Income protection for the 2024/25 year
This contract year has seen a further 13 indicators "protected", bringing the total to 32. This includes:
- 19 disease register indicators
- 6 clinical indicators
- 1 public health indicator
- 6 quality improvement indicators.
A total of 212 points have been "income protected".
What does income protected mean?
Practices performance will be paid at the 2023/24 achievement level. Practices will therefore not be penalised if their performance falls, but importantly any improvements in these indicators will not be rewarded. PCIT created a support article directing practices to the existing resources subscribers enjoy that they could use to optimise their performance for the 2023/24 contract year within 2 days of the release of this information.
Which indicators have been protected?
Summary Table:
A summary of the income protection is shown in the following table:
Clinical/Policy Area | ID/Description | QOF Points |
Disease registers | AF001, AST005, CAN001, CHD001, CKD005, COPD015, DEM001, DM017, EP001, HF001, HYP001, LD004, MH001, OB003, OST004, PAD001, PC001, RA001, STIA001 | 81 |
Asthma | AST008 - Smoking | 6 |
Cancer | CAN004 - Cancer care review | 6 |
| Cancer | CAN005 - Support information | 2 |
| COPD | COPD014 - Pulmonary rehab | 2 |
| Depression | DEP004 - Depression review | 10 |
| Mental Health | MH021 - 6 physical health check elements | 6 |
| QI Indicators | All - 6 | 74 |
Smoking | SMOK005 - Smokers with chronic disease offered support to quit | 25 |
QOF disease registers
The QOF disease registers for Atrial Fibrillation, Asthma, COPD, Cancer, CKD, CHD, Heart failure, Hypertension, PAD, STIA, Dementia, Diabetes, Epilepsy, Learning disabilities, Mental health, Obesity, Osteoporosis, Palliative Care and Rheumatoid Arthritis.
Asthma
Indicator ID | Description |
AST008 | The percentage of patients with asthma on the register aged 19 years or under, in whom there is a record of either personal smoking status or exposure to second hand smoke in the preceding 12 months. |
Cancer
Indicator ID | Description |
CAN004 | The percentage of patients with cancer, diagnosed within the preceding 24 months, who have a patient Cancer Care Review using a structured template recorded as occurring within 12 months of diagnosis. |
Indicator ID | Description |
The percentage of patients with cancer, diagnosed within the preceding 12 months, who have had the opportunity for a discussion and informed of the support available from primary care, within 3 months of diagnosis. |
COPD
Indicator ID | Description |
COPD014 | The percentage of patients with COPD and Medical Research Council (MRC) dyspnoea scale ≥3 at any time in the preceding 12 months, with a subsequent record of referral to a pulmonary rehabilitation programme (excluding those who have previously attended a pulmonary rehabilitation programme). |
Depression
Indicator ID | Description |
DEP004 | The percentage of patients aged 18 or over with a new diagnosis of depression in the preceding 1 April to 31 March, who have been reviewed not earlier than 10 days after and not later than 56 days after the date of diagnosis |
Mental health
Indicator ID | Description |
MH021 | Percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who received all six elements of the Physical Health Check for people with Severe Mental Illness. |
QI indicators
There is no requirement for QI work for QOF in the 2024/25 contract year
Smoking
Indicator ID | Description |
SMOK005 | The percentage of patients with any or any combination of the following conditions: CHD, PAD, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma, schizophrenia, bipolar affective disorder or other psychoses who are recorded as current smokers who have a record of an offer of support and treatment within the preceding 12 months. |
Common questions
What about prevalence and list size variations? Will this still be taken into account?
Despite being protected, QOF earnings in 2024/25 will continue to be adjusted to take account of prevalence and list size variation.
Practices chasing prevalence of a way of increasing income may wish to read our support article about why this is not a sensible approach.
As disease registers are being protected do I still need to maintain them?
The guidance is clear that practices are still expected to maintain disease registers accurately as this activity performs an important role in maintaining clinical quality. This information will continue to be extracted by GPES.
Our practice is merging, closing or opening between 2023/24 and 2024/25 how will this affect us?
Merging
The combined 2023/24 performance, list and prevalence for the practices merging will be used to calculate new practice data that can be used in 2024/25. In cases where it is complex enough that this is not possible NHSE propose using the higher performance of the original practices or 2024/25 data for list and prevalence adjustments
Splitting
Practices will be paid based on the 2023/24 performance of the practice they were created from. 2024/25 list and prevalence adjustments will be used
New Practices
New practices will be paid on actual performance in 2024/25
So can I just stop doing all of the clinical work?
Technically yes - however there are a number of other factors to consider, as follows:
Best practice
It is best practice to:
- Record the smoking status of young people with asthma. This is a NICE quality standard.
- Provide information on support services to patients with a new cancer diagnosis and provide a cancer care review within a year. This is part of the NHS Long Term Plan for Cancer.
- Offer pulmonary rehabilitation to patients with COPD and an MRC score of 3 or more. This is a NICE quality standard.
- Review patients with depression soon after they are diagnosed. It is NICE guidance to review how treatment is going between 2 and 4 weeks after starting treatment.
- Perform physical health checks on patients with SMI. This is a NICE quality standard.
- Offer support to quit smoking to patients with chronic diseases. This is NICE guidance.
Team familiarity and process
Practice teams already have processes in place for doing this work. If it is decided to stop these, if these indicators are reinstated in future years restarting that work can take significant organisational change. Equally your clinicians will be out of the practice of making sure this work is done, so you will need to invest time and effort in highlighting it needs to start again.
Impact on 2025/26 contract year
There are a number of the indicators where not doing work during the 2024/25 year will potentially have an impact on performance in the 2024/26 year. For example:
- CAN004 looks at patients diagnosed with cancer within the last 24 months and checks to see if a cancer care review has been done within 12 months of diagnosis. Hence it follows that if a patient is diagnosed in the 2024/25 year but not reviewed, this could impact on 2025/26 performance adversely.
- CAN005 looks at patients diagnosed within the last 12 months who have been offered support information. The business rules for this look back 15 months, to take account of those patients who were diagnosed in the previous contract year but didn't have the KPI achieved so that they can check to see if it has been achieved within the current contract year. So for patients diagnosed 1st Jan 2025 - 31st March 2025 (i.e. during the income protected time) not doing this work will potentially adversely affect 2025/26 performance.
- DEP004 looks at patients diagnosed with depression in the last 12 months who have been followed up between 10 and 56 days after diagnosis. The business rules for this look back 15 months, to take account of those patients who were diagnosed in the previous contract year but didn't have the KPI achieved so that they can check to see if it has been achieved within the current contract year. So for patients diagnosed 1st Jan 2025 - 31st March 2025 (i.e. during the income protected time) not doing this work will potentially adversely affect 2025/26 performance.
CQC
The CQC will continue to look at a broad range of measures to monitor practices performance. Given the data for these indicators is still being extracted and published it follows that the CQC may well use this information to target its work.
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