The quality and outcomes framework (QOF) of the nGMS contract is divided into four domains, the largest of which is the clinical one.

The clinical domain covers ten disease areas:CHD & LVD; hypothyroidism; diabetes; cancer; hypertension; asthma; COPD;mental health;stroke & TIA;and epilepsy.Each disease area has a series of evidence-based indicators. Points are attached to each indicator and the number achieved by the practice determines the sum paid.There are 1050 points available through the QOF, 550 of these from the clinical indicators. In 2005/2006 each point is worth £124.60.

The summary tables below set out the respective clinical indicators for each of the ten disease areas, together with the points available and payment stages.

CHD  
No. Indicator Points Payment stages
CHD 1 The practice can produce a register of patients with coronary heart disease 6  
CHD 2 The percentage of patients with newly diagnosed angina (diagnosed after 1 April 2003) who are referred for exercise testing and/or specialist assessment 7 25-90%
CHD 3 The percentage of patients with coronary heart disease whose notes record smoking status in the past 15 months, except those who have never smoked where smoking status need be recorded only once since diagnosis 7 25-90%
CHD 4 The percentage of patients with coronary heart disease who smoke, whose notes contain a record that smoking cessation advice or referral to a specialist service, where available, has been offered within the past 15 months 4 25-90%
CHD 5 The percentage of patients with coronary heart disease whose notes have a record of blood pressure in the previous 15 months 7 25-90%
CHD 6 The percentage of patients with coronary heart disease in whom the last blood pressure reading (measured in the previous 15 months) is 150/90 mmHg or less 19 25-70%
CHD 7 The percentage of patients with coronary heart disease whose notes have a record of total cholesterol in the previous 15 months 7 25-90%
CHD 8 The percentage of patients with coronary heart disease whose last measured total cholesterol (measured in the previous 15 months) is 5 mmol/l or less 16 25-60%
CHD 9 The percentage of patients with coronary heart disease with a record in the past 15 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken (unless a contraindication or side-effects are recorded) 7 25-90%
CHD 10 The percentage of patients with coronary heart disease who are currently treated with a betablocker (unless a contraindication or side-effects are recorded) 7 25-50%
CHD 11 The percentage of patients with a history of myocardial infarction (diagnosed after 1 April 2003) who are currently treated with an ACE inhibitor or angiotensin II antagonist 7 25-70%
CHD 12 The percentage of patients with coronary heart disease who have a record of influenza immunisation in the preceding 1 September to 31 March 7 25-85%
Total points 101  
LVD  
LVD 1 The practice can produce a register of patients with CHD and left ventricular dysfunction 4  
LVD 2 The percentage of patients with a diagnosis of CHD and left ventricular dysfunction (diagnosed after 1 April 2003) which has been confirmed by an echocardiogram 6 25-90%
LVD 3 The percentage of patients with a diagnosis of CHD and left ventricular dysfunction who are currently treated with ACE inhibitors (or angiotensin II antagonists) 10 25-70%
Total points 20  

Hypothyroidism  
No. Indicator Points Payment stages
Thyroid 1 The practice can produce a register of patients with hypothyroidism 2  
Thyroid 2 The percentage of patients with hypothyroidism with thyroid function tests recorded in the previous 15 months 6 25-90%
Total points 8  

Diabetes mellitus  
No. Indicator Points Payment stages
DM 1 The practice can produce a register of all patients with diabetes mellitus 6  
DM 2 The percentage of patients with diabetes whose notes record BMI in the previous 15 months 3 25-90%
DM 3 The percentage of patients with diabetes in whom there is a record of smoking status in the previous 15 months, except those who have never smoked where smoking status need be recorded only once since diagnosis 3 25-90%
DM 4 The percentage of patients with diabetes who smoke and whose notes contain a record that smoking cessation advice or referral to a specialist service, where available, has been offered in the past 15 months 5 25-90%
DM 5 The percentage of patients with diabetes who have a record of HbA1c or equivalent in the previous 15 months 3 25-90%
DM 6 The percentage of patients with diabetes in whom the last HbA1c is 7.4 or less (or equivalent test/reference range depending on local laboratory) in the past 15 months 16 25-50%
DM 7 The percentage of patients with diabetes in whom the last HbA1c is 10 or less (or equivalent test/reference range depending on local laboratory) in the past 15 months 11 25-85%
DM 8 The percentage of patients with diabetes with a record of retinal screening in the previous 15 months 5 25-90%
DM 9 The percentage of patients with diabetes with a record of the presence or absence of peripheral pulses in the previous 15 months 3 25-90%
DM 10 The percentage of patients with diabetes with a record of neuropathy testing in the previous 15 months 3 25-90%
DM 11 The percentage of patients with diabetes who have a record of the blood pressure in the previous 15 months 3 25-90%
DM 12 The percentage of patients with diabetes in whom the last blood pressure is 145/85 mmHg or less 17 25-55%
DM 13 The percentage of patients with diabetes who have a record of micro-albuminuria testing in the previous 15 months (exception reporting for patients with proteinuria) 3 25-90%
DM 14 The percentage of patients with diabetes who have a record of serum creatinine testing in the previous 15 months 3 25-90%
DM 15 The percentage of patients with diabetes with a diagnosis of proteinuria or micro-albuminuria who are treated with ACE inhibitors (or angiotensin II antagonists) 3 25-70%
DM 16 The percentage of patients with diabetes who have a record of total cholesterol in the previous 15 months 3 25-90%
DM 17 The percentage of patients with diabetes whose last measured total cholesterol within the previous 15 months is 5 mmol/l or less 6 25-60%
DM 18 The percentage of patients with diabetes who have had influenza immunisation in the preceding 1 September to 31 March 3 25-90%
Total points 99  

Cancer  
No. Indicator Points Payment stages
Cancer 1 The practice can produce a register of all cancer patients diagnosed after 1 April 2003 6  
Cancer 2 The percentage of patients with cancer diagnosed from 1 April 2003 with a review by the practice recorded within 6 months of confirmed diagnosis.This should include an assessment of support needs, if any, and a review of coordination arrangements with secondary care 6 25-90%
Total points 12  

Hypertension  
No. Indicator Points Payment stages
BP 1 The practice can produce a register of patients with established hypertension 9  
BP 2 The percentage of patients with hypertension whose notes record smoking status at least once since diagnosis 10 25-90%
BP 3 The percentage of patients with hypertension who smoke, whose notes contain a record that smoking cessation advice or referral to a specialist service, if available, has been offered at least once 10 25-90%
BP 4 The percentage of patients with hypertension in whom there is a record of the blood pressure in the past 9 months 20 25-90%
BP 5 The percentage of patients with hypertension in whom the last blood pressure (measured in the past 9 months) is 150/90 mmHg or less 56 25-70%
Total points 105  

Asthma  
No. Indicator Points Payment stages
Asthma 1 The practice can produce a register of patients with asthma, excluding patients with asthma who have been prescribed no asthma-related drugs in the past 12 months 7  
Asthma 2 The percentage of patients aged 8 and over diagnosed as having asthma from 1 April 2003 where the diagnosis has been confirmed by spirometry or peak flow measurement 15 25-70%
Asthma 3 The percentage of patients with asthma between the ages of 14 and 19 in whom there is a record of smoking status in the previous 15 months 6 25-70%
Asthma 4 The percentage of patients aged 20 and over with asthma whose notes record smoking status in the past 15 months, except those who have never smoked where smoking status need be recorded only once since diagnosis 6 25-70%
Asthma 5 The percentage of patients with asthma who smoke, and whose notes contain a record that smoking cessation advice or referral to a specialist service, if available, has been offered within the past 15 months 6 25-70%
Asthma 6 The percentage of patients with asthma who have had an asthma review within the past 15 months 20 25-70%
Asthma 7 The percentage of patients aged 16 years and over with asthma who have had influenza immunisation in the preceding 1 September to 31 March 12 25-70%
Total points 72  

COPD  
No. Indicator Points Payment stages
COPD 1 The practice can produce a register of patients with COPD 5  
COPD 2 The percentage of patients in whom diagnosis has been confirmed by spirometry including reversibility testing for newly diagnosed patients with effect from 1 April 2003 5 25-90%
COPD 3 The percentage of all patients with COPD in whom diagnosis has been confirmed by spirometry including reversibility testing 5 25-90%
COPD 4 The percentage of patients with COPD in whom there is a record of smoking status in the previous 15 months, except those who have never smoked where smoking status need be recorded only once since diagnosis 6 25-90%
COPD 5 The percentage of patients with COPD who smoke, whose notes contain a record that smoking cessation advice or referral to a specialist service, if available, has been offered in the past 15 months 6 25-90%
COPD 6 The percentage of patients with COPD with a record of FEV1 in the previous 27 months 6 25-70%
COPD 7 The percentage of patients with COPD receiving inhaled treatment in whom there is a record that inhaler technique has been checked in the preceding 2 years 6 25-90%
COPD 8 The percentage of patients with COPD who have had influenza immunisation in the preceding 1 September to 31 March 6 25-85%
Total points 45  

Mental health  
No. Indicator Points Payment stages
MH 1 The practice can produce a register of patients with severe long-term mental health problems who require and have agreed to regular follow-up 7  
MH 2 The percentage of patients with severe long-term mental health problems with a review recorded in the preceding 15 months.This review includes a check on the accuracy of prescribed medication, a review of physical health and a review of coordination arrangements with secondary care 23 25-90%
MH 3 The percentage of patients on lithium therapy with a record of lithium levels checked within the previous 6 months 3 25-90%
MH 4 The percentage of patients on lithium therapy with a record of serum creatinine and TSH in the preceding 15 months 3 25-90%
MH 5 The percentage of patients on lithium therapy with a record of lithium levels in the therapeutic range within the previous 6 months 5 25-70%
Total points 41  

Stroke and TIA  
No. Indicator Points Payment stages
Stroke 1 The practice can produce a register of patients with stroke or transient ischaemic attack (TIA) 4  
Stroke 2 The percentage of new patients with presumptive stroke (presenting after 1 April 2003) who have been referred for confirmation of the diagnosis by CT or MRI scan 2 25-80%
Stroke 3 The percentage of patients with TIA or stroke who have a record of smoking status in the past 15 months, except those who have never smoked where smoking status need be recorded only once since diagnosis 3 25-90%
Stroke 4 The percentage of patients with a history of TIA or stroke who smoke and whose notes contain a record that smoking cessation advice or referral to a specialist service, if available, has been offered in the past 15 months 2 25-70%
Stroke 5 The percentage of patients with TIA or stroke who have a record of blood pressure in the notes in the preceding 15 months 2 25-90%
Stroke 6 The percentage of patients with a history of TIA or stroke in whom the last blood pressure reading (measured in past 15 months) is 150/90 mmHg or less 5 25-70%
Stroke 7 The percentage of patients with TIA or stroke who have a record of total cholesterol in the past 15 months 2 25-90%
Stroke 8 The percentage of patients with TIA or stroke whose last measured total cholesterol (measured in the past 15 months) is 5 mmol/l or less 5 25-60%
Stroke 9 The percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken (unless a contraindication or side-effects are recorded) 4 25-90%
Stroke 10 The percentage of patients with TIA or stroke who have had influenza immunisation in the preceding 1 September to 31 March 2 25-85%
Total points 31  

Epilepsy  
No. Indicator Points Payment stages
Epilepsy 1 The practice can produce a register of patients receiving drug treatment for epilepsy 2  
Epilepsy 2 The percentage of patients aged 16 and over on drug treatment for epilepsy who have a record of seizure frequency in the previous 15 months 4 25-90%
Epilepsy 3 The percentage of patients aged 16 and over on drug treatment for epilepsy who have a record of medication review in the previous 15 months 4 25-90%
Epilepsy 4 The percentage of patients aged 16 and over on drug treatment for epilepsy who have been seizure free for the past 12 months recorded in the past 15 months 6 25-70%
Total points 16  

Guidelines in Practice, November 2005, Volume 8(11)
© 2005 MGP Ltd
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