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QOF clinical indicators 2012/13: summary tables

The quality and outcomes framework of the GMS contract 2012/13 came into effect on 1 April 2012. The clinical domain covers the following areas: asthma; atrial fibrillation; cancer; cardiovascular disease (primary prevention); coronary heart disease (secondary prevention); chronic kidney disease; COPD; contraception; dementia; depression; diabetes mellitus; epilepsy; heart failure; hypertension; hypothyroidism; learning disabilities; mental health; obesity; osteoporosis (secondary prevention of fragility fractures); palliative care; peripheral arterial disease; smoking; and stroke and transient ischaemic attack. Each disease area has a series of evidence-based indicators (listed below). Medicines management and quality and productivity indicators are also included below. Points are attached to each indicator and determine the sum paid to each practice.

 

Key: Amended indicators

Asthma
	No.	Indicator	Amendments	Points	Payment stages
	ASTHMA 1	The practice can produce a register of patients with asthma, excluding patients with asthma who have been prescribed no asthma-related drugs in the previous 12 months	-	4
	ASTHMA 8	The percentage of patients aged 8 years and over, diagnosed from 1 April 2006 as having asthma with measures of variability or reversibility	Increased threshold	15	45–80%
	ASTHMA 10	The percentage of patients with asthma between the ages of 14 and 19 years in whom there is a record of smoking status in the previous 15 months	ASTHMA 10 replaces ASTHMA 3	6	45–80%
	ASTHMA 9	The percentage of patients with asthma who have had an asthma review in the preceding 15 months that includes an assessment of asthma control using the three RCP questions	ASTHMA 9 replaces ASTHMA 6	20	45–70%
Total points				45

Atrial fibrillation
	No.	Indicator	Amendments	Points	Payment stages
	AF1	The practice can produce a register of patients with atrial fibrillation	-	5
	AF5	The percentage of patients with atrial fibrillation in whom stroke risk has been assessed using the CHADS2 risk stratification scoring system in the preceding 15 months (excluding those whose previous CHADS2 score is greater than 1)	New indicator	10	40–90%
	AF6	In those patients with atrial fibrillation in whom there is a record of a CHADS2 score of 1 (latest in the preceding 15 months), the percentage of patients who are currently treated with anticoagulation drug therapy or antiplatelet therapy	AF6 replaces AF3	6	50–90%
	AF7	In those patients with atrial fibrillation whose latest record of a CHADS2 score is greater than 1, the percentage of patients who are currently treated with anticoagulation therapy	AF7 replaces AF3	6	40–70%
Total points				27

Cancer
	No.	Indicator	Amendments	Points	Payment stages
	CANCER 1	The practice can produce a register of all cancer patients defined as a ‘register of patients with a diagnosis of cancer excluding non-melanotic skin cancers from 1 April 2003’	-	5
	CANCER 3	The percentage of patients with cancer, diagnosed within the past 18 months, who have a patient review recorded as occurring within 6 months of the practice receiving confirmation of the diagnosis	Increased threshold	6	50–90%
Total points				11

Cardiovascular disease—primary prevention
	No.	Indicator	Amendments	Points	Payment stages
	PP1	In those patients with a new diagnosis of hypertension (excluding those with pre-existing CHD, diabetes, stroke and/or TIA) recorded between the preceding 1 April to 31 March: the percentage of patients aged 30 to 74 years who have had a face-to-face cardiovascular risk assessment at the outset of diagnosis (within 3 months of the initial diagnosis) using an agreed risk-assessment tool	Increased threshold	8	40–75%
	PP2	The percentage of people with hypertension (diagnosed after 1 April 2009) who are given lifestyle advice in the last 15 months for: increasing physical activity, smoking cessation, safe alcohol consumption, and healthy diet	Increased threshold	5	40–75%
Total points				13

Coronary heart disease—secondary prevention
	No.	Indicator	Amendments	Points	Payment stages
	CHD1	The practice can produce a register of patients with CHD	-	4
	CHD6	The percentage of patients with CHD in whom the last blood pressure reading (measured in the previous 15 months) is ≤150/90 mmHg	Increased threshold	17	40–75%
	CHD8	The percentage of patients with CHD whose last measured total cholesterol (measured in the previous 15 months) is ≤5 mmol/l	Increased threshold	17	45–70%
	CHD9	The percentage of patients with CHD with a record in the previous 15 months that aspirin, an alternative antiplatelet therapy, or an anticoagulant is being taken	Increased threshold	7	50–90%
	CHD10	The percentage of patients with CHD who are currently treated with a beta blocker	Increased threshold	7	40–65%
	CHD14	The percentage of patients with a history of myocardial infarction (from 1 April 2011) currently treated with an ACE inhibitor (or ARB if ACE intolerant), aspirin or an alternative antiplatelet therapy, beta blocker, and statin	Increased threshold	10	45–80%
	CHD12	The percentage of patients with CHD who have a record of influenza immunisation in the preceding 1 September to 31 March	Increased threshold	7	50–90%
Total points				69

Chronic kidney disease
	No.	Indicator	Amendments	Points	Payment stages
	CKD1	The practice can produce a register of patients aged 18 years and over with CKD (US National Kidney Foundation: Stage 3 to 5 CKD)	-	6
	CKD2	The percentage of patients on the CKD register whose notes have a record of blood pressure in the previous 15 months	Points reduced from 6 to 4 and increased threshold	4	50–90%
	CKD3	The percentage of patients on the CKD register in whom the last blood pressure reading (measured in the preceding 15 months) is ≤140/85 mmHg	Increased threshold	11	45–70%
	CKD5	The percentage of patients on the CKD register with hypertension and proteinuria who are treated with an ACE inhibitor or ARB	Increased threshold	9	45–80%
	CKD6	The percentage of patients on the CKD register whose notes have a record of a urine albumin:creatinine ratio (or protein:creatinine ratio) test in the preceding 15 months	Increased threshold	6	45–80%
Total points				36

Chronic obstructive pulmonary disease
	No.	Indicator	Amendments	Points	Payment stages
	COPD14	The practice can produce a register of patients with COPD	-	3
	COPD15	The percentage of all patients with COPD diagnosed after 1 April 2011 in whom the diagnosis has been confirmed by post-bronchodilator spirometry	Increased threshold	5	45–80%
	COPD10	The percentage of patients with COPD with a record of FEV1 in the previous 15 months	Increased threshold	7	40–75%
	COPD13	The percentage of patients with COPD who have had a review, undertaken by a healthcare professional, including an assessment of breathlessness using the MRC dyspnoea score in the preceding 15 months	-	9	50–90%
	COPD8	The percentage of patients with COPD who have had influenza immunisation in the preceding 1 September to 31 March	Increased threshold	6	45–85%
Total points				30

Contraception*
	No.	Indicator	Amendments	Points	Payment stages
	SH1	The practice can produce a register of women who have been prescribed any method of contraception at least once in the last year, or other appropriate interval (e.g. last 5 years for an intrauterine system)	-	4
	SH2	The percentage of women prescribed an oral or patch contraceptive method in the last year who have also received information from the practice about long acting reversible methods of contraception in the previous 15 months	Increased threshold	3	50–90%
	SH3	The percentage of women prescribed emergency hormonal contraception at least once in the year by the practice who have received information from the practice about long acting reversible methods of contraception at the time of, or within one month of, the prescription	Increased threshold	3	50–90%
*The contraception indicators are listed as part of the 'additional services' section of the QOF guidance for GMS contract 2012/13			Total points	10

Dementia
	No.	Indicator	Amendments	Points	Payment stages
	DEM1	The practice can produce a register of patients diagnosed with dementia	-	5
	DEM2	The percentage of patients diagnosed with dementia whose care has been reviewed in the previous 15 months	Increased threshold	15	35–70%
	DEM4	The percentage of patients with a new diagnosis of dementia recorded between the preceding 1 April to 31 March with a record of FBC, calcium, glucose, renal and liver function, thyroid function tests, serum vitamin B12, and folate levels recorded 6 months before or after entering on to the register	DEM4 replaces DEM3	6	45–80%
Total points				26

Depression
	No.	Indicator	Amendments	Points	Payment stages
	DEP1	The percentage of patients on the diabetes register and/or the CHD register for whom case finding for depression has been undertaken on one occasion during the preceding 15 months using two standard screening questions	Increased threshold	6	50–90%
	DEP6	In those patients with a new diagnosis of depression, recorded between the preceding 1 April to 31 March, the percentage of patients who have had an assessment of severity at the time of diagnosis using an assessment tool validated for use in primary care	DEP6 replaces DEP4	17	50–90%
	DEP7	In those patients with a new diagnosis of depression and assessment of severity recorded between the preceding 1 April to 31 March, the percentage of patients who have had a further assessment of severity 2–12 weeks (inclusive) after the initial recording of the assessment of severity. Both assessments should be completed using an assessment tool validated for use in primary care	DEP7 replaces DEP5	8	45–80%
Total points				31

Diabetes mellitus
	No.	Indicator	Amendments	Points	Payment stages
	DM32	The practice can produce a register of all patients aged 17 years and over with diabetes mellitus, which specifies the type of diabetes where a diagnosis has been confirmed	DM32 replaces DM19	6
	DM2	The percentage of patients with diabetes whose notes record body mass index (BMI) in the previous 15 months	Points reduced from 3 to 1 and increased threshold	1	50–90%
	DM26	The percentage of patients with diabetes in whom the last IFCC-HbA1c is 59 mmol/mol or less in the preceding 15 months	-	17	40–50%
	DM27	The percentage of patients with diabetes in whom the last IFCC-HbA1c is 64 mmol/mol or less in the preceding 15 months	Increased threshold	8	45–70%
	DM28	The percentage of patients with diabetes in whom the last IFCC-HbA1c is 75 mmol/mol or less in the preceding 15 months	Increased threshold	10	50–90%
	DM21	The percentage of patients with diabetes who have a record of retinal screening in the preceding 15 months	Increased threshold	5	50–90%
	DM29	The percentage of patients with diabetes with a record of a foot examination and risk classification: 1) low risk (normal sensation, palpable pulses), 2) increased risk (neuropathy or absent pulses), 3) high risk (neuropathy or absent pulses plus deformity or skin changes or previous ulcer) or 4) ulcerated foot within the preceding 15 months	Increased threshold	4	50–90%
	DM10	The percentage of patients with diabetes with a record of neuropathy testing in the preceding 15 months	Increased threshold	3	50–90%
	DM30	The percentage of patients with diabetes in whom the last blood pressure is ≤150/90 mmHg in the preceding 15 months	Increased threshold	8	45–71%
	DM31	The percentage of patients with diabetes in whom the last blood pressure is ≤140/80 mmHg in the preceding 15 months	Increased threshold	10	40–65%
	DM13	The percentage of patients with diabetes who have a record of micro-albuminuria testing in the preceding 15 months (exception reporting for patients with proteinuria)	Increased threshold	3	50–90%
	DM22	The percentage of patients with diabetes who have a record of estimated glomerular filtration rate (eGFR) or serum creatinine testing in the preceding 15 months	Points reduced from 3 to 1 and increased threshold	1	50–90%
	DM15	The percentage of patients with diabetes with a diagnosis of proteinuria or micro-albuminuria who are treated with ACE inhibitors (or ARBs)	Increased threshold	3	45–80%
	DM17	The percentage of patients with diabetes whose last measured total cholesterol within the preceding 15 months is ≤5 mmol/l	Increased threshold	6	40–75%
	DM18	The percentage of patients with diabetes who have had influenza immunisation in the preceding 1 September to 31 March	Increased threshold	3	45–85%
Total points				88

Epilepsy
	No.	Indicator	Amendments	Points	Payment stages
	EPILEPSY 5	The practice can produce a register of patients aged 18 years and over receiving drug treatment for epilepsy	-	1
	EPILEPSY 6	The percentage of patients aged 18 years and over on drug treatment for epilepsy who have a record of seizure frequency in the preceding 15 months	Increased threshold	4	50–90%
	EPILEPSY 8	The percentage of patients aged 18 years and over on drug treatment for epilepsy who have been seizure free for the last 12 months recorded in the preceding 15 months	Increased threshold	6	45–70%
	EPILEPSY 9	The percentage of women under the age of 55 years who are taking antiepileptic drugs who have a record of information and counselling about contraception, conception, and pregnancy in the preceding 15 months	Increased threshold	3	50–90%
Total points				14

Heart failure
	No.	Indicator	Amendments	Points	Payment stages
	HF1	The practice can produce a register of patients with heart failure	-	4
	HF2	The percentage of patients with a diagnosis of heart failure (diagnosed after 1 April 2006), which has been confirmed by an echocardiogram or by specialist assessment	Increased threshold	6	50–90%
	HF3	The percentage of patients with a current diagnosis of heart failure due to left ventricular dysfunction (LVD) who are currently treated with an ACE inhibitor or ARB, who can tolerate therapy and for whom there is no contraindication	Increased threshold	10	45–80%
	HF4	The percentage of patients with a current diagnosis of heart failure due to LVD who are currently treated with an ACE inhibitor or ARB, who are additionally treated with a beta blocker licensed for heart failure, or recorded as intolerant to or having a contraindication to beta blockers	Increased threshold	9	40–65%
Total points				29

Hypertension
	No.	Indicator	Amendments	Points	Payment stages
	BP1	The practice can produce a register of patients with established hypertension	-	6
	BP4	The percentage of patients with hypertension in whom there is a record of the blood pressure in the preceding 9 months	Points reduced from 16 to 8 and increased threshold	8	50–90%
	BP5	The percentage of patients with hypertension in whom the last blood pressure (measured in the preceding 9 months) is ≤150/90 mmHg	Points reduced from 57 to 55 and increased threshold	55	45–80%
Total points				69

Hyperthyroidism
	No.	Indicator	Amendments	Points	Payment stages
	THYROID 1	The practice can produce a register of patients with hypothyroidism	-	1
	THYROID 2	The percentage of patients with hypothyroidism with thyroid function tests recorded in the preceding 15 months	Increased threshold	6	50–90%
Total points				7

Learning disabilities
	No.	Indicator	Amendments	Points	Payment stages
	LD1	The practice can produce a register of patients aged 18 years and over with learning disabilities	-	4
	LD2	Percentage of patients on the learning disability register with Down's Syndrome aged 18 years and over who have a record of blood TSH in the preceding 15 months (excluding those who are on the thyroid disease register)	Increased threshold	3	45-70%
Total points				7

Mental health
	No.	Indicator	Amendments	Points	Payment stages
	MH8	The practice can produce a register of patients with schizophrenia, bipolar disorder, and other psychoses	-	4
	MH11	The percentage of patients with schizophrenia, bipolar affective disorder, and other psychoses who have a record of alcohol consumption in the preceding 15 months	Increased threshold	4	50–90%
	MH12	The percentage of patients with schizophrenia, bipolar affective disorder, and other psychoses who have a record of BMI in the preceding 15 months	Increased threshold	4	50–90%
	MH13	The percentage of patients with schizophrenia, bipolar affective disorder, and other psychoses who have a record of blood pressure in the preceding 15 months	Increased threshold	4	50–90%
	MH19	The percentage of patients aged 40 years and over with schizophrenia, bipolar affective disorder, and other psychoses who have a record of total cholesterol:hdl ratio in the preceding 15 months	MH19 replaces MH14	5	45–80%
	MH20	The percentage of patients aged 40 years and over with schizophrenia, bipolar affective disorder, and other psychoses who have a record of blood glucose or HbA1c in the preceding 15 months	MH20 replaces MH15	5	45–80%
	MH16	The percentage of women (aged from 25 to 64 in England and Northern Ireland, from 20 to 60 in Scotland, and from 20 to 64 in Wales) with schizophrenia, bipolar affective disorder, and other psychoses whose notes record that a cervical screening test has been performed in the preceding 5 years	Increased threshold	5	45–80%
	MH17	The percentage of patients on lithium therapy with a record of serum creatinine and TSH in the preceding 9 months	Increased threshold	1	50–90%
	MH18	The percentage of patients on lithium therapy with a record of lithium levels in the therapeutic range within the preceding 4 months	Increased threshold	2	50–90%
	MH10	The percentage of patients on the register who have a comprehensive care plan documented in the records agreed between individuals, their family and/or carers as appropriate	Increased threshold	6	30–55%
Total points				40

Obesity
	No.	Indicator	Amendments	Points	Payment stages
	OB1	The practice can produce a register of patients aged 16 and over with a BMI ≥30 in the previous 15 months	-	8
Total points				8

Osteoporosis: secondary prevention of fragility fractures
	No.	Indicator	Amendments	Points	Payment stages
	OST1	The practice can produce a register of patients: 1. Aged 50–74 years with a record of a fragility fracture after 1 April 2012 and a diagnosis of osteoporosis confirmed on DXA scan, and 2. Aged 75 years and over with a record of a fragility fracture after 1 April 2012	New Indicator	3
	OST2	The percentage of patients aged between 50 and 74 years, with a fragility fracture, in whom osteoporosis is confirmed on DXA scan, who are currently treated with an appropriate bone-sparing agent	New Indicator	3	30—60%
	OST3	The percentage of patients aged 75 years and over with a fragility fracture, who are currently treated with an appropriate bone-sparing agent	New indicator	3	30—60%
Total points				9

Palliative care
	No.	Indicator	Amendments	Points	Payment stages
	PC3	The practice has a complete register available of all patients in need of palliative care/support irrespective of age	-	3
	PC2	The practice has regular (at least 3-monthly) multidisciplinary case review meetings where all patients on the palliative care register are discussed	-	3
Total points				6

Peripheral arterial disease
	No.	Indicator	Amendments	Points	Payment stages
	PAD1	The practice can produce a register of patients with peripheral arterial disease	New Indicator	2
	PAD2	The percentage of patients with peripheral arterial disease with a record in the preceding 15 months that aspirin or an alternative antiplatelet is being taken	New Indicator	2	40—90%
	PAD3	The percentage of patients with peripheral arterial disease in whom the last blood pressure reading (measured in the preceding 15 months) is ≤150/90 mmHg	New indicator	2	40—90%
	PAD4	The percentage of patients with peripheral arterial disease in whom the last measured total cholesterol (measured in the preceding 15 months) is ≤5.0 mmol/l	New indicator	3	40—90%
Total points				9

Smoking
	No.	Indicator	Amendments	Points	Payment stages
	SMOKING 5	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 whose notes record smoking status in the preceding 15 months	SMOKING 5 replaces SMOKING 3	25	50–90%
	SMOKING 6	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 smoke, whose notes contain a record of an offer of support and treatment within the preceding 15 months	SMOKING 6 replaces SMOKING 4	25	50–90%
	SMOKING 7	The percentage of patients aged 15 years and over whose notes record smoking status in the preceding 27 months	SMOKING 7 replaces RECORDS 23	11	50–90%
	SMOKING 8	The percentage of patients aged 15 years and over who are recorded as current smokers who have a record of an offer of support and treatment within the preceding 27 months	New indicator	12	40–90%
Total points				73

Stroke and transient ischaemic attack
	No.	Indicator	Amendments	Points	Payment stages
	STROKE 1	The practice can produce a register of patients with stroke or TIA	-	2
	STROKE 13	The percentage of new patients with a stroke or TIA who have been referred for further investigation	Increased threshold	2	45–80%
	STROKE 6	The percentage of patients with a history of stroke or TIA in whom the last blood pressure reading (measured in the previous 15 months) is ≤150/90 mmHg	Increased threshold	5	40–75%
	STROKE 7	The percentage of patients with stroke or TIA who have a record of total cholesterol in the past 15 months	Increased threshold	2	50–90%
	STROKE 8	The percentage of patients with stroke or TIA whose last measured total cholesterol (measured in the previous 15 months) is ≤5 mmol/l	Increased threshold	5	40–65%
	STROKE 12	The percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record that an antiplatelet agent (aspirin, clopidogrel, dipyridamole, or a combination), or an anticoagulant is being taken (unless a contraindication or side-effects are recorded)	Increased threshold	4	50–90%
	STROKE 10	The percentage of patients with TIA or stroke who have had influenza immunisation in the preceding 1 September to 31 March	Increased threshold	2	45–85%
Total points				22

Medicines management
	No.	Indicator	Amendments	Points	Payment stages
	Medicines 2	The practice possesses the equipment and in-date emergency drugs to treat anaphylaxis	-	2
	Medicines 3	There is a system for checking the expiry dates of emergency drugs on at least an annual basis	-	2
	Medicines 4	The number of hours from requesting a prescription to availability for collection by the patient is 72 hours or less (excluding weekends and bank/local holidays)	-	3
	Medicines 6	The practice meets the PCO prescribing adviser at least annually and agrees up to three actions related to prescribing	-	4
	Medicines 8	The number of hours from requesting a prescription to availability for collection by the patient is 48 hours or less (excluding weekends and bank/local holidays)	-	6
	Medicines 10	The practice meets the PCO prescribing adviser at least annually, has agreed up to three actions related to prescribing and subsequently provided evidence of change	-	4
	Medicines 11	A medication review is recorded in the notes in the preceding 15 months for all patients being prescribed four or more repeat medicines Standard 80%	-	7
	Medicines 12	A medication review is recorded in the notes in the preceding 15 months for all patients being prescribed repeat medicines Standard 80%	-	8
			Total points	36

Quality and productivity
	No.	Indicator	Amendments	Points	Payment stages
	QP6	The practice meets internally to review the data on secondary care outpatient referrals provided by the PCO	-	5	-
	QP7	The practice participates in an external peer review with a group of practices to compare its secondary care outpatient referral data either with practices in the group of practices or with practices in the PCO area and proposes areas for commissioning or service design improvements to the PCO	-	5	-
	QP8	The practice engages with the development of and follows three agreed care pathways for improving the management of patients in the primary care setting (unless in individual cases they justify clinical reasons for not doing this) to avoid inappropriate outpatient referrals and produces a report of the action taken to the PCO no later than 31 March 2012	-	11	-
	QP9	The practice meets internally to review the data on emergency admissions provided by the PCO	-	5	-
	QP10	The practice participates in an external peer review with a group of practices to compare its data on emergency admissions either with practices in the group of practices or practices in the PCO area and proposes areas for commissioning or service design improvements to the PCO	-	15	-
	QP11	The practice engages with the development of and follows three agreed care pathways (unless in individual cases they justify clinical reasons for not doing this) in the management and treatment of patients in aiming to avoid emergency admissions and produces a report of the action taken to the PCO no later than 31 March 2012	-	27.5	-
	QP12	The practice meets internally to review the data on accident and emergency attendances provided by the PCO no later than 31 July 2012. The review will include consideration of whether access to clinicians in the practice is appropriate, in light of the patterns on accident and emergency attendance	New indicator	7
	QP13	The practice participates in an external peer review with a group of practices to compare its data on accident and emergency attendances, either with practices in the group of practices or practices in the PCO area and agrees an improvement plan firstly with the group and then with the PCO no later than 30 September 2012. The review should include, if appropriate, proposals for improvement to access arrangements in the practice in order to reduce avoidable A&E attendances and may also include proposals for commissioning or service design improvements to the PCO	New indicator	9
	QP14	The practice implements the improvement plan that aims to reduce avoidable accident and emergency attendances and produces a report of the action taken to the PCO no later than 31 March 2013	New indicator	15
			Total points	99.5