Using EMIS searches to identify priority QOF areas

There are several key figures needed if a practice wishes to identify QOF areas to prioritise during the year by looking at potential missing income per indicator.  PCIT recommends reviewing these figures at regular intervals throughout the fiscal year to inform practice workload planning and ensure the practice is working towards achievement of maximum potential income for QOF.

Practices with access to PCIT's OneAnalytics platform will find this information already calculated on the QOF dashboard.  Practices who do not have access to that platform can use the guide below to manually calculate the information.

Calculate the Value of a QOF Point

The first step is to calculate the value of a QOF point for your practice and the relevant disease area. A guide to this calculation can be found in QOF Income including the impact of prevalence

Although there is a base value of a QOF point which is  £225.49 for 2025/26 this amount is then adjusted to take into account your practice population and disease prevalence and how that compares to the national average. 

A QOF point will therefore be worth a different amount for each disease area in your practice.

Note that this will always be approximated as final figures depend on prevalence calculated nationally at the end of March.  For this projection you will need to use the 2024/25 prevalence figures which can be found at NHS England - QOF Database

Once you know approximately how much a QOF point is worth you can calculate your potential missing income. 

Potential Missing Income per Indicator

For this you will want to look at the QOF year end searches that you can find in 004A QOF Reporting (v50) (Year End) NOT the rolling version.  You will need to run all the searches in this folder but given the size of the folder you may want to run a few subfolders at a time.

To see your % achievement you will need to go to the search for that indicator.

The target for AST007 is 70% (Upper Threshold or UT) and this is worth 20 QOF points.

The number of QOF points per indicator and the thresholds below are all listed in the QOF guidance document and in our support articles.  See our support article for AST007.

You will also need to know the Lower Threshold (LT) which is the lowest % that will achieve any QOF points.  For AST007 the LT is 45% and the UT is 70% which means the 20 QOF points are achieved between 45% and 70%

70%-45% = 25%

20 QOF points / 25% = 0.8 QOF points per 1%

If the practice currently has an achievement of 50% they still need to achieve 20% to get full QOF points.

20% x 0.8 = 16 QOF points outstanding

£225.49 x 16 = £3,607.84

So a practice with an average list size and average prevalence would have potential missing income for this indicator of £3,607.84

 

Potential Missing Income Per Patient

For the income per patients, you will need to look at the Details section at the bottom of the page for the patient numbers.

The Population Count is the number of patients who have achieved the indicator - the 'numerator'

The Parent is the overall number of patients being counted in the ‘denominator’ (all patients currently eligible for this indicator who have not been removed with a PCA).

The Excluded figure is the Parent – Population Count

Note that EMIS does not show any decimal points in the % achievement so you may want to manually calculate the % when close to target or if you want an exact number of patients needed to hit the target.

To calculate number of patients needed to achieve max points you need to look at the target (Upper Threshold) for the indicator which is 70% for AST007 and calculate 70% of the Parent population. 

In the example above 70% of 507 would be 354.9 so you would need to review 355 patients to achieve full points if the parent population remains the same.

Remember PCAs change the Parent population so you may want to recalculate this if you have just sent out a 2nd invite to all outstanding patients or coded a number of patient declines.  This is because when a PCA is added a patient will be removed from the denominator (if they have not met the achievement criteria) and this can then increase the achievement. 

For example if a practice has done 200 asthma reviews and the Parent population is 400 then the achievement so far would be 50%.  If the Parent population was reduced to 350 then those 200 asthma reviews would mean an achievement of 57%.

To calculate potential missing income per patient:

Missing income per patient = Missing income for the indicator / Patients needed to achieve Upper Threshold

If the overall missing income for this indicator was £3,607.84 and the practice needed to review 50 patients to achieve the Upper Threshold of 70% then the missing income per patients would be:  £3,607.84 / 50 = £72.1568 per patient

 Once the practice has all of these figures they can be combined with other factors such as work involved, staffing needed and overall practice and local priorities to inform the practice’s plan of attack for QOF.  Make sure to review these figures throughout the year to keep on track.

 

 

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