Quality and Outcomes Framework Assessor Training

QOF Basics

Domains, Evidence and Local Frameworks

Plan!

• Overview of QOF

• Domains

• QMAS

• Sources of Evidence

• Developing Local Frameworks

QOF Improvement Cycle

Review

QOF IMPROVEMENT

CYCLE

Planning

ActionLearning

QOF 2004/5

Feb 2004 Agree

aspiration

Apr 2004Pay QPrep and QuIP

DES

April 2004QOF goes

live

April 2004DH guidance

on review visits

End April 2004

Monthly aspiration payments

August 2004QMAS system

goes live & provides monthly feedback

Oct 04 – Jan 05

Annual review visits take

place

April 2005 Achievement

payments made

QOF Activities for 2004/5

Quality and Outcomes Framework (QOF)

• New primary care tool and major source of new funding

• Four domains - Clinical, organisational, patient experience and additional services

• Focused on the improvement of quality and outcomes of patient health

• Evidence based indicators

Structure of the QOF

1050 points available• £75 per point 04/05• £120 per point 05/06

4 Domains:– Clinical – Organisational– Patient Experience– Additional Services

QOF Domains

• Clinical domain– 10 disease areas– 550 points

• Organisational domain– 5 areas– 184 points

• Additional Services domain– 4 areas– 36 points

• Patient Experience domain– 2 areas– 100 points

• Holistic Care, Quality Practice and Access Bonus Points– Total 180 points

Clinical Domain

• The 76 Clinical Indicators split into 3 types– Structure – e.g is a

disease register in place– Process – e.g is the

indicator being measured and an appropriate intervention being made – for what % of relevant population

– Outcome – how well is the condition being controlled – across what % of the population

Payments

• New money in primary care• Aspiration payments (monthly from April 2004)• Achievement (lump sum in April 2005)• £s per point

– 2004/05 = £75– 2005/06 = £120

• List size• Prevalence• Pre-payment verification

IM&T and Data Flows

• Practices require an RFA99 compliant clinical system

• Reports from QMAS – monthly to PCTs, at least

monthly to practices

• QMAS reports will, in time, have comparative data on achievement and trends – local and national

• Impact of Freedom of Information Act– January 2005

QMAS

Quality Management Analysis System

Principles• Not patient based data

– Pre-populated with IAU data

• Single national system ensures:– High trust and transparent– Changes to QOF scheme can be supported– Payments calculated on a consistent basis for all

practices– Single feed to NHAIS payment system– Practice and PCT access to same information

based on access rights– Reduced dependence on individual suppliers– Value for money

Other achievement data – web interface QMAS Central

Server

PCTPayment

Agency

NHAIS

Confirm Achievement

Automated

“Manual”

Achievement data from clinical system

GP Practice

BACS Payment

PCT

GP Practice

QMAS Central Server

Evidence

• Information the practice must submit in advance of the visit together with guidance for PCO assessors

• Grades of Evidence– Indicator– Written Evidence– Assessment Visit– Assessors’ Guidance

Local Frameworks

• Who can develop local QOFs?– PMS– APMS– PCTMS

• Local variations must have comparable frameworks

• Must be points based and add up to 1050

Continued…

• Local QOF must be agreed by Director of Public Health or another suitable person

• Equally, should be similar reward for similar effort between national QOF and locally agreed variants

• All practices participating in a QOF should have a QOF assessment visit

Summary

• QOF will drive local quality improvements in primary care

• Lay assessors will bring objectivity and patient focus to visits

• Local ‘intelligence’ important to know (K2)

• Part of a world first!