Quality Outcomes Framework (QOF)

Overview

QOF payments 2021/2022

NHS England and Improvement wrote issued temporary GP contract changes to support COVID-19 vaccination programme in December 2021. This letter confirmed that calculations for QOF 2021/2022 will have credited points applied for the QoF Year End Achievement Calculation 2021/2022. These credited points will be summed with conditional points during the year end calculations and displayed within the Achievement Summary Report and Detailed Provider Achievement Report within CQRS.

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 2021/2022 in CQRS

– enrol for 2022/2023 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) 2021/22

This page features Frequently Asked Questions (FAQs) about the Quality Outcomes Framework (QOF) 2021/22.

What is the national average practice list size that will be used in the re-calculations for QOF 2021/22 achievement?

The national average practice list size used for the 21/22 achievement calculation is 9085.

What is the value of a QOF point?

The value of a QOF point for 2021/22 is £201.16

How will GP Practices be paid for QOF 2021/22?

NHS England and Improvement published a letter on the 7th January 2021 which confirmed calculations for QOF 2021/2022 will have income protection arrangements applied. QoF will be processed as per normal timelines.

A summary of the arrangements for for 2021/22 achievement is below.

Performance based payments will be made for:

– vaccination and immunisations indicators

– cervical screening indicators

– register indicators

– eight prescribing indicators

Reallocation of points to the eight prescribing indicators from:

– New indicators for 21/22 (cancer and the mental health indicators)

– Non-diabetic hyperglycaemia indicator introduced in 2021/22

Quality improvement indicators will be paid in full.

The remaining 28 indicators (315 points) will be income protected using very similar methodology to the one applied in 2020/21.

Which manual indicators do I need to complete on CQRS?

Manual entry of indicators is not required for 2021/2022, 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?

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, raise a call with the CQRS Service Desk.

Check that your participation in QOF 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 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?

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 or from 1 April?

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 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 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 and no manual entry is required

– Where data has been extracted and and required manual entry has been completed (not applicable for 2021/22)

– 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 (not applicable for 2021/22)

– 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 (not applicable for 2021/22)

– 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.

Please also note that in 2021/22, income protection will have been applied to some indicators which do not need to be updated/reconciled.

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, 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 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 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 2022. 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.

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

The CQRS team 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 2021/2022

The QoF calculation for 2021/2022 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 2022/2023 to ensure aspiration payments are in place.

To support practices as they prioritise Covid-19 related activity, no manual entry will be required from practices.

However, practices will still be required to:

– declare any achievement payments for QOF 2021/2022 in CQRS

– enrol for 2022/2023 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 (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) 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) 2021/22 to receive achievement payments

Participate in QOF 2021/22 on CQRS before 31 March 2022.

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

4. Participate in Quality and Outcomes Framework (QOF) 2022/23 to receive aspiration payments

If you are expecting a QOF 2022/23 aspiration payment, ensure you have participated in QOF 2022/23.

If you haven’t received an offer of participation for QOF 2022/23 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.