1. Quality and Outcomes Framework Assessor Training QOF Basics Domains, Evidence and Local Frameworks

2. Plan! • Overview of QOF • Domains • QMAS • Sources of Evidence • Developing Local Frameworks

3. QOF Improvement Cycle Planning QOF IMPROVEMENT CYCLE Learning Action Review

4. QOF Activities for 2004/5 Feb 2004 Agree aspiration April 2005 Achievement payments made Apr 2004 Pay QPrep and QuIP DES Oct 04 – Jan 05 Annual review visits take place QOF 2004/5 April 2004 QOF goes live April 2004 DH guidance on review visits August 2004 QMAS system goes live & provides monthly feedback End April 2004 Monthly aspiration payments

5. Quality and Outcomes Framework (QOF) • New primary care tool and major source of new funding • Four domains - Clinical, organisational, patient experience and additional services • Focused on the improvement of quality and outcomes of patient health • Evidence based indicators

6. Structure of the QOF 1050 points available • £75 per point 04/05 • £120 per point 05/06 4 Domains: • Clinical • Organisational • Patient Experience • Additional Services

7. Clinical domain 10 disease areas 550 points Organisational domain 5 areas 184 points Additional Services domain 4 areas 36 points Patient Experience domain 2 areas 100 points Holistic Care, Quality Practice and Access Bonus Points Total 180 points QOF Domains

8. Clinical Domain • The 76 Clinical Indicators split into 3 types • Structure – e.g is a disease register in place • Process – e.g is the indicator being measured and an appropriate intervention being made – for what % of relevant population • Outcome – how well is the condition being controlled – across what % of the population

9. Payments • New money in primary care • Aspiration payments (monthly from April 2004) • Achievement (lump sum in April 2005) • £s per point • 2004/05 = £75 • 2005/06 = £120 • List size • Prevalence • Pre-payment verification

10. IM&T and Data Flows • Practices require an RFA99 compliant clinical system • Reports from QMAS • monthly to PCTs, at least monthly to practices • QMAS reports will, in time, have comparative data on achievement and trends • local and national • Impact of Freedom of Information Act • January 2005

11. QMAS Quality Management Analysis System

12. Principles • Not patient based data • Pre-populated with IAU data • Single national system ensures: • High trust and transparent • Changes to QOF scheme can be supported • Payments calculated on a consistent basis for all practices • Single feed to NHAIS payment system • Practice and PCT access to same information based on access rights • Reduced dependence on individual suppliers • Value for money

13. Automated GP Practice “Manual” Achievement data from clinical system BACS Payment Other achievement data – web interface QMAS Central Server NHAIS Confirm Achievement Payment Agency PCT

14. QMAS Central Server GP Practice PCT

15. Evidence • Information the practice must submit in advance of the visit together with guidance for PCO assessors • Grades of Evidence • Indicator • Written Evidence • Assessment Visit • Assessors’ Guidance

16. Local Frameworks • Who can develop local QOFs? • PMS • APMS • PCTMS • Local variations must have comparable frameworks • Must be points based and add up to 1050

17. Continued… • Local QOF must be agreed by Director of Public Health or another suitable person • Equally, should be similar reward for similar effort between national QOF and locally agreed variants • All practices participating in a QOF should have a QOF assessment visit

18. Summary • QOF will drive local quality improvements in primary care • Lay assessors will bring objectivity and patient focus to visits • Local ‘intelligence’ important to know (K2) • Part of a world first!