About the Quality and Outcomes Framework (QOF)
The NICE QOF Indicator Programme
What is the QOF?
Introduced in 2004 as part of the General Medical Services Contract, the QOF is a voluntary incentive scheme for GP practices in the UK, rewarding them for how well they care for patients.
The QOF contains groups of indicators, against which practices score points according to their level of achievement. NICE has been asked to focus on the clinical and health improvement indicators in the QOF, which includes a number of domains such as coronary heart disease and hypertension.
The QOF gives an indication of the overall achievement of a practice through a points system. Practices aim to deliver high quality care across a range of areas, for which they score points. Put simply, the higher the score, the higher the financial reward for the practice. The final payment is adjusted to take account of the practice list size and prevalence. The results are published annually.
The NICE QOF Indicator Programme
NICE's role is to manage the process to develop the clinical and health improvement indicators for the QOF. This involves prioritising areas for new indicator development, developing and selecting indicators, and ensuring consultation with individuals and stakeholder groups.
We will also recommend whether existing indicators should continue to be part of the QOF. For example, where the activity being measured has become part of standard clinical practice, there would no longer be a need to provide a financial incentive.
For details of the indicators in the NICE QOF Indicator menu please view the NICE Menu of Indicators.
This also contains full details of the decision process for the recommendation of potential indicators.
For details of the recommendations relating to existing indicators please view the Advisory Committee outputs.
NHS Employers (on behalf of the four UK health departments) and the BMA will negotiate which indicators should be applied nationally as part of the QOF and what the value and thresholds of the indicators should be.
Our process guide sets out in detail the processes involved in managing the development of indicators for the QOF, which ensure that indicators are developed in an open, transparent and timely way, with input from individuals and stakeholder organisations.
For details of all current QOF indicators and guidance please view the NHS Employers website.
For details of practice results against QOF indicators please view the NHS Information Centre´s website.
Why is NICE involved?
A public consultation document was published by the Department of Health (DH) in late October 2008 to involve patients, carers, NHS professionals and commissioners in how a more independent and transparent process for reviewing and developing indicators should work. The consultation set out proposals on how this new process should work in England, and the DH held discussions with the devolved administrations about how to ensure a collaborative approach across the UK. All four UK countries have agreed to take part in the new NICE-led process.
An analysis of the submissions received to this consultation is available on the DH website
What NICE adds
Currently, QOF indicators do not systematically take cost effectiveness into account. There is evidence that some QOF payments do not currently reflect the value of the indicators, in terms of health benefit. One of NICE's acknowledged key strengths is our robust process for assessing what is both clinically and cost effective for use in the NHS.
It is important that the process for assessing evidence to review or develop QOF indicators is separate from the process for negotiating and approving changes to the QOF. NICE acts independently when producing clinical and public health guidance for the NHS and we will bring this experience to assessing evidence and developing indicators for the QOF.
By overseeing the process of developing and reviewing performance indicators for the QOF, we can ensure that the principles behind our recommendations are reflected in the indicators. This will encourage the implementation of guidance and lead to improvements in care across the UK.
Partner organisations
A number of partner organisations contribute to the development of clinical and health improvement indicators for the QOF. A brief summary of the role played by these organisations are given below.
The Primary Care Group in the School of Health and Population Sciences at the University of Birmingham and the York Health Economics Consortium (YHEC)
The Primary Care Group in the School of Health and Population Sciences at the University of Birmingham in collaboration with the York Health Economics Consortium (YHEC) will develop indicators on clinical or public health topics that are recommended by the independent Primary Care QOF Indicator Advisory Committee. They will provide an ongoing review of QOF indicators to make recommendations to the Committee on thresholds, continued incentivisation and the evidence base. They will apply a cost-effectiveness methodology to the indicators and provide recommendations to the Committee.
The NHS Information Centre and Connecting for Health
The NHS Information Centre, working with Connecting for Health, is responsible for managing the production of business rules and data extraction solutions to support the process, including Read code releases, and will work with the four UK health departments.
NHS Evidence will provide accredited sources of evidence. These sources of evidence will be considered by the QOF Indicator Programme team when considering clinical or public health topics proposed by individuals or stakeholder organisations.
Other organisations
NICE works closely with many professional, NHS and public sector organisations, including those representing patients and carers. The following list is not exhaustive, but identifies other key partners in the QOF Indicator Programme:
- British Medical Association
- Department of Health
- General Practitioners Committee
- NHS Employers
- NHS Information Centre
- NHS Quality Improvement Scotland and the Scottish Intercollegiate Guidelines Network (SIGN)
- Northern Ireland Department of Health, Social Services and Public Safety
- Royal College of General Practitioners (RCGP)
- Scottish Government Health Directorates
- Welsh Assembly Government
This page was last updated: 02 March 2012