QOF: Quality and Outcomes Framework
QOF is the NHS England pay-for-performance programme for GP practices, rewarding achievement against clinical and public health indicators worth up to 635 points per practice per year.
What is QOF?
The Quality and Outcomes Framework (QOF) is the annual reward and incentive programme for NHS GP practices in England, introduced in 2004 as part of the new General Medical Services (GMS) contract. It represents the world's largest pay-for-performance programme in primary care and directly links a significant portion of GP practice income to measured clinical performance.
Domain Structure and Points
QOF 2024/25 is structured around two principal domains:
- Clinical Domain (528 points): Indicators across 20+ clinical areas including cardiovascular disease, diabetes, mental health, COPD, asthma, cancer, and chronic kidney disease. Each indicator specifies a target population, a clinical action, and an achievement threshold range (typically 40%–90%).
- Public Health Domain (107 points): Covers cervical screening, child health surveillance, and vaccination programmes.
Financial Value Per Point
For 2024/25, the national average value per QOF point is approximately £213.37, adjusted for list size and prevalence. A practice with an average list size of ~8,000 patients achieving full points could earn over £135,000 in QOF payments. However, the Adjusted Patient List (prevalence adjustment) means practices in areas with higher chronic disease burden can earn more per point — QOF is explicitly designed to reward need-adjusted achievement.
Exception Reporting
Practices can legitimately exclude (exception report) patients from QOF denominators where treatment would be clinically inappropriate, the patient has dissented, or the patient has not attended despite three invitations. Exception rates are monitored by NHS England — abnormally high rates trigger review. Analytics to monitor exception reporting rates and identify unjustified patterns is essential for practices under IIF or PCN-level scrutiny.
Why QOF Analytics Matters
Most practices only review QOF performance when extracting data for submission. Real-time visibility into achievement rates against each indicator — and identification of patients who need clinical actions to move the practice across threshold boundaries — can be worth tens of thousands of pounds in additional QOF income without any additional clinical workload beyond appropriate care delivery.