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 2004 Pay QPrep and QuIP DES April 2004 QOF goes live April 2004 DH guidance on review visits End April 2004 Monthly aspiration payments August 2004 QMAS 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 PCT Payment 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!