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Following recent discussions, the BMA and NHS Employers have agreed on the changes to the quality and outcomes framework (QOF) of the GMS contract for 2008–2009. A guidance document has been produced by the GPC to explain the changes, which came into effect on 1 April 2008. The main changes are as follows:

• 58.5 points have been reallocated to new QOF indicators in the patient experience (PE) domain to reward patient satisfaction with access
• Of these points, 38.5 came from the clinical, organisational, and holistic domains, and the remaining 20 points from the existing PE domain
• QOF payments for the new PE indicators are yet to be agreed, but will be dependent on the results of questions from a new patient experience survey on 48-hour access and advanced booking.

In light of the expert panel review, a number of further changes have been made to the existing clinical indicators as highlighted in Table 1; the updated clinical indicator tables can be viewed here. G

Julia Morris, Editor
julia.morris@mgp.ltd.uk

Table 1: Changes to the clinical indicators
Previous indicator	Replacement indicator (changes highlighted in bold)
AF 2	AF 4: The percentage of patients with atrial fibrillation diagnosed after 1 April 2008 with ECG or specialist-confirmed diagnosis
CKD 4	CKD 5: The percentage of patients on the CKD register with hypertension and proteinuria who are treated with an ACE inhibitor or angiotensin II receptor blocker (unless a contraindication or side effects are recorded)
COPD 9	COPD 12: The percentage of all patients with COPD diagnosed after 1 April 2008 in whom the diagnosis has been confirmed by post-bronchodilator spirometry
PC 1	PC 3: The practice has a complete register available of all patients in need of palliative care/support irrespective of age
SMOKING 1	SMOKING 3: The percentage of patients with any or any combination of the following conditions: CHD, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma, schizophrenia, bipolar affective disorder or other psychoses, whose notes record smoking status in the previous 15 months
SMOKING 2	SMOKING 4: The percentage of patients with any or any combination of the following conditions: CHD, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma, schizophrenia, bipolar affective disorder or other psychoses, who smoke, whose notes contain a record that smoking cessation advice or referral to a specialist service, where available, has been offered within the previous 15 months
STROKE 11	STROKE 13: The percentage of new patients with a stroke or TIA who have been referred for further investigation