QOF Practice Guide 2013/14

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London Area Team
Section sub-heading
QOF 2013/14
Practice Guide
Issue November 2013
1 NHS | Presentation to [XXXX Company] | [Type Date]
QOF Indicators -2013/14
• The Quality and Outcomes Framework for 2013/14 is published on the
NHS Employers website;
http://www.nhsemployers.org/Aboutus/Publications/Pages/qof-2013-14.aspx
• This document does not replace national guidance and will be used in
conjunction with national guidance so that practices are aware of what
to submit to NHS England in 2013/14.
• Practices should read and refer to both guidance documents to ensure
that they accurately record activity and submit evidence.
• The London Area Team (LAT) has provided a list of indicators which
sets out how evidence should be submitted. The evidence
requirements mirror exactly that set out in national guidance.
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QOF Claims & Evidence Submission 2013/14
The LAT Evidence List sets out how practices are required to submit
evidence in 2013/14. Practices must submit evidence by the method set
out in this guide.
All evidence must be submitted electronically and received by midnight
on 31 March 2014.
All practices must ensure that the following is completed by that deadline:
• Submission on CQRS (please see slide 4)
• Submission of manual declaration to LAT (on the QOFD form
provided - please see slide 5)
• Manual submission of evidence to LAT as required by the QOFD form
In line with national guidance NHS England may request submission of
additional evidence where deemed necessary e.g. as part of post
3 payment verification
Calculating Quality Reporting Service (CQRS)
• CQRS, together with the General Practice Extraction Service (GPES) has replaced the Quality
Management and Analysis System (QMAS), which calculated QOF achievement up until the end of
2012/13.
• CQRS is capable of calculating achievement and payments on quality services, including QOF by
obtaining data from general practice clinical systems using the (GPES).
• Practices are responsible for ensuring that the data on their clinical system is accurate and recorded in
accordance with QOF framework. Submissions on CQRS are the practices’ responsibility and Area
Teams will not be able to make manual submissions on behalf of practices.
• If a GP practice decides to opt out of GPES, which we would not recommend, CQRS would not
receive any automatic feeds of data to calculate QOF. Practices will still have to provide information
that the LAT has reasonably requested as evidence of their achievement. This may involve the
practice undertaking manual audits for all of the indicators and typing the data into CQRS using the
data entry screens. The practice should contact their LAT to discuss this.
4
QOFD Declaration and Reports
The QOFD form relates to evidence required for the following
indicators:
• Clinical Domain - PC002
• Public Health Domain -SMOK003 , CS001,3 & 4,
MAT001
• QP Domain
It must be submitted together with an electronic signature on
the QOFD form (the practice should retain a copy)
5
QP Implementation and Evidence
• The LAT has delegated responsibility for implementing the QP domain
to your local CCG who may have provided information about how this is
managed locally.
• In many areas the CCG may have set out separate requirements for
practices, linked to local implementation, for submitting evidence. This
guide and the LAT requirements do not replace this.
• In order to ensure consistency in assessment all practices are required
to submit evidence to the LAT as set out in slide 7 (QP LAT Evidence)
• For 2013/14 it is acceptable to use information the practice holds (in
patient records) on patient A&E attendances, admissions and outpatient
referrals to support internal and external audit in relation to the QP
domain. This should be used in conjunction with aggregated / non
6 patient identifiable data on secondary care activity
QP LAT Evidence
As set out in the QOFD form practices are required to provide evidence in
relation to achievement of QP indicators 3,6 and 9
Any of the following formats are acceptable to NHS England:
• Forms provided by the CCG provided they meet all the criteria set out on
the QOF 2013/14 framework and the QOFD form.
• Template forms provided by the LAT (please see evidence list for forms)
• A practice template provided they meet the criteria set out on the QOF
2013/14 framework and the QOFD form
This evidence will be used by NHS England in conjunction with information
provided by the CCG to assess achievement.
For the avoidance of doubt all evidence required for QP 3, 6, 9 must be
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submitted
both to the local CCG and NHS England.
QOF Assessment – key points
• The LAT shall assess in accordance with national guidance, as
supported by this guidance.
• To ensure consistency and fairness in assessment of the QP indicators,
the LAT may review and moderate CCG assessment of achievement as
necessary.
• QP Indicators - Where assessment against an indicator is dependent
on achieving a linked indicator, assessment will take into account
achievement against the linked indicator. For example if the practice
does not achieve against QP2, it shall not be eligible for claiming
against QP3.
• Achievement shall be assessed against evidence submitted by 31
March 2014. No evidence will be accepted after that date.
8
Timetable (Provisional
(Provisional)and subject to CQRS
functionality)
Action
Date
QOF guidance to Practices
December 2013
FQA’s Report and further guidance issued
10 Jan / 14 Feb / 14 Mar / 11 Apr
QOF Capitation Calculation
1 January 2014
National Prevalence Day
31 March 2014
Final Deadline to submit data on CQRS
31 March 2014
Final Deadline to submit manual evidence and declaration
31 March 2014
LAT to review practice evidence and issue report on assessment
following internal moderation
April – May 2014
LAT to publish appeal timetable
21 April 2014
Practice deadline for submitting notice of dispute
16 May 2014
Practice deadline for submitting dispute evidence
End of May 2014
Dispute and moderation panels
June 2014
LAT to process payments
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June 2014
Moderation, Disputes and Appeals
• The QOF Implementation and Review Group (The Group) shall provide
oversight to marking and assessment across the 3 London Teams in
the event of a dispute being raised by the practice.
• Members of this group will not have been involved in the initial
assessment of evidence, which will have been undertaken by officers in
the LAT.
• Practices who are unhappy with their assessment can submit a dispute
to the Group. The dispute must set out the practice’s contentions and
include all relevant evidence.
• The Group will undertake an initial internal review to ensure that the
evidence has been correctly assessed.
• Where the practice dispute is not resolved, it shall be submitted to an
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appeal panel.
Pre and Post Payment Verification
• QOF activity and data will be used to identify outliers and unusual
patterns of activity.
• Where outliers are identified we shall write to the practice asking for
clarification and/or additional information. The practice should provide a
detailed and evidence based response. This will be reviewed by our
clinical advisors.
• The LAT reserves the right to request further reasonable information
from practices identified as outliers, as recommended by our clinical
advisors.
• The post-payment verification process for 2013/14 will be line with
national requirements / procedure
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Queries and FAQ’s
Practices may submit QOF queries and issues to the following generic
email accounts:
South London - nhscb.lon-sth-qof@nhs.net
North East London - england.lon-ne-qof@nhs.net
North West London - england.lon-nw-qof@nhs.net
The LAT shall provide a monthly response, sent to all practices, to the
queries by the 2nd Friday of January, February and March. If a query or
an issue requires a more urgent/individualised response, this will be
issued to the practices on an exceptional basis.
Please note that that we will not be able to review or comment on any
evidence prior to assessment (which will take place after 31 March 2014)
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Submitting Evidence- Top tips.
• Do not leave it to the last minute as you will not have time
to resolve any technical issues and may miss the deadline.
• Submit early as 31 March or last working day before
submission is the busiest time and this puts pressure on
the IT systems. This can lead to frustration and
unnecessary problems for all.
• Avoid submitting outside working hours as the LAT team
will not be able to support you or resolve IT problems.
• Keep a record of the submission email
• If you are experiencing problems, send an alert to your AT
generic inbox and save a copy of this and our reply.
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Contacts
Contact
Area Team
Email
Phone
QOF manual
submission,
Queries and
issues
South
nhscb.lon-sth-qof@nhs.net
020 7932 9018
North East and
Central
england.lon-ne-qof@nhs.net
020 7932 3731
North West
england.lon-nw-qof@nhs.net
020 7932 3061
General
queries
South
nhscb.lon-sth-pcc@nhs.net
020 7932 9018
North East and
Central
england.lon-ne-pcc@nhs.net
020 7932 3731
North West
england.lon-nw-pcc@nhs.net
020 7932 3061
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