QOF Guidance and Business Rules

Topics:

This page provides an overview of the Quality and Outcomes Framework

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 the Payment Calculation and Analysis System (PCAS). 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.