Quality Outcomes Framework (QOF) Payments

QOF payments

CQRS uses information collected by General Practice Extraction Service (GPES) on behalf of NHS England about General Practice (GP) achievement under the Quality and Outcomes Framework (QOF). The information is used by CQRS to calculate GP achievement payments values for the current financial year, and to set aspiration payment values for the following year. QOF reporting collections are run throughout the year, but these are not used to calculate the payment made at the end of the financial year.year.

Reporting collections

QOF reporting collections run throughout the year, with the information made available in CQRS afterwards. This allows practices to check it against the information in their clinical systems throughout the year and address potential issues in advance of the year end period.

If collected information appears incorrect:

– contact your clinical system supplier to check what information was collected

– gather evidence to demonstrate correct information

– contact your commissioner

We advise keeping CQRS final QOF achievement submission reports for future reference. QOF information is kept on CQRS for at least 5 years.

Related links

Calculating Quality Reporting Service (CQRS) training is available. Log in details are not required.

The training provides a step-by-step guide for performing key processes in CQRS. This includes a guide to submitting and declaring achievement for payment for each of the Enhanced Services currently available on CQRS.

This page features Frequently Asked Questions (FAQs) about the Quality and Outcomes Framework (QOF).

What is the national average practice list size that will be used in the re-calculations for QOF achievement?

The national average practice list size used for the 23/24 achievement calculation is 9639.

What is the value of a QOF point?

The value of a QOF point for 2023/24 is £213.43

Which manual indicators do I need to complete on CQRS?

Manual entry of indicators is required for the following indicators in 2023/2024, unless you are one of the small number of organisations that must enter data manually for all indicators.

QI013

The contractor can demonstrate continuous quality improvement activity focused upon workforce and wellbeing as specified in the QOF guidance

The contractor has participated in network activity to regularly share and discuss learning from quality improvement activity focused on workforce and wellbeing as specified in current QOF guidance. This would entail attending two primary care network meetings, at the start and towards the end of QI activity. If a practice is not within a PCN, the expectation is that two meetings would be held locally with other practices

QI016

The contractor can demonstrate that it has in place a recognised and validated approach to understanding demand/activity, capacity and appointment data and has made improvements to data quality to better reflect practice work.

QI017

The contractor can demonstrate that it has utilised demand and capacity data to inform operational decisions and plan for demand and capacity matching .

QI018

The contractor has participated in network activity to review the smart cards of all staff employed under the Additional Roles Reimbursement Scheme (ARRS), to ensure that the staff role assigned on their smart card aligns with the role they are employed under within the ARRS.

QI019

The contractor can demonstrate improvement in reducing avoidable appointments by

1. Using BI tools, if available and practice collected data where not, to understand the practice activity including variations over the days of the week, time of day and time of year.

2. Developing an understanding of the telephone queue either by extracting data from their cloud-based telephony system or asking staff to collect data over a period.

3. Using that data to understand their peaks of activity and better matching their capacity to their demand by, for instance, reviewing rotas.

4. Using improvement techniques described in the Primary Care Transformation Team’s webinar series on Demand and Capacity which provides practical advice and guidance.

5. Referencing the Royal College of General Practitioner’s 6 steps to start to improve delivering continuity of care from their Continuity Toolkit for those who need it and adapting to suit the needs of the practice.

Do I have to manually enter all data for QOF?

Practices that need to manually enter QOF information include:

shared practices: practices sharing a clinical system need to separately enter their achievement manually as CQRS only collects automatically for one practice

If an automated extract will not be supplied by your GP practice system supplier, you will need to manually enter your QOF 2023/24 data.

What is required if a GP practice is closing before 31 March 2024?

If your GP practice is closing before 31 March, please perform the following actions:

Check the GP practice closure date on CQRS. If it is not correct, contact your commissioning organisation, who will need to update this via PCSE. If it has been updated.

Check that your participation in QOF ends on the same date that your GP practice closes. If not, please contact your commissioner.

Manually enter data for QOF achievement. Ensure that you set the date in CQRS for the period that you are entering data for. This should be the same as the practice closure date.

What do I need to do if a GP practice is merging or splitting before 31 March 2024?

CQRS will not be provided with the information to correctly calculate QOF achievement for the merged or split section of a GP practice.

CQRS will calculate QOF achievement as if the GP practice has not undergone a split or merge.

Your commissioning organisation will need to manually determine the impact of the merge/split on the QOF payments and apply these through the PCSE system.

What do I need to do if a practice is closing, merging or splitting on 31 March 2024 or from 1 April 2024?

Check with your GP practice system supplier to investigate if they will be sending an automated QOF extract for your practice for 31 March that will correctly reflect the state of your GP practice before the closure, split or merge. If an automated collection is being sent, no further actions are required beyond the standard year-end actions.

If an automated extract will not be supplied by your GP practice system supplier, you will need to manually enter your QOF achievement data.

For a step-by-step guide, refer to the Full Manual Entry Guide.

Is the Commissioning Organisation required to sign off QOF aspiration payments?

No. The aspiration payment for any practices that we have achievement data for will be calculated following the QOF achievement calculation and release of payment files. The exact payment date will depend on local arrangements.

How will I know if I will receive my estimated QOF aspiration payment?

Standard aspiration payments will be applied where practices have fully completed entry of data. This includes:

– Where all information has been extracted and no manual entry is required

– Where data has been extracted and required manual entry has been completed

– Where all data has been manually entered. Practices where automated data is available and manual indicators have been entered where necessary.

Estimated aspiration payments

Estimated aspiration payments will be available where data in CQRS is incomplete. This includes:

– Practices where automated data is available from GPES, but the manual indicators have not been entered

– Practices where the automated data is not available for the year end extract from GPES but have entered data for the four required manual indicators – Practices for which no data is available, from GPES or manual.

Once all required QOF data is supplied, the standard aspiration will be calculated, and an adjustment made.

What happens to aspiration payments for practices that have merged?

Before undertaking any action, contact your commissioning organisation for advice – they may have an established process in place.

There is some reconciliation work required to ensure that practices are paid the appropriate aspiration which takes into account the QOF achievement for patients that merged into the practice during the QOF year.

To complete the reconciliation:

– provide updated CRP figures to the CQRS team so that CQRS can be updated to reflect the new practice list size including the merged patients

– the extract for QOF year-end will produce an interim achievement figure. This will be an inflated figure as it includes the new patients. Do not declare this figure.

– CQRS will calculate an interim aspiration figure – this will also be an inflated figure due to the list size adjustment

– the practice will need to go through and balance the achievement by checking each indicator and removing the counts for the patients that belonged to the closed practice up to the closing date of the practice. Once the counts for the patients that belong to the closed practice have been removed, the practice can evidence this to the commissioning organisation and declare the achievement. Please note that adjustments applied as part of income protection do not need to be amended.

– aspiration payments will then be adjusted for the rest of the financial year to ensure that the right amount is paid. This is likely to be less than the initial payments.

How do I review my QOF achievement data on CQRS?

From the 6 April 2024, you will be able to:

– log in to CQRS

– select the Reports Tab (it should default to Achievement)

– select the report Achievement Summary

Then, select the parameters:

– select the Financial Year option and set the achievement year

– select the Quality Service option and set to Quality and Outcomes Framework for the relevant year

– select the achievement date 31/03/2024

– select the option to Run Report

The QOF achievement data for your GP practice should then be displayed. Initially this will show the domains, the total achievement, any adjustments, CPI calculation and Contract duration. You can then access further information within each domain by clicking on it. This will display the Indicator Groups. Clicking in each of the indicators will display further information, including how the QOF achievement has been calculated.

 

What is CPI on the achievement summary report?

The contractor population index (CPI) adjustment has been included in the QOF calculation since 2004. A description can be found in the Statement of Financial Entitlements (SFE) and in all previous versions available on the government’s website. The CPI calculation was performed on all historical QOF payments on the QMAS system, and now CQRS, in accordance with the details in the SFE.

https://www.gov.uk/government/publications/nhs-primary-medical-services-directions-2013

CPI adjustment is calculated on the practice list size divided by the national average

 

What reports can I use to confirm which practices have completed their manual data entry on CQRS for QOF?

Two reports are available for commissioners under the Data Entry tab.

1. Data Entry Quality Service Data Complete

Select the Quality Service relevant to QOF for the achievement year and click Run Report. The report will list all GP practices within your commissioning area who are participating in QOF for that year and have completed their manual indicators.

2. Data Entry Quality Service Data Missing

Select the Quality Service ‘QOF’ and click Run Report. The report will list all GP practices within your commissioning area who are participating in QOF but have not completed their manual indicators

When will I see QOF achievement data in CQRS?

Achievement data will start becoming visible in CQRS from 6 April 2024. Some practices may see this data a few days later if their data is collected via additional extractions.

In line with previous years, once the achievement payment has been approved, CQRS will adjust the standard aspiration as required to reflect the actual QOF achievement.

What should a GP practice do if they don’t agree with the achievement data they see in CQRS?

If your practice disagrees with the achievement payment values calculated in CQRS:

– assemble evidence in support of the disagreement and inform your commissioning organisation

– if the numerator, denominator or exceptions are incorrect, contact your GP system supplier and obtain the relevant evidence

– provide full evidence to your commissioning organisation. They will be required to review the evidence and negotiate an adjustment

The CQRS team cannot resolve disputes or update your data in CQRS. Amendments to data as a result disputes and queries are actioned by your commissioning organisation.

I have calculated the QOF figure for my practice outside of the CQRS system – is the CQRS figure incorrect?

The calculated figure is based on the data extracted from your GP system. The calculation in CQRS is rigorously tested and we are confident that the calculation method is correct. If it is not what you are expecting to see, then you need to query this with your GP system supplier in the first instance.

The calculation includes several factors, so it is unlikely that a locally calculated figure will match the figure in the system.

Indicator calculation:

Actual achievement/Maximum potential achievement x Points available for indicator x Value of a QOF point x Adjustment prevalence (patient set/CRP)/National prevalence (average prevalence)

Will a GP practice need to retain clinical system audit reports of the final QOF achievement submission reports?

GPs are encouraged to retain clinical system audit reports. This supports any post verification work and assists reconciliation against the final CQRS report. CQRS will retain QOF data for five years.

This guide describes the actions required from GP practices in preparation for the year-end data extract for Quality and Outcomes Framework (QOF).

1. Check performance

Check your practice’s QOF performance on your clinical system.

If necessary, take action to improve before submitting.

If required, ask your commissioner to submit updated Contractor Registered Population (CRP) for your practice to the CQRS Service Desk.

2. Get set up on Calculating Quality Reporting System (CQRS)

If you already have a CQRS log in, check that you can log in to the system and ensure your password and security questions are up to date.

If not already set up, ask your Commissioning Organisation to register a member of staff as a CQRS user/administrator, for example your practice manager.

Ask your user/administrator to set up logins for all staff members submitting QOF.

Ask all staff members submitting QOF to check that they can log in.

3. Participate in Quality and Outcomes Framework (QOF) 2023/24 to receive achievement payments

Participate in QOF 2023/24 on CQRS before 31 March 2024.

For a step-by-step guide, refer to Module 4 and Module 5 at: https://academy.midlandsandlancashirecsu.nhs.uk/cqrs-national-training/e-learning/.

Contact your commissioning organisation if you have not received an offer of participation.

4. Participate in Quality and Outcomes Framework (QOF) 2024/25 to receive aspiration payments

The QOF 2024/25 Service will go live March 13th 2024 on CQRS.

5. Submit manual indicators

Manually enter your QOF data if it will not be automatically extracted. Your Commissioning Organisation will advise if you are required to do this.

6. Review and declare achievement

Check your achievement information on CQRS.

Review it against your clinical system QOF data.

If you disagree with any of the values, assemble evidence to support your argument and contact your commissioning organisation. Please note that the CQRS cannot update your QOF data, this must be done through your commissioning organisation.

Once you are satisfied your achievement is correct, declare achievement on CQRS for approval and payment.

7. Keep your reports

Keep your clinical system audit reports from the final QOF submission to help with any future verification and reconciliation.