QOF Data for England 2020/21

The data for the QOF in England has now been published on the site for they year 2020-21. You won't need me to tell you that it was quite an unusual year. Inb QOF terms most of the indicators were suspended through the year. Prescribing indicators were suspended a bit later on through the year than other but, in the end, all that remained were the flu and cervical screening indicators. These all had their points doubled.

The other area that was still active was the prevalence adjustment. Effectively this meant that practices were still paid for the number of patients on their disease registers. It still paid to add patients to disease registers.

Of course there were a lot of other complications and this is probably one of the reasons that NHS Digital did not publish points totals this year. There were several new indicators in there as well and points would not really have made a lot of sense and certainly would not have tallied with payments. However the data was still collected and is presented on the site. As with many things 2020-21 is going to stand out a bit on the charts. Please do have an explore of the data.

Although most of the indicators are down the figures are a testement to the huge amount of work that was done by practices to some of the most vulnerable members of our practice lists. Even with all of the restrictions that were necessary through the year large numbers of patients continued to get appropriate care for chronic disease.

I hope to have data from Northern Ireland in a few weeks. QOF no longer takes place in Scotland and Wales has a very minimal system and I could not find published data last year.

Release notes 2015

All four countries now have data on the site for the year 2014/15. The four countries have continued to diverge in their requirements and common ground is becoming smaller. Where indicators are broadly equivalent I have tried to make them comparable.

There are a couple of things worth noting below.

Wales

Wales was first to publish this year, about two weeks ahead of Scotland and a month ahead of England and Northern Ireland, which was impressive. There are no significant issues with their statistics. They have continued to publish data about local practices groups so I have used these on the site. I can't find any official codes for these so they have a "QDB" code which is entirely made up by me.

Scotland

Most of the Scottish data is fairly straightforward. There seems to have been a bit of muddle about the actual identifiers for indicators and I have used those in the final publication. QS002 was used last year and then for a completely different indicator this year so I have used QS002A for the new one.

England

English data imported fairly easily this year, much helped by a "raw data" publication. There is a new "sub-region" which was used in publication which adds another level to the hierarchy on the site with the exception of Wessex. On the spreadsheets Wessex CCG was listed as its own sub region and to avoid a horrible loop it simply skips the sub region stage.

Northern Ireland

As things stand there is no prevalence data for Northern Ireland where there is no other indicator in that disease area. This affects obesity, epilepsy and learning disability and there is not a lot of smoking data either. I will update this if more information becomes available.

There are now Local Commissioning Groups in Northern Ireland. I have used these in much the same way as the old boards although they cover different areas, most notably by having a separate group for Belfast.

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.

Downloads

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.

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.

2012 Wales and Scotland data now online

I am delighted to be able to say that the 2012 data for Wales and Scotland is now on the site. Some of the virtual indicators and registers (mostly around depression incidence and smoking) have not yet been calculated. The site still defaults to 2011 until England data is on (it is 80% of the site) but 2012 is available in the left side menus.

So the English don't feel left out there is also a recalculation of the 2011 data at CCG level. In many cases the composition of the CCG is so similar to the PCT that it makes no difference but it may prove interesting. Either search for the CCG or drill down from England page or up from an English practice.

It is likely to be about three weeks before the English data is available on the site and I have no firm date for Northern Ireland.

2011 Data online - and the new site

I am delighted to be able to say that the 2011 data is on the site, and the new version of the site is on line. This currently mirrors of the function of the old site with more detail at the SHA, country and UK level.

There is more functionality to come which is made easier by an entirely new data model in the background. The database will be able to cope with things such as comparisons between years.

There is also a new look which is hopefully easier to find your way around. Search is on pretty much every page. Please do let me know how you find it. Everything can change and this is rather more simple in the new site. I have used Django to build the site which has a very simple template system. I would update the look to this blog but Blogger templates are such horrible things that I really can't figure out at all.

The downloads should be available soon. I need to tidy the database a little first.

Does QOF work?

There is quite a bit of publicity today for a paper in the BMJ asking whether hypertension targets have any effect on outcomes. Neither blood pressure or cardiovascular morbidity seem to have been affected.

It was with a sense of dread that found the paper. QOF has had more than its fair share of thinly disguised rants appearing as research. I was however very pleasantly surprised to find a well constructed piece of research with tightly defined methods and considerably clarity of thought. Maybe it takes researchers in the USA (Harvard to be exact) to look at these things objectively.

There is considerably debate about performance related pay and very variable evidence about how effective it is. There has been some research in the USA where schemes tend to make up a much smaller proportion of practice income than in the NHS.

It is of course disappointing although not particularly surprising to see a lack of observable effect. QOF is not, of course, a controlled intervention and it is possible to argue that we will never know what would have happened without it but this is pretty weak.

Now for the political bit. The cash for the QOF came, to a large extent, from a transfer from the old capitation payments. So the pay which previously went to practices and was used for treatment of hypertension was paid, in a different way, to practice for the same treatment of hypertension.

So little change but I am strangely cheerful that it has been demonstrated in such a high quality piece of research. More please.

Patient survey results out, but not available

My practice received the results of the nation patient survey today. As most practices are probably aware these relate to last year, 2008/9, and apply to two new indicators in the Patient Experience domain. Just as a reminder -

PE7 Patient experience of access (1)
The percentage of patients who, in the appropriate national survey, indicate they were able to obtain a consultation with a GP (in England) or appropriate health professional (in Scotland, Wales and NI) within 2 working days (in Wales this will be 24 hours).
Range 70-90% 23.5 points

PE8 Patient experience of access (2)
The percentage of patients who, in the appropriate national survey, indicate they were able to book an appointment with a GP more than 2 days ahead.
Range 60-90% 35 points

As you can see these command quite a lot of points, more than Stoke, Heart Failure, Cancer and Palliative Care combined.

Now that we have seen our results we are absolutely ... Ah, can't actually tell you how we feel about them. I can tell you other people aren't happy and are questioning the statistical validity due to very small sample sizes, but not if I feel the same. You see it is a secret. It is not, I hasten to ask our secret but instead it is the government's secret - at least until a time of their choosing. The statistics came with this warning:

The data is restricted until full national publication of all survey results by the Department of Health. The data must not be shared with any third parties except where expressly permitted by the Department of Health. This includes giving any indication over the content such as "favourable" or "unfavourable" comparisons of data.

Sharing of individual results with GP practices is permitted. Any communications with GP practices over their individual results should also enforce the confidentiality of the data and the duty not to share the data with any other third party ahead of official publication. A template letter will be available from the Department of Health to help in this regard.

PCTs should also refuse any Freedom of Information requests for this information, given national plans to publish the GP patient survey data. Any wrongful release of data to any other third party should be reported immediately to the Department of Health and may lead to an inquiry.

Now, I would hate to spoil a good press conference (30th June apparently) but we are now in the bizarre situation situation of GPs trying to get a handle on whether there is a systemic problem here without proper information. I personally receive three copies of the survey, all with different ID numbers and returned them all!. It is impossible to see if there is a problem or not without the data. Emails going around are a little cryptic as they can't disclose the data. All in the name of a stage managed press release. Expect to see a lot of argument about this over the next couple of weeks.

Welsh data now online

The QOF data for Wales in 2006/7 is now available. It actually came out about six weeks ago but I missed it at the time and heard via a reader last week.

This completes the data for 2006/7 although I do still need to update the downloads section of the site over the next couple of days.

Exception reporting in England - all new!

In all of the general excitement(!) of the release of the 2006/7 QOF data it would be quite easy to miss the QOF exception bulletin produced by the Information Centre for England for the same year. Not perhaps the most gripping of documents but very useful none the less. It is rather dry with plenty of statistics but relatively little comment and no exploration of the reasons behind individual indicators. If you are not familiar with exception reporting in QOF it may be worth looking back at past exception articles.

I am not going to repeat any of the data there, rather to try to provide a little background to help understand what is going on. Page 11 (and to their credit the page numbered 11 is also the 11th page of the PDF - certainly not universal) shows a table of the top ten excepted indicators. There is also the bottom ten but I will concentrate, as I imagine most people will, on the highest figures.

Top of the list is CKD 3 (CKD and hypertension with BP less than 140/85) which has an exception rate of nearly 30%. The equivalent indicator for hypertension alone (BP5) does not even reach the top ten. What is going on here? Well firstly hypertension is very difficult to control in kidney disease so maximum tolerated can quite easily be reached. There is, however, a bigger and more technical issue. Following diagnosis of a condition a patient is automatically excepted for the next nine months if they don't meet the target. This was a new indicator this year and was not really a commonly made diagnosis before. With a simple assumption that practices started work on this QOF a year before (April 2006) then three quarters of the patients could have been excepted if they did not hit the target ( 9/12 ). Suddenly 30% seems fairly good. We can expect to see this drop next year.

Next is CHD 10 (beta blockers in CHD) which has always had a high exception reporting component. Rises a bit this year may be due to the advice that beta blockers are not much use after a year following a heart attack. They are also used much less first line for hypertension than previous due to new research. QOF is looking a bit dated here. Expect a rise again next year.

At third is AF 02 (ECG to diagnose atrial fibrillation) at 21%. Once again this indicator is for quite a short period - looking back over a year. Thus in this case 25% could be excepted automatically. Still fairly high though.

The timescale issue is also true of Asthma 8 (reversibility) at 20%, Stroke 11 (referred for investigation) at 18% and Dep 2 (depression scoring) at 17%. Again these only apply since first of April 2006.

MH 6 (comprehensive care plan) actually seems quite low at 17% due to the mental health register containing everyone who has ever had a psychosis or bipolar disorder - whether they still have the condition or not. MH 9 (annual review) is much the same at 15%.

Finally in the top ten is Epilepsy 8 (fit free for a year) at 17%. This reflects the difficulty in controlling some forms of epilepsy combined with a general lack of problem seen by some patients with occasional fits.

What is interesting is that only Epilepsy and beta blocker indicators have some clinical relevance in the exception reporting. All of the others (eight out of ten) say more about the business rules and the administrative nature of the indicator rather than patients or practices. So the take home message has to be don't place too much importance on exception reporting rates.

English data now online

The English data is now on the QOF database joining the Scottish and Northern Ireland data which has also been tidied up a little. The English data was a little delayed by the postal strike eventually arrived safely.

There are a couple of "virtual" indicators, largely relating to prevalence. I have created two depression indicators relating to the prevalence of people requiring screening for depression and those who have a history of depression recorded in the past. I would avoid putting too much weight on the latter as historical coding may be really quite variable between practices. In fact as practices were not specifically working towards these virtual indicators they should all be used with some caution.

I have also been asked about smoking prevalence. There is therefore a virtual indicator here too. Here it relates to the number of smokers amongst those covered by the smoking area (those with CHD, LVD, stroke, asthma, COPD and hypertension) who have been asked. This is not the only way to do it and is purely a judgement call on my part. In particular it may not correlate with some of the "official" registers and is not the one used for payment.

You may also notice that I do not put prevalence information for the palliative care domain on the main prevalence list. For one thing this prevalence is not used for payment. Secondly the numbers are generally so small as to be unreliable and thirdly they are so small they are suppressed for confidentiality reasons in many cases by the departments of health.

There are about half a dozen English practices without names or addresses. There was not a comprehensive look up table included with the English data this time so I have used several different sources. I will try to correct these in time.

Finally we are still awaiting the Welsh data. I have heard nothing official but will keep asking!

UK Prevalence Data

Although we don't have full practice level data for Wales and England yet there is some national level data. We can work out prevalence in all four of the countries and for the UK as a whole. They are listed below. Smoking is not in the table as it is not listed at the national level but should be available when the practice level data comes through.

On the subject of practice level data there is some more information on the information centre website. They are planning to send out CDs so I will apply for one. Unfortunately there is a postal strike over the next week which may affect delivery somewhat. There should certainly be some demand. The 2006 full data database has been downloaded from this site over eight hundred times.

No news from Wales as yet.

	England	Scotland	N Ireland	Wales	UK
Asthma	5.78%	5.48%	5.75%	6.53%	5.79%
Atrial fibrillation	1.29%	1.27%	1.25%	1.61%	1.30%
Cancer	0.91%	0.92%	0.79%	0.93%	0.91%
Chronic kidney disease	2.39%	1.82%	2.44%	2.28%	2.34%
COPD	1.43%	1.86%	1.53%	1.94%	1.49%
Coronary heart disease	3.54%	4.55%	4.18%	4.28%	3.67%
Dementia	0.40%	0.55%	0.52%	0.42%	0.41%
Depression Screening		7.24%	7.50%	7.56%	7.39%
Depression Ever		6.25%	6.13%	7.27%	6.55%
Diabetes mellitus	3.66%	3.52%	3.17%	4.21%	3.66%
Epilepsy	0.60%	0.72%	0.74%	0.73%	0.62%
Heart failure	0.78%	0.88%	0.81%	0.51%	0.78%
Hypertension	12.51%	12.61%	11.68%	14.26%	12.58%
Hypothyroid	2.55%	3.14%	2.90%	3.13%	2.63%
Learning disabilities	0.26%	0.41%	0.32%	0.30%	0.28%
Mental health	0.71%	0.79%	0.75%	0.72%	0.72%
Obesity	7.42%	7.01%	8.38%	9.64%	7.53%
Palliative care	0.09%	0.10%		0.10%	0.10%
Stroke and TIA	1.61%	1.97%	1.62%	1.97%	1.66%

Scottish and Irish data ... and that's it.

The data for Scotland and Northern Ireland was released last Monday and is now on the site. It has been a little more awkward uploading the data this year due to the changes in the areas and the appearance of areas without prevalences (palliative care) and depression having two different prevalences. I hope this makes some sense when viewing the data but nothing is set in stone and bright ideas welcome!

Wales also released some data this week but this did not go down to practice level and is therefore not particularly useful for many purposes. The statistical release was described as release one so there may be more although the site also suggests that there will not be an update for a further year. I am enquiring about further data.

Even more oddly is the English data. The Information Centre has spreadsheets of data at national, SHA and PCT level but not practice level. Practice level data is available but only one practice at a time through their own web interface. I have emailed them asking about spreadsheets but have not year heard back. In fairness they were probably quite busy on Friday.

I will keep you informed about their replies.

2006/7 Data Publication Dates

I do get asked quite a bit when the new data is due to come onto the site. Well all the data comes from the various departments of health in the four countries. The current plans from England and Scotland are to release the data sometime in September. Something of a relief for me, at least, as I have to get all of the new data into the database.

As an aside the English GP patient survey 2007 has been released. As this is down to practice level and is in a reasonably friendly format I will try to put this onto the site in addition. It also includes interesting figures such as rurality (really horrible word!) and deprivation factors. For largely presentation reasons however this is unlikely to precede the full QOF data (it will be linked from the 2006/7 QOF data).

Prevalence data for England and Northern Ireland

Prevalence data is starting to get out! In the table below you can see the data from England and Northern Ireland. The English data was taken from QMAS at the start of April and the NI data from their official prevalence bulletin. I would recommend the NI bulletin for further reading as there are a lot of nice charts showing the spread of the prevalence. When comparing the data with previous years it is important to remember that there have been big rule changes in mental health and smaller one in LVD. Also of note is that the palliative care prevalence is for information only and does not change the cash value of points as the others do.

There are couple of figures in the NI bulletin I don't understand - mainly the depression 2 and LVD 3 listings. I can't quite see the relevance but I will ask!

Prevalence Area	England	Northern Ireland
CHD	3.551	4.196
LVD	0.790	0.818
Stroke	1.615	1.619
Hypertension	12.466	11.651
Diabetes	3.629	3.138
COPD	1.425	15.33
Epilepsy	0.590	0.745
Thyroid	2.490	2.872
Cancer	0.897	0.778
Palliative Care	0.087	0.090
Mental Health	0.716	0.753
Asthma	5.771	5.78
Dementia	0.400	0.526
Depression*	7.004	6.5
Kidney Disease	2.242	2.307
Atrial Fibrillation	1.295	1.252
Obesity	7.223	7.989
Learning disabilities	0.256	0.316
Smoking - for recording**	19.557	18.55

* I am not sure exactly what this depression figure means. I think it is the number of people eligible for depression screening.

** This is the number of people eligible to be asked regularly about their smoking. It is the combined prevalence of diabetes, hypertension, heart disease, COPD and stroke