Hacking QOF Part 1: COPD Overview

So, the 2024/25 Quality and Outcomes Framework (QOF) Guidance has now been published. No doubt most practice managers, partners and PCN managers are poring over it to get an idea of the ramifications. As part of a series of hacks to help you nail QOF, we are running a series on some of the major conditions that you might find yourself managing. We will cover theory and the practical aspects of delivery.

Our post today looks at chronic obstructive pulmonary disease (COPD). It will benefit pharmacists (both new to general practice and those for whom COPD is outside the scope of practice), technicians, and other health professionals who undertake COPD reviews. We conclude with a snapshot of what a complete basic consultation looks like.

Income Protected COPD Indicators

On Page 6, the Guidance provides an insight into the Government thinking in the following paragraph:

NHS England has income protected an increased number of indicators for 2024/25. Building upon the income protection of the disease register indicators within QOF for 2023/24, a further 13 indicators will be subject to income protection in the 2024/25 QOF, bringing the total to 32. This includes 19 register indicators, 6 clinical indicators, 1 public health indicator and 6 quality improvement indicators. These 32 indicators have a total of 212 points assigned to them, which is a third of the total points available within OQF.

Quality and Outcomes Framework guidance for 2024/25, 1 April 2024

This matches the press release that NHS England published on 28 February 2024, which indicated that the reasoning behind this was to cut bureaucracy for practices and adopt a higher trust approach.

Among the income protected indicators, COPD accounts for 10 points in total. These come from indicators COPD015 (8 points) and COPD014 (2 points). The respective descriptors are as follows:

COPD015: The contractor establishes and maintains a register of:

1. Patients with a clinical diagnosis of COPD before 1 April 2023 and

2. Patients with a clinical diagnosis of COPD on or after 1 April 2023 whose diagnosis has been confirmed by a quality assured post bronchodilator spirometry FEV1/FVC ratio below 0.7 between 3 months before and 6 months after diagnosis (or if newly registered at the practice in the preceding 12 months a record of an FEV1/FVC ratio below 0.7 recorded within 6 months of
   registration); and
3. Patients with a clinical diagnosis of COPD on or after 1 April 2023 who are unable to undertake spirometry.

COPD014: (Appears to be on a sliding scale between 40-90%)

The percentage of patients with COPD and Medical Research Council (MRC) dyspnoea scale ≥3 at any time in the preceding 12 months, with a subsequent record of referral to a pulmonary rehabilitation programme (excluding those who have previously attended a pulmonary rehabilitation
programme).

Clinical Domain COPD Indicator

Within the Clinical Domain, COPD010 attracts a maximum of a further 9 points on a sliding scale between 50-90%. The description is as follows:

COPD010. The percentage of patients with COPD on the register, who have had a review in the preceding 12 months, including a record of the number of exacerbations and an assessment of breathlessness using the Medical Research Council dyspnoea scale

Essential Elements for a Complete COPD review

The implications of this from a QOF perspective are listed on Page 69 of the guidance. In order to satisfy the conditions for a successful COPD review, you will need to record/code the following alongside the fact that you have done an annual COPD review:

1. Number of COPD exacerbations in the previous year
2. The degree of breathlessness (Medical Research Council [MRC] dyspnoea scale).
3. A tool such as the COPD Assessment Test (CAT) to assess current health status is optional from a QOF perspective, but good practice from a clinical perspective.

Note that QOF requires the use of the MRC dyspnoea scale, not the modified MRC scale. If you are not sure what this means, look out for the additional training around COPD that should be up and running soon.

You can take advantage of your PMR system add-ins to help you meet all the criteria above. For example, if you happen to be using EMIS Web and have chosen the Ardens COPD template, you get the following image when you load it. (Right click to open image in a new tab and then zoom in as required). Note that we are using an anonymised dummy patient in this example to show the QOF criteria, which are highlighted in red.

Once you have completed the essential fields, you get the following basic consultation that satisfies the QOF requirements (and the GP partner[s] too :-)).

Look out for the additional training that we provide that should help build a deeper understanding of COPD and its management.

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