The new quality and outcomes framework (QOF2) of the revised GMS contract came into effect in April 2006.

The updated clinical domain covers the following areas: CHD; heart failure; diabetes; asthma; hypertension; COPD; chronic kidney disease; obesity; mental health; stroke & TIA; palliative care; dementia; depression; hypothyroidism; cancer; atrial fibrillation; smoking; epilepsy and learning disabilities. 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. In 2006/2007 each point is worth £124.60.

CHD  
No. Indicator Points Payment stages
CHD 1 The practice can produce a register of patients with coronary heart disease 4  
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 40-90%
CHD 5 The percentage of patients with coronary heart disease whose notes have a record of blood pressure in the previous 15 months 7 40-90%
CHD 6 The percentage of patients with coronary heart disease in whom the last blood pressure reading (measured in the past 15 months) is 150/90 mmHg or less 19 40-70%
CHD 7 The percentage of patients with coronary heart disease whose notes have a record of total cholesterol in the previous 15 months 7 40-90%
CHD 8 The percentage of patients with coronary heart disease whose last measured total cholesterol (measured in the past 15 months) is 5 mmol/l or less 17 40-70%
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 40-90%
CHD 10 The percentage of patients with coronary heart disease who are currently treated with a beta blocker (unless a contraindication or side-effects are recorded) 7 40-60%
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 40-80%
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 40-90%
Total points 89  

Heart failure  
No. Indicator Points Payment stages
HF 1 The practice can produce a register of patients with heart failure 4  
HF 2 The percentage of patients with a diagnosis of heart failure (diagnosed after 1 April 2006) which has been confirmed by an echocardiogram or by specialist assessment 6 40-90%
HF 3 The percentage of patients with a current diagnosis of heart failure due to LVD who are currently treated with an ACE inhibitor or angiotensin receptor blocker, who can tolerate therapy and for whom there is no contraindication 10 40-80%
Total points 20  

Diabetes mellitus  
No. Indicator Points Payment stages
DM 19 The practice can produce a register of all patients aged 17 years and over with diabetes mellitus, which specifies whether the patient has type 1 or type 2 diabetes 6  
DM 2 The percentage of patients with diabetes whose notes record BMI in the previous 15 months 3 40-90%
DM 5 The percentage of diabetic patients with who have a record of HbA1c or equivalent in the previous 15 months 3 40-90%
DM 20 The percentage of patients with diabetes in whom the last HbA1c is 7.5 or less (or equivalent test/reference range depending on local laboratory) in the previous 15 months 17 40-50%
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 previous 15 months 11 40-90%
DM 21 The percentage of patients with diabetes with a record of retinal screening in the previous 15 months 5 40-90%
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 40-90%
DM 10 The percentage of patients with diabetes with a record of neuropathy testing in the previous 15 months 3 40-90%
DM 11 The percentage of patients with diabetes who have a record of the blood pressure in the previous 15 months 3 40-90%
DM 12 The percentage of patients with diabetes in whom the last blood pressure is 145/85 mmHg or less 18 40-60%
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 40-90%
DM 22 The percentage of patients with diabetes who have a record of estimated glomerular filtration rate (eGFR) or serum creatinine testing in the previous 15 months 3 40-90%
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 40-80%
DM 16 The percentage of patients with diabetes who have a record of total cholesterol in the previous 15 months 3 40-90%
DM 17 The percentage of patients with diabetes whose last measured total cholesterol within previous 15 months is 5 mmol/l or less 6 40-70%
DM 18 The percentage of patients with diabetes who have had influenza immunisation in the preceding 1 September to 31 March 3 40-85%
Total points 93  

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 previous 12 months 4  
ASTHMA 8 The percentage of patients aged eight and over diagnosed as having asthma from 1 April 2006 with measures of variability or reversibility 15 40-80%
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 40-80%
ASTHMA 6 The percentage of patients with asthma who have had an asthma review in the previous 15 months 20 40-70%
Total points 45  

Hypertension  
No. Indicator Points Payment stages
BP 1 The practice can produce a register of patients with established hypertension 6  
BP 4 The percentage of patients with hypertension in whom there is a record of the blood pressure in the previous 9 months 20 40-90%
BP 5 The percentage of patients with hypertension in whom the last blood pressure (measured in the previous 9 months) is 150/90 mmHg or less 57 40-70%
Total points 83  

COPD  
No. Indicator Points Payment stages
COPD 1 The practice can produce a register of patients with COPD 3  
COPD 9 The percentage of all patients with COPD in whom diagnosis has been confirmed by spirometry including reversibility testing 10 40-80%
COPD 10 The percentage of patients with COPD with a record of FEV1 in the previous 15 months 7 40-70%
COPD 11 The percentage of patients with COPD receiving inhaled treatment in whom there is a record that inhaler technique has been checked in the previous 15 months 7 40-90%
COPD 8 The percentage of patients with COPD who have had influenza immunisation in the preceding 1 September to 31 March 6 40-85%
Total points 33  

Chronic kidney disease  
No. Indicator Points Payment stages
CKD 1 The practice can produce a register of patients aged 18 years and over with CKD (US National Kidney Foundation: Stage 3 to 5 CKD) 6  
CKD 2 The percentage of patients on the CKD register whose notes have a record of blood pressure in the previous 15 months 6 40-90%
CKD 3 The percentage of patients on the CKD register in whom the last blood pressure reading, measured in the previous 15 months, is 140/85 mmHg or less 11 40-70%
CKD 4 The percentage of patients on the CKD register with hypertension who are treated with an ACE inhibitor or angiotensin II receptor blocker (unless a contraindication or side-effects are recorded) 4 40-80%
Total points 27  

Obesity  
No. Indicator Points Payment stages
OB 1 The practice can produce a register of patients aged 16 and over with a BMI greater than or equal to 30 in the previous 15 months 8  
Total points 8  

Mental Health  
No. Indicator Points Payment stages
MH 8 The practice can produce a register of people with schizophrenia, bipolar disorder and other psychoses 4  
MH 9 The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses with a review recorded in the preceding 15 months. In the review there should be evidence that the patient has been offered routine health promotion and prevention advice appropriate to their age, gender and health status 23 40-90%
MH 4 The percentage of patients on lithium therapy with a record of serum creatinine and TSH in the preceding 15 months 1 40-90%
MH 5 The percentage of patients on lithium therapy with a record of lithium levels in the therapeutic range within the previous 6 months 2 40-90%
MH 6 The percentage of patients on the register who have a comprehensive care plan documented in the records agreed between individuals, their family and/or carers as appropriate 6 25-50%
MH 7 The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who do not attend the practice for their annual review who are identified and followed up by the practice team within 14 days of non-attendance 3 40-90%
Total points 39  

Stroke and TIA  
No. Indicator Points Payment stages
STROKE 1 The practice can produce a register of patients with stroke or TIA 2  
STROKE 11 The percentage of new patients with a stroke who have been referred for further investigation 2 40-80%
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 40-90%
STROKE 6 The percentage of patients with a history of TIA or stroke in whom the last blood pressure reading (measured in the previous 15 months) is 150/90 mmHg or less 5 40-70%
STROKE 7 The percentage of patients with TIA or stroke who have a record of total cholesterol in the past 15 months 2 40-90%
STROKE 8 The percentage of patients with TIA or stroke whose last measured total cholesterol (measured in the previous 15 months) is 5 mmol/l or less 5 40-60%
STROKE 12 The percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record that an anti-platelet agent (aspirin, clopidogrel, dipyridamole or a combination), or an anti-coagulant is being taken (unless a contraindication or side-effects are recorded) 4 40-90%
STROKE 10 The percentage of patients with TIA or stroke who have had influenza immunisation in the preceding 1 September to 31 March 2 40-85%
Total points 24  

Palliative care  
No. Indicator Points Payment stages
PC 1 The practice has a complete register available of all patients in need of palliative care/support 3  
PC 2 The practice has regular (at least 3-monthly) multidisciplinary case review meetings where all patients on the palliative care register are discussed 3  
Total points 6  

Dementia  
No. Indicator Points Payment stages
DEM 1 The practice can produce a register of patients diagnosed with dementia 5  
DEM 2 The percentage of patients diagnosed with dementia whose care has been reviewed in the previous 15 months 15 25-60%
Total points 20  

Depression  
No. Indicator Points Payment stages
DEP 1 The percentage of patients on the diabetes register and/or the CHD register for whom case finding for depression has been undertaken on one occasion during the previous 15 months using two standard screening questions 8 40-90%
DEP 2 In those patients with a new diagnosis of depression, recorded between the preceeding 1 April to 31 March, the percentage of patients who have had an assessment of severity at the outset of treatment using an assessment tool validated for use in primary care 25 40-90%
Total points 33  

Hyperthyroidism  
No. Indicator Points Payment stages
THYROID 1 The practice can produce a register of patients with hypothyroidism 1  
THYROID 2 The percentage of patients with hypothyroidism with thyroid function tests recorded in the previous 15 months 6 40-90%
Total points 7  

Cancer  
No. Indicator Points Payment stages
CANCER 1 The practice can produce a register of all cancer patients defined as a register of patients with a diagnosis of cancer excluding non-melanotic skin cancers from 1 April 2003 5  
CANCER 3 The percentage of patients with cancer, diagnosed within the past 18 months who have a patient review recorded as occurring within 6 months of the practice receiving confirmation of the diagnosis 6 40-90%
Total points 11  

 

Atrial fibrillation  
No. Indicator Points Payment stages
AF 1 The practice can produce a register of patients with atrial fibrillation 5  
AF 2 The percentage of patients with atrial fibrillation diagnosed after 1 April 2006 with ECG or specialist confirmed diagnosis 10 40-90%
AF 3 The percentage of patients with atrial fibrillation who are currently treated with anti-coagulation drug therapy or an anti-platelet therapy 15 40-90%
Total points 30  

Smoking  
No. Indicator Points Payment stages
SMOKING 1 The percentage of patients with any or any combination of the following conditions: coronary heart disease, stroke or TIA, hypertension, diabetes, COPD or asthma whose notes record smoking status in the previous 15 months. Except those who have never smoked where smoking status need only be recorded once since diagnosis 33 40-90%
SMOKING 2 The percentage of patients with any or any combination of the following conditions: coronary heart disease, stroke or TIA, hypertension, diabetes, COPD or asthma who smoke whose notes contain a record that smoking cessation advice or referral to a specialist service, where available, has been offered within the previous 15 months 35 40-90%
Total points 68  

Epilepsy  
No. Indicator Points Payment stages
EPILEPSY 5 The practice can produce a register of patients aged 18 and over receiving drug treatment for epilepsy 1  
EPILEPSY 6 The percentage of patients aged 18 and over on drug treatment for epilepsy who have a record of seizure frequency in the previous 15 months 4 40-90%
EPILEPSY 7 The percentage of patients aged 18 and over on drug treatment for epilepsy who have a record of medication review involving the patient and/or carer in the previous 15 months 4 40-90%
EPILEPSY 8 The percentage of patients aged 18 and over on drug treatment for epilepsy who have been seizure free for the past 12 months recorded in the previous 15 months 6 40-70%
Total points 15  

Learning disabilities  
No. Indicator Points Payment stages
  The practice can produce a register of patients with learning disabilities 4  
Total points 4  

Guidelines in Practice, March 2006, Volume 9(3)
© 2005 MGP Ltd
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