Quality Outcomes Framework (QOF)

Overview

QOF Payments 2020/2021

NHS England and Improvement published a letter on the 7th January 2021 which confirmed calculations for QOF 2020/2021 will have income protection arrangements applied.

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

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 NHS England area team

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

Year-end collection for payment

To support practices as they prioritise Covid-19 related activity, manual indicators will be automatically populated to ‘Yes’ for practices who have not submitted their manual indicators:

However, practices will still be required to:

declare any achievement payments for QOF 2020/2021 in CQRS

enroll for 2021/2022 QoF in CQRS

Related links

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

CQRS user guides are also available, providing 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.

Quality Outcomes Framework (QOF) Frequently Asked Questions (FAQs) 2020/21

This page features Frequently Asked Questions (FAQs) about the Quality Outcomes Framework (QOF) 2020/21.

What is the national average practice list size that will be used in the re-calculations for QOF 2020/21 achievement?

The national average practice list size as of 1 January 2021 is TBC

The national average practice list size as of 1 January 2020 is 8799

The national average practice list size as of 1 January 2019 is 8479

The national average practice list size as of 1 January 2018 is 8096

What is the value of a QOF point?

The value of a QOF point for 2020/21 is £194.83

The value of a QOF point for 2019/20 is £187.74

The value of a QOF point for 2018/29 is £179.26

The value of a QOF point for 2017/18 is £171.20

How will GP Practices be paid for QOF 2019/20?

NHS England and Improvement published a letter on the 7th January 2021 which confirmed calculations for QOF 2020/2021 will have income protection arrangements applied. QoF will be processed as per normal timelines.

Which manual indicators do I need to complete on CQRS?

Manual entry of indicators is not required for 2020/2021, unless you are one of the small number of organisations that must enter data manually for all indicators. More detail can be found below on the circumstances which normally require a full manual submission.

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

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 2020/21 data

What do I need to do for QOF if I am part of a shared practice?

Where more than one GP practice has been set up on a single instance of a clinical system and the clinical system supplier cannot produce separate QOF extracts for each GP practice, the GP practice is required to manually enter its data onto CQRS.

For a step by step guide, refer to the training materials on our website.

What is required if a GP practice is closing before 31 March 2020?

If your GP practice is closing before the 31 March 2020 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, raise a call with the CQRS Service Desk.

Check that your participation in QOF 2019/20 ends on the same date that your GP practice closes. If not, raise a call with the CQRS Service Desk.

Manually enter data for QOF 2019/20. 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 2020?

CQRS does not have the information to correctly calculate QOF achievement for the merged or split section of a GP practice.

CQRS will calculate QOF 2019/20 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 NHAIS/Exeter system.

A Provider Post Achievement Modelling tool is available on CQRS to assist with this process.

What do I need to do if a practice is closing, merging or splitting on the 31 March 2020 or from the 1 April 2020?

Check with your GP practice system supplier to investigate if they will be sending an automated QOF extract for your practice for the 31 March 2020 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 2019/20 data.

For a step by step guide, refer to the Full Manual Entry Guide on our website.

What do I need to do for QOF if I am part of a shared practice?

Where more than one GP practice has been set up on a single instance of a clinical system and the clinical system supplier cannot produce separate QOF extracts for each GP practice, the GP practice is required to manually enter its data onto CQRS.

For a step by step guide, refer to the full user guide on our website.

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 2019/20 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?

In total there are five possible scenarios:

Standard aspiration payments

The following two scenarios will receive the standard aspiration payment for QOF 2020/21:

Practices where automated data is available and the four required manual indicators have been entered.

Practices who have been advised to manually enter all QOF indicators and have manually entered this data.

Estimated aspiration payments

The remaining three scenarios will receive an estimated aspiration payment for QOF 2020/21:

Practices where automated data is available from GPES, but the four required indicators have not been manually 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 QOF 2019/20 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.

Updated CRP figures should be provided to NHSD so that CQRS can be updated to reflect the new practice list size including the merged patients.

Option 1 – automated extract and calculation with subsequent reconciliation

You can let it calculate through year-end and reconcile afterwards:

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

the extract for QOF year-end 19/20 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. This will not be paid until the achievement figure is declared

the practice will then get a balancing figure for 19/20 achievement

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 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

there will be an adjustment figure for QOF 19/20 achievement that will come via NHAIS

there will then be a balancing figure for 20/21 aspiration that will also come via NHAIS

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

Option 2 – manually enter and declare QOF for each practice by 31 March 2020

Each practice could manually enter and declare their own QOF based on their achievement. This would need to be submitted and financially approved before 31 March. If it wasn’t financially declared by 31 March, the automated extract would overwrite anything that had been input. If declared and approved by 31 March, Aspiration would then be calculated on this figure and it wouldn’t be necessary to reconcile or balance any payments.

How do I review my QOF 2019/20 achievement data on CQRS?

From the 5 April 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 to 2019/20

select the Quality Service option and set to Quality and Outcomes Framework 2019/20

select the option to Run Report

The QOF 2019/20 achievement data for your GP practice should then be displayed. Initially this will show the clinical and public health domains, the total achievement and any adjustments for PMS contracts, CPI calculation and Contract duration. You can then access further information within each domain, (for example Clinical) 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 reports are available on CQRS to help with QOF 2019/20?

A full list of reports is available on the GP Collections website under the Reporting section.

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

1. Data Entry Quality Service Data Complete

select the Quality Service ‘QOF 19/20’ and click Run Report

the report will list all GP practices within your commissioning area who are participating in QOF 2019/20 and have completed their manual indicators

2. Data Entry Quality Service Data Missing

select the Quality Service ‘QOF 19/20’ and click Run Report

the report will list all GP practices within your commissioning area that are participating in QOF 2019/20 but have not completed their manual indicators

When will I see QOF 2019/20 achievement data in CQRS?

Achievement data will start becoming visible in CQRS from 5 April 2020. 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 2019/20 achievement.

Is there a deadline for declaring QOF 2019/20 data in CQRS?

There is no specific deadline enforced by CQRS. The Statement of Financial Entitlement (SFE) states that the date for declaration should be by the end of June, but can be extended if the achievement data is in dispute between the GP practice and the commissioning organisation.

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

NHS Digital cannot resolve disputes or update your data in CQRS. Amendments to data as a result of 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 a number of 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.

QOF Payments 2020/2021

NHS England and Improvement published a letter on the 7th January 2021 which confirmed calculations for QOF 2020/2021 will have income protection arrangements applied.

The QoF calculation for 2020/2021 uses a combination of actual achievement and historic data. Historic data assumes that practices would have continued to perform at the same levels throughout the COVID 19 response period as they had done in previous years. As there is a combination of actual achievement and historic achievement data used we will still need to collect year end data and enrol practices into QOF for 2021/2022 to ensure aspiration payments are in place.

To support practices as they prioritise Covid-19 related activity, manual indicators will be automatically populated to ‘Yes’ for all practices.

However, practices will still be required to:

declare any achievement payments for QOF 2020/2021 in CQRS

enroll for 2021/2022 QoF in CQRS

Quality Outcomes Framework (QOF) Year End Checklist

This guide describes the actions required from GP practices in preparation for the year-end data extract for Quality and Outcomes Framework 20-21 (QOF).

1. Check performance

Check your practice’s 2020/21 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) 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) 2020/21 to receive achievement payments

Participate in QOF 2020/21 on CQRS before 31 March 2021.

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

4. Participate in Quality and Outcomes Framework (QOF) 2021/22 to receive aspiration payments

If you are expecting a QOF 2021/22 aspiration payment, ensure you have participated in QOF 2021/22.

If you haven’t received an offer of participation for QOF 2021/22 contact your commissioning organisation.

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.