Quality and Outcomes Framework
The Quality and Outcomes Framework (QOF) is a system designed to remunerate general practices for providing good quality care to their patients, and to help fund work to further improve the quality of health care delivered. It is a fundamental part of the General Medical Services (GMS) Contract, introduced in 2004.
QOF Business Rules
Achievement in the Quality and Outcomes Framework (QOF) of the General Medical Services contract is recorded on a national system know as QMAS (Quality Management and Analysis System). Results are entered onto the system either through an automatic extraction from the patient’s electronic health record on GP clinical systems or through manual input. The dataset and business rules detail the logic and sequence in which the numerator and denominator data is extracted to determine indicator achievement. It also ensures data is extracted consistently across all practices.
Each dataset and business rule contains the information required to identify those patients who are eligible for inclusion on the disease register, indicator denominator and the indicator numerator. The denominator is made up of the patient population eligible for the care, as outlined in the indicator wording, and the numerator is the number of patients who have actually received the care.
How are the QOF business rules developed?
In April 2010, The Information Centre for health and social care (IC) took over the development of the business rules from NHS Employers and Connecting for Health. The IC works alongside the National Institute for Health and Clinical Excellence (NICE), who is responsible for reviewing and developing the clinical and health improvement QOF indicators, to ensure the business rules deliver the requirements of the indicators as recommended by NICE.
Any changes to the QOF business rules are subject to a formal four country review process which is designed to quality assure the business rules ahead of publication. The review panel includes representatives from the four UK health departments, NHS Employers, the General Practitioners Committee (through the joint British Medical Association Royal College of General Practitioners IT Committee), system suppliers led by the IC and other technical or coding experts.
The IC reviews and addresses any issues that are raised by the panel and considers whether further action is necessary. Where there are issues that cannot be resolved through the review, the IC will work with NICE, NHS Employers and the Department of Health to agree a way forward.
QOF Guidance and Business Rulesets
QOF Guidance and Business Rulesets can be accessed by the links below.