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The Importance of Maximising Your QOF Income

Insight Solutions Healthcare IT Professionals

There is no doubt QOF is diminishing but whilst it is still part of the GMS contract, it is essential practices maximise their true QOF potential. Primary Care income is being squeezed more and more so why is it practices still go ‘gung ho’ to achieve maximum points but do not consider the true value of each point they achieve?

So, what are we missing? Prevalence is the key to unlocking your income. On the 31st March each year, data is taken from every practice on the number of patients on each register – this establishes a national prevalence figure. Do you know how your practice prevalence compares to the national figures? Why is this important?

The average list size in England for 2016/17 is 7460 patients, giving an average £ per point of £165.18. Therefore, if you have a larger than average list size your £ per point will increase (9500 patients, average £ per point will increase to £210.35) and a smaller than average list size your £ per point will decrease. Disease prevalence is then taken into account – if you have a higher burden of disease on your practice for diabetes, the point value will increase, lower burden, point value will decrease. So let’s look at a real-life example to help put that into context:


Based on their list size of 10,000 patients, this practice average £ per point is £221.42 – however because their practice prevalence is low, the point value for diabetes drops to £147.73 per point. There are 86 points available for diabetes, this is an overall drop compared to the national average of £12,685.36 annually – that is a lot of money to lose, especially when you are doing the work. Remember, this is just one disease area …

If this is a true reflection of the practice and their diabetic register is accurate then yes, their average point value should drop as the burden of diabetes is much less than the average practice. However, in our experience this is nearly always due to coding inconsistencies.

Insight’s expert consultants work with practices every day to help them understand and address their coding inconsistencies to ensure you get paid for the work you do. This also applies to enhanced services. Every patient you add onto a QOF register will increase the value of each point for that disease area. Another real-life example to help put this into context, we have chosen HF due to LVSD (19 points) as this is a real common coding problem area:


We know practices are good at diagnosing, referring, treating and reviewing patients -but data inconsistencies means you are not rewarded for this work. QOF registers will not manage themselves; they need to be regularly validated. Whilst QOF is still a key component of the GMS contract it is essential for both your income and patient care that you validate your registers. For more information on how Insight can help, please contact us:

Tel: 01527 557407
Email: [email protected]
Website: www.insightsol.co.uk