Quality and Outcomes Framework guidance for 2024/25

Quality and Outcomes Framework guidance for 2024/25

The NHS England document this support article relates to was published on 28th March 2024

What do I need to know?

Clarification on where there are no patients within a QOF cohort

It was clarified in section 1.3 "Identifying the target population or disease register" subsection v. that "Where a practice does not have registered patients within a particular cohort, no specific care interventions are needed and so QOF points will not be earnable".  This is likely to affect those areas of QOF where there are very low numbers of patients within the eligible cohort such as new asthma diagnoses.

Confirmation of income protection

This document confirmed what was already known from the Amanda Doyle letter on the 28th February that a number of disease registers were to be income protected for the contract year 2024/25.  See the PCIT support article for more information on how you may wish to approach this.

Changes to CHOL003 and CHOL004

CHOL003

See our full CHOL003 support article for full details of this indicator

Indicator ID

Description

CHOL003

Percentage of patients on the QOF Coronary Heart Disease (CHD), Peripheral Arterial Disease (PAD), Stroke/Transient Ischaemic Attack (TIA) or Chronic Kidney Disease (CKD) Register who are currently prescribed a statin, or where a statin is declined or clinically unsuitable, another lipid-lowering therapy.


CHOL003 has been created to replace CHOL001.  There are some minor but important changes to this indicator:
  1. Patients who have had a haemorrhagic stroke are now excluded from this indicator
  2. Codes for inviting patients have been added to this indicator

CHOL004

See our full CHOL004 support article for full details of this indicator

Indicator ID

Description

CHOL004

Percentage of patients on the QOF Coronary Heart Disease (CHD), Peripheral Arterial Disease (PAD), or Stroke/Transient Ischaemic Attack (TIA) Register, who have a recording of LDL (Low-density Lipoprotein) cholesterol in the preceding 12 months that is 2.0 mmol/L or lower or where LDL cholesterol is not recorded a recording of non-HDL (High-density Lipoprotein) cholesterol in the preceding 12 months that is 2.6 mmol/L or lower.


CHOL004 has been created to replace CHOL002.  There are some minor but important changes to this indicator:
  1. Patients who have had a haemorrhagic stroke are now excluded from this indicator
  2. The main cholesterol result is switched from non-HDL to LDL
  3. the LDL target has been increased from <1.8 to ≤2.0mmol/L.  This means non-HDL will only count if your lab does not report LDL values.
  4. there are now PCAs (exception reporting) for maximal tolerated therapy, declined or unsuitable
  5. Codes for inviting patients have been added to this indicator (only if invited twice with no result or invited twice following a raised result)

Changes to Blood pressure indicators

Ambulatory blood pressure results are now recognised alongside home BP readings and will be subject to the lower 135/85 and 145/85 targets.

Cervical smears

There is clarification for this that the first two invitations are sent by the national call/recall service and that there should be third sent by the GP practice.

Minor details added

Asthma

The guidance highlights that:
  1. the asthma review aims to encourage the provision of good quality annual asthma reviews which when done well can help identify people at increased risk of poor outcomes
  2. Signposts the NICE NG80 guidance which emphasises a face to face assessment of inhaler technique (or by video where that's not possible) as well as other elements of the asthma review
  3. the BTS/SIGN guideline proposes a structured system for recording inhaler technique, morbidity, PEF levels, current treatment and asthma action plans
  4. there are a range of resources that may be helpful (PCIT has helped Greener Practice create resources to aid implementation of their guidance, this can be seen here for EMIS and here for TPP S1):
    1. BTS/SIGN guidelines
    2. Greener Practice guidelines
    3. Primary Care Respiratory Society guidelines
    4. Asthma and Lung guidelines

Atrial Fibrillation

The guidance highlights that approximately 9% of patients with AF are not on any form of anticoagulant.

Cancer

CKD

The economic burden of CKD is highlighted.  SGLT2 inhibitor use as a way of potentially minimising risk of progression is highlighted.

Depression

The guidance adds that NICE recommends a review between 2-4 weeks from diagnosis.  Also that patients aged 18-25 or thought to be at an increased risk of suicide should be reviewed after 1 week.

Diabetes

The guidance adds that NICE guidelines also recommend that an SGLT2 inhibitor should be offered or considered depending on the level of ACR in people with type 2 diabetes and renal disease.

Heart Failure

The guidance highlights that ACEi/ARB and B-blockers should be titrated upwards until the target or maximum tolerated dose is reached.  It is also highlighted that more detailed monitoring than the annual review will be needed if the person has significant comorbidity or their condition has deteriorated since the previous review.

Learning Disability

A lot of additional details about the health inequality gaps for people with a learning disability as well as the prevalence and risk of difficulties communicating.  The introduction of the "reasonable adjustment digital flag" is highlighted.

Mental Health

The guidance flags that patients with SMI have a reduced live expectancy of 10-20 years, also that a UK study found that almost 80% of the life expectancy gap could be attributed to common physical problems - with cardiovascular disease being the largest single contributor.  It also flags the NICE recommended elements of the health check.
It also highlights that practices may be expected to demonstrate they have a process for resolving patients with SMI from the register and that non-clinical members of the practice should not make the decision to add a remission code.
There is more detail added about the rationale for alcohol and HbA1c screening

Non Diabetic Hyperglycaemia

There are updates to the prevalence and also a highlighting of the evidence of the benefit of the NHS Diabetes Prevention Programme

Palliative Care

The guidance highlights the importance of ensuring that patients with non-cancer diagnoses are added to the register.  It also adds the criteria that contractors should be able to demonstrate compliance with NICE Quality Standards for End of life Care of Adults (QS13) and for infants, children and young people (QS160).

Rheumatoid Arthritis

Further detail about patients with "inactive rheumatoid arthritis" added.  It highlights that where patients who aren't receiving treatment for RA and have no clear evidence of past or current disease, an anti-CCP may help and that a clinical review is undertaken of the original diagnosis and any inaccurate diagnoses removed.