About the Quality and Outcomes Framework (QOF)
What is the QOF?
Introduced in 2004 as part of the General Medical Services Contract, the QOF is a voluntary incentive scheme for GP practices in the UK, rewarding them for how well they care for patients.
The QOF contains groups of indicators, against which practices score points according to their level of achievement. NICE's role focuses on the clinical and public health domains in the QOF, which include a number of areas such as coronary heart disease and hypertension.
The QOF gives an indication of the overall achievement of a practice through a points system. Practices aim to deliver high quality care across a range of areas, for which they score points. Put simply, the higher the score, the higher the financial reward for the practice. The final payment is adjusted to take account of the practice list size and prevalence. The results are published annually.
Why is NICE involved?
A public consultation document was published by the Department of Health (DH) in late October 2008 to involve patients, carers, NHS professionals and commissioners in how a more independent and transparent process for reviewing and developing indicators should work. The consultation set out proposals on how this process should work in England, and the DH held discussions with the devolved administrations about how to ensure a collaborative approach across the UK. All four UK countries have agreed to take part in the NICE-led process.
The NICE QOF Indicator Programme
NICE's role is to manage the process to develop clinical and public health indicators for the QOF. This involves prioritising areas for new indicator development, developing and selecting indicators, advising on thresholds and ensuring consultation with individuals and stakeholder groups. We also recommend whether existing indicators should continue to be part of the QOF.
For details of the indicators in the NICE QOF Indicator menu please view the NICE Menu of Indicators. This also contains full details of the decision process for the recommendation of potential indicators.
For details of the recommendations relating to existing indicators please view the Advisory Committee outputs.
The NICE QOF Advisory Committee provides independent advice to NHS England, who then used this to inform negotiations between NHS Employers and the General Practitioners Committee (GPC) of the British Medical Association (BMA). NICE and the QOF Advisory Committee have no involvement in the negotiations between NHS Employers and the GPC.
The Indicators Process guide describes the process NICE uses to develop indicators from NICE quality standards, NICE guidance and NICE accredited sources. The process guide was consulted on from August to November 2013 and all stakeholder comments were considered accordingly.
For details of all current QOF indicators and guidance please view the NHS Employers website.
For details of practice results against QOF indicators please view the Health and Social Care Information Centre´s website.
What NICE adds
One of NICE's acknowledged key strengths is our robust process for assessing what is both clinically and cost effective for use in the NHS.
It is important that the process for assessing evidence to review or develop QOF indicators is separate from the process for negotiating and approving changes to the QOF. NICE acts independently when assessing evidence and developing indicators for the QOF.
By overseeing the process of developing and reviewing performance indicators for the QOF, we ensure that the principles behind our recommendations are reflected in the indicators. This can encourage the implementation of guidance and lead to improvements in care across the UK.
A number of partner organisations contribute to the development of clinical and public health indicators for the QOF. A brief summary of the role played by these organisations is given below.
The National Collaborating Centre for Indicator Development (NCCID)
The NCCID is contracted by NICE to support specific aspects of the indicator development process, such as piloting potential indicators and carrying out cost-effectiveness analysis.
The HSCIC works with NICE to develop and test potential new indicators, develop technical specifications and business rules for new indicators, and ensure indicators are assured by the HSCIC indicator assurance service and held within the National Library of Assured Indicators hosted by the HSCIC.
NICE works closely with many professional, NHS and public sector organisations, including those representing patients and carers. The following list is not exhaustive, but identifies other key partners in the QOF Indicator Programme:
- British Medical Association
- Department of Health
- General Practitioners Committee
- Health and Social Care Information Centre
- NHS Employers
- NHS England
- NHS Quality Improvement Scotland and the Scottish Intercollegiate Guidelines Network (SIGN)
- Northern Ireland Department of Health, Social Services and Public Safety
- Public Health England
- Royal College of General Practitioners (RCGP)
- Scottish Government Health Directorates
- Welsh Assembly Government
This page was last updated: 27 March 2014