QOF Consultation

It is nearly the deadline for responses for the consultation by the NICE committee on potential new QOF indicators (5pm on the 23rd of February). The first that these indicators could be expected to be seen would be 2016-17 and in general the committee has been largely ignored over the last couple of years. You can read the NICE consultation papers and my response to them.

Release notes

2014 QOF data

The data for 2013/14 is now on the site. It proved a bit of a challenge this year as, for the first time, there were material differences between the QOF in the four countries. Many of these differences were around the areas of thresholds and timings although the gaps have widened in 2014/15 so need to be tackled.

I had to bite the bullet and have some sort of policy about this and how to present the data. For precision each indicator is reported at practice level as they have been published by the four countries. Indicators particular to Scotland have the (S) suffix, Wales uses the W suffix and Northern Irish indicators end NI. England has no suffix - the assumption seems to be that the other nations have opted out of the English QOF. Not all indicators have an equivalent in each country.

One of the strengths of this site has always been that fact that data from all four countries can be compared. I was quite keen that this could continued. In any case the indicators are often quite similar. We are not so much comparing apples and oranges but rather Cox's and Braeburn apples (again possibly a rather pointless comparison as Cox's knock Braeburns out of the park every time in my view but it will do as analogy).

The site has grouped similar indicators as they have changed over time. If you click on the calendar icon you may see several similar indicators being used over time. This is a rough approximation but pretty effective. I have used the same sort of grouping to compare indicators between countries. The figures for the UK are based on this grouping and use indicators without a suffix where there is an English equivalent.

This does mean that the centile figures are largely confined to each country (where there are country specific indicators) but remain UK wide where the indicators are the same across the UK. This mostly is the case in disease prevalence.

Currently there is a bug which means that practices outside England do not compare properly with the UK figures. I will correct this over the next few days.

Welsh Practice Groupings

The data for Wales was published with small practice grouping and I have taken these onto the site. The systems is pretty good at arbitrary hierarchies so manages these fairly easily. There is not much detail about these groupings other than names and I have made up some custom codes for them.

Depression Prevalence

For the last couple of years the depression prevalence figure has been based on the number of patients who had received a diagnosis after the first of April 2006. Prior to that it was based on the number of patients who had received a diagnosis ever. This caused a bit of a jump in the figures and this did stand out last year. There was also some muddle in the figures last year.

This prevalence was in the figures as "DEP PREV 2". I have changed this to reflect the new rules to "DEP PREV 3" although these two are linked and the historical trend will appear between them. I will tidy up last years figures to the same in the next couple of days.


Some of these decisions may not be what you would have done. All of the figures will be available for download in about a week. These will be as CSV files and an MS Access file. With ten years of figures they are getting quite big now (the main database is now over a gigabyte of disk space). In particular the Access database tends to be quite large and I am open to suggestions about how to make this easier. Microsoft's solution seems to be a Sharepoint server but I don't have one of those. If you are a seller of MS Sharepoint or even if you are Microsoft and you want to show off your wares by distributing a large database please do get in touch!

Many thanks for your patience.

Putting your Friends and Family Test on line

The Friends and Family test has been part of the GP contract since Monday. The mainstay of this for many practices is likely to be a paper based system in the waiting room.

Using an online form has advantages which complement a paper based system. It is much easier for patients to use if they are at home and calling the surgery or dealing with a repeat prescription for example.

Setting up an online form can seem daunting but is actually quite simple and, even better, can be done for free. I have used Google Docs and the video below shows you how to set it up. It is unedited so the whole process takes less than the five minute running time of the video. Of course publicising the link will take a little longer but once the form is set up it should last for a good long time.

I would use the "full screen" icon underneath the video otherwise you won't be able to see much!

Sending letter to patients over 75 (with video)

I was at The Commissioning Show this week and there still seem to be a few practices who have not informed patients over 75 years old about their named GP. This should be done by 1st July and, as that is next Tuesday, time is of the essence.

There are three stages:

  • Identify the patients
  • Send the letters (or other notification)
  • Put the code in to say that you have done so - 67DJ

We use EMIS Web (for about six weeks!) and have used Docmail for our bulk mailing for a while. They are approved to handle patient data and the whole thing (paper, envelope, printing) is less than the price of a stamp, even after VAT.

This should be able to be done in less than 30 minutes, or forty if you include watching my video below. This uses EMIS and Docmail although is certainly not a complete Docmail tutorial. Once the address are uploaded it is pretty much self explanatory. Do please let me know either here, in the youtube comments or on Twitter if you find this useful.

Why the Contractor Population Index matters, and how they got it wrong.

The Contractor Population Index, like most things that are working well, has not attracted much attention until now. Its purpose has been to make sure that the cash value of a QOF point takes into account the size of the practice. A practice with ten thousand patients should, all other things being equal, get twice as much for each QOF point as a practice with five thousand. Changes and mistakes in how this is calculated will cost practices thousands of pounds.

Until April 2013 an “average” practice in England was considered to have 5891 patients ( the three other countries used their own values). Effectively QOF was paid in blocks of 5891 patients. In the first year of QOF a point was worth £120 per 5891 patients, or just a shade over 2p per patient. This value gradually increased over the following years. It didn’t actually matter what an actual average practice list was, we were effectively being paid per patient.It simply made the contract easier to present when larger numbers were used.

Autumn 2012 probably represented the lowest point in relations between the GPC and the Department of Health. The contract imposition at the time was wide ranging. In paragraphs 33-35 of the letter from Richard Armstrong in December 2012 it was proposed to change the 5891 figure based on the actual average list size. This was stated as requiring an increase of 16% - 6834 patients. The actual figure was to be calculated on the first day of January before the QOF year began. In the long term the trend is for average lists to rise if the population increases or smaller practices close. Of course if the cash value of a point stays the same it is spread between a larger number of patients and the value per patient will fall. For one year only there was to be an increasein the value of a QOF point. Mr Armstrong’s letter stated that “This would be a cost neutral change in 2013/14.”

In the end the average list size on 1st of January was 6911 - an increase of 17.3%

When we received the calculation from CQRS last week there was another problem. Whilst both the imposition letter and the Statement of Financial Entitlement (the document that lays out what practices should be paid in exhaustive detail) say that the average list size before the start of the QOF year should be used (i.e. 1st January 2013 for the year just gone) the HSCIC have instead used 1st January 2014. As the trend to larger lists has continued they have used an average list size of 7052 - a 19.7% increase on the old figure. That sixteen percent increase in the value of a point is being stretched even further. For a 10,000 patient practice this would represent more than £3,500 loss.

This loss is simply an incorrect interpretation of the rules and was sorted within a week.

There is, unfortunately, a further sting in the tail. That figure from the first of January 2014 will be used for QOF payments in April 2015. Thanks to HSCIC we now know there will be 2% less money per patient. Even with the new, slimmer, QOF this decrease will wipe out the majority of the 0.28% uplift to GP payments this year.

Letter from the HSCIC now amended to the correct date..

Statement of Financial Entitlement 2013

The "Cost Neutral" promise

Charts can now be copied and downloaded

I had an email a few weeks ago asking why the charts on the site could not be copied or downloaded. The simple answer is that that in order to have interactivity on the charts as the mouse hovers over them and to keep loads relatively low on the server the charts are generated in your browser by javascript. All of the actual work is done by the really easy to use Google Charts library. Because of the way that this is done - it never really exists as a "picture" - it seemed downloading would be impossible. This is a pity because they can be handy to use in documents and presentations. If you have seen any presentations that I have done I use screenshots of the site and these can be a bit of a faff to produce.

On looking a little further I was pleasantly surprised to see that those nice folk at Google had made a print and copy option for the charts. This only happened at the end of January and the site is currently on an even newer (and possibly less stable version) as there was a small bug which Google quickly squashed.

So if you want to download or print a chart just click on the link underneath to get a fully usable print or embeddable png. I would be grateful if you could mention the source when you use this in presentations or documents but otherwise there are no conditions on what you do with them.

2012/13 QOF Data now on the site

All of the QOF data for 2012/13 is now on the main website and will be available for download in a few days. Due to the timings of it being published this year and the time I had available the data for all four countries is going on at the same time.

There are a few small changes this year. Firstly there were new smoking indicators which now applied to all patients who had reached their fifteenth birthday. As there is both an indicator showing how many people were asked, and a second indicator about giving advice to people who said that they smoked we can used the numerator of the first and the denominator of the second to give an idea of the proportion of patients who smoke. This is a little limited as it only applies to patients who were asked but may be useful or at least interesting. This appears at SMO PREV ALL in the numbers. It is entirely a pseudo indicator made up by myself.

I had an interesting email during the year about the prevalence figures on the site. In several disease areas, such as diabetes, osteoporosis or rheumatoid arthritis the register is restricted according to the age of patients. For instance diabetes is 17 or over and nobody goes on the osteoporosis register until they are fifty years old. At the moment the denominator on the site is the whole practice list, rather than just those patients who could possibly qualify for the register. This would tend to underestimate the prevalence in the qualifying population.

There are two sides to this. Using the adjusted denominator makes it easier to compare populations. It is a more realistic measure of disease prevalence although in many cases the actual disease is relatively rare outside these age groups. The vast majority of diabetes, for instance, occurs in later life. Osteoporotic fracture is rare before 50.

There are snags though. Only England produces the adjusted figures and they are listed on the spreadsheets as estimates. It is also easier to see the relative disease burden on practices from the whole list figures. Comparison with earlier years is also easier.

My compromise is to keep the main prevalence figures the same but to include the adjusted figures for English practices. If you click through on diabetes you will see DM 32 Adj which has the same numerator but the adjusted denominator. Not so much a compromise as a fudge - I do both things!

Downloads should be available in a few days. As always the Access version is a bit painful to set up but I will try and push my increasingly aged laptop through it! General QOF stuff (and some stuff that comes to mind but absolutely no pictures of my lunch) please do follow me on twitter. You can see recent tweets to the right of this post.

The year 2013/14 will, for the first time have different indicators in each of the four contries. I have a year to figure out how to deal with this! In the meantime I hope to get a better API up and running. Also we should get some idea of what a new DES for admissions avoidance in England. It may be possible to model some of this from QOF data, but we await the details.