1. QOF Calculations
What is the 'Contractor Population Index' (CPI) and how does it work?
The CPI is calculated by dividing the practice list size by an NHS agreed 'average list size'. In 2018/19 the agreed average list size is 8096. Each year this agreed list size is increased.
- Example practice;
With 12650 patients the CPI would be 12650 divided by 8096 = 1.56. This CPI of 1.56 is then used in the practice final achieved pounds calculation
- Example practice;
For achieved QOF points a total of £100,000.00 x CPI 1.56 = £156,000.00
The greater your practice list size the greater your CPI will be which will have a positive effect on your QOF payment.
By increasing your QOF register sizes (prevalence) you can make a big difference to the value of your achieved QOF points. The value of the QOF point for 2018/19 is £179.62.
You can view your practice prevalence by going to 'Reporting > QOF Indicators > National Prevalence'
As you can see in this example above Dementia is much higher than the national average 222.7% which means the QOF point value would be around £400. Where the prevalence is below the national average such as Cardiovascular Disease
Primary Prevention which in this example is only 10.9% of the national average the value of the QOF point drops to around £19.50
So this screen is a good visual aid to check that your practice is on track to match if not better the national average prevalence.
2. QOF Alerts
To ensure that all staff have access to the correct and most up to date QOF templates it is essential that the QOF alerts are configured correctly. This is detailed in the setup article for when you first go live with Ardens. If not then there is a risk that staff will use the wrong templates and potentially the wrong codes which may affect QOF achievements.
Many practices find it useful to set the QOF alerts to 'End of Year'. This can be configured by going to 'Reporting > QOF Indicators ' and at the top of the screen click on 'QOF Dates'. The QOF alert dates will not be changed until the next time the reports have run overnight.
NB: Always ensure that old templates are deactivated, please see housekeeping support article to find out more about this.
3. Automatic Episodicity
This can be very helpful for QOF registers that are specifically looking for a new episode of a diagnosis such as cancer. Go to 'Setup > Users & Policy > Organisational Preferences > Clinical Coding'. From here you can add a diagnosis cluster or remove one.
The next time a diagnosis is recorded the clinician will be prompted to record it as a new episode.
NB: This screen should be reviewed as new versions of QOF are released. In the example above you can see one of the clusters than has been used has been retired.
4. Indicator Values
This is another useful screen that can be used to target work effort with the most QOF value. Columns can be sorted by clicking on the column header to order by highest value to lowest
Go to ‘Reporting > QOF Indicators > Indicator Values’
5. Target Patients
This screen can be useful towards the end of the QOF year again to target work effort to most QOF value.
Go to ‘Reporting > QOF Indicators > Target Patients’
6. Validating Registers and Increasing Prevalence
Under the terms of the GMS contract 2018/19, It is a contractual requirement to validate your QOF registers
“While it is noted that these may not be completely accurate, it is the responsibility of the contractor to demonstrate that it has systems in place to maintain a high-quality register and this may be verified by commissioners by comparing the reported prevalence with the expected prevalence and ask contractors to explain any reasons for variations”
The cut off date for prevalence data extractions or 'National Prevalence Day' used to be 14th February each year but is now in line with the QOF year and always on 31st March.
To help practices we have a set of QOF reports which can be found at 'Reporting > Clinical Reporting > Ardens > Missed Income > QOF’. A separate 'QOF Health Check' support article explains how to use these reports
Caution: Some registers can create an additional amount of workload for the practice in a tight time frame and could have a negative impact on other indicators, such as;
- Depression diagnosis – review 10-56 days later
- Cancer diagnosis – review within 6 months
- Dementia diagnosis – bloods 12 months before to 6 months after
If patients are not already on the register you may have already completed some of the requirements but because no diagnosis has been recorded not getting paid. There is usually a greater income benefit to increasing prevalence.
7. Problem Registers
There are two specific QOF registers that cause issues for practices, they are Cancer and Cardiovascular Disease Primary Prevention.
Potential loss of QOF income. Any new cancer diagnosis codes needs to be recorded as a New episode to ensure that the patient is on the cancer register.
Potential loss of QOF income. Any new hypertension diagnosis codes needs to be recorded as a New episode to ensure that the patient is on the cancer register.
Reports are available to help identify these diagnosed missing patients to review and potentially amend the episodicity (Cancer and Hypertension diagnosis) and record a QRISK2 score if appropriate (hypertension diagnosis)
8. Individualised QOF Income Reports
Request an individualised QOF income report and we are confident that we can identify areas where you can increase your potential QOF income by £3,000 or more
Find out more here