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Quality and Outcomes Framework for UK GPs

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Parent and child at the GP's surgery.

QOF stands for Quality and Outcomes Framework. In the UK, it is a voluntary set of targets that medical General Practitioners (GPs) can aim for.

The targets are set by the National Health Service (NHS) and each target has points attached to it. As Bruce Forsyth would say on Play Your Cards Right, 'What do points make?' The audience shouts back, 'Prizes!'

QOF points are worth about £120 each to a GP practice with around 5,700 patients. As there are 1,000 points1 available, this can be seen as a way of making a pretty penny for the practice.

The targets cover the main areas of a GP's practice: Clinical, Organisational and Additional Services and Patient Experience. Each of these headings is split into sub-headings or 'indicators' so that specific targets can be volunteered for and then tested. This testing is carried out by a group of assessors that generally include a local GP from a different practice, a member of the local Primary Care Trust staff, a Pharmaceutical Advisor and an ordinary person.

Before the inspectors visit, the GP's practice will prepare its own evidence on how it has met the targets it has volunteered to achieve and will say how many points it is aiming for. By the time of the visit, the inspectors have this information and will have the opportunity to examine their own specific areas of expertise.

Clinical Domain

This covers items such as coronary heart disease (CHD), stroke, cancer, diabetes, mental health, hyperthyroidism, chronic obstructive pulmonary disease (COPD) and epilepsy. The GP assessor will look at anonymous patient records to ensure that the levels of work being claimed in the clinical domain are reflected in the work being done with patients. They also look at statistics available from one of the computer systems used by GPs to see that their levels of patient prevalence would fit in with the prevalence of the surrounding areas. In other words, if a doctor said 'We hardly have anyone with asthma round here,' he or she may be saying it because they didn't want to be penalised for not doing enough work with asthmatics and so lose points. However, if it is a true statement, the GP would not be penalised.

Generally speaking, this voluntary scheme encourages doctors to carry out the good practice that many of us would have thought doctors would do anyway.

Organisational Domain

This involves categories such as records and information about patients, information for patients, education and training, practice management and medicines management. The non-clinical assessors will look at how the practice manages much of its day-to-day working and its interface with the patients. Are the patients' records kept up to date? Are patients given information about specific health schemes being promoted by the NHS, such as smoking cessation?

Additional Services Domain

Some services are now voluntary for GPs to opt into. These include clinical screening, child health surveillance, maternity services and contraceptive services. If a doctor is claiming to offer these, then the assessors need to see that patients are being offered to a reasonable standard and may request proof of each item claimed and the quality of that service. Often this will involve the practice having a written policy which needs to be understood by all relevant staff and to have evidence that that policy is adhered to.

Patient Experience

To get paid for these points, a GP's practice has to conduct an annual patient survey. The questions need to follow a preset formula fairly closely. The practice then has to meet to discuss the results of the survey and to set itself an action plan to cover the next two years, taking into account the points raised by patients.

After the Visit

The assessors report their findings to the practice and give them a pat on the back for what has been done well and encourage them to try harder on the things they are slipping back on. They may also warn the practice that it may have funds withdrawn if it is clear that they have previously claimed money for points that they have no evidence of achieving.

This informal report is turned into a formal paper report and a copy is sent to the practice for comments before it is sent off to the NHS coordinators. Over the next year, auditors come out and check a sample of GP practices to ensure that the general standard of assessment is accurate. They will also penalise GPs who are not honest about their points attainment.

The overall aim of this is to improve health services locally. If your GP doesn't seem to be coming up to scratch in any of these areas, you might want to advise your Primary Care Trust about it.

1This is the 2006 figure, which is down from 1,050 in 2005.

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