepsy | 1 | Income Protected |
| LD | LD004 – register of pts with learning disability | 4 | Income Protected |
| Osteoporosis | OST004 – register of pts aged ≥50 yrs with fragility fracture and diagnosis confirmed on DEXA scan (those aged ≥75 yrs do not require DEXA for diagnosis) | 3 | Income Protected |
| RA | RA001 – register pf pts aged ≥16 yrs with rheumatoid arthritis | 1 | Income Protected |
| Pall care | PC001 – register of pts in need of palliative care | 3 | Income Protected |
| NDH | NDH002 – % pts with non-diabetic hyperglycaemia with HbA1c or fasting glucose | 18 | 50-90% |
Understanding Your (Human) Resources
In this case resources we mean the personnel that you have at your disposal to undertake the workload. Think not just of your practice-based staff, but also the wider pool of resources such as PCN staff in ARRS roles, assuming your practice is part of a PCN. In addition, you need to be clear how much of each resource you have i.e. the number of full-time equivalents. While this may be straightforward for practice-based staff, it’s perhaps a bit harder for PCN staff who need to be shared across practices and might be subject to higher turnover, leading to fluctuating availability.
The list of roles includes the following:
- GPs
- Admin staff
- Practice Nurses
- Diabetic Nurses
- Asthma/COPD Nurses
- Clinical Pharmacists
- Pharmacy Technicians
- Social Prescribers
- Health & Wellbeing Coaches
- Care Coordinators
- Physician Associates
- Apprentice Physician Associates
- First Contact Physiotherapists
- Dietitians
- Podiatrists
- Occupational Therapists
- Nursing Associates
- Trainee Nursing Associates
- Paramedics
- Mental Health Practitioners
- Advanced Practitioners
- General Practice Assistants
- Enhanced Practice Nurse
Matching the Roles to the Jobs
This is the final stage of Stage 1. It is useful to have a chart that allows you to match the capabilities of each role against all the relevant indicators. This is relatively easy to do on a spreadsheet. You will find that, for many indicators, different roles can fulfil the required tasks. You can decide on which roles will focus on which targets, but you will also have a fall-back list in case you run out of one role. We provide an example of this type of spreadsheet below.
If you would like a copy of the chart in Excel format, you are welcome to download a copy here. We only ask that you spread the news that you got it from our site so that more people can benefit directly.
We trust that you have found Part 1 of “Smash QOF in Ten Months the Easy Way” useful. If you haven’t subscribed already, why not consider doing so in order not to miss any more useful tips. Click here for details. In Part 2, we’ll look at Planning the Workload.
