QOF, Contract and
Enhanced Services
2015/2016
Document detailing what changes and what doesn’t in QOF,
the Contract and Enhanced Services for 2015/2016
Jean Keenan
20th April 2015
QOF calculations 2015/16
For 2015/16 there are 559 points in QOF across two domains for clinical and public health indicators, the
same as last year.
The national average practice population figure for the 2015/16 QOF year is taken from the Calculating
Quality Reporting Service (CQRS) on 1 January 2015 and is 7,233 (increase of 146 patients).
The value of a QOF point for 2015/16 is £160.15 (increase of £3.23 per point)
The planned changes to thresholds have been deferred for a further year to 1 April 2016.
QOF changes 2015/16
There are very few changes to QOF this year, and none of them have a great impact. I have been through
all the Read codes to check that there is nothing, to “get” you, but there are really very few changes.
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Patients with AF need to have CHA2DS2-VASc calculated and recorded, and if it is 2 or more they
need to be prescribed anticoagulation drug therapy.
38DE0 CHA2DS2-VASc Score - Congestive heart failure, hypertension, age 2, diabetes
mellitus, stroke 2, vascular disease, age, sex category score
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CHD 006 has been removed, so the need to prescribe 4 types of drugs following an MI has gone.
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A care plan for all patients diagnosed with dementia will now have to be produced, replacing just
reviewing patients newly diagnosed with dementia
DM004 the percentage of patients diagnosed with dementia whose care plan has been reviewed in
a face-to-face review in the preceding 12 months.
Care Plan (in previous 12 months after dementia diagnosis)
8CMZ. Dementia care plan
8CSA. Dementia advance care plan agreed
OR
Review of Care Plan (in previous 12 months after dementia diagnosis)
8CMG2 Review of dementia advance care plan
Exceptions:
Care Plan declined (in previous 12 months)
8IAe0 Dementia advance care plan declined
OR
Review of Care Plan declined (in previous 12 months)
To be in v32 of the business rules
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For all tests required to be carried out for all new dementia diagnoses, the timescales have changed
from 6 months before/after entering the register to 12 months before and up to 6 months after
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CKD Register - Patients aged 18 or over with CKD with classification of categories G3a to G5
(previously stage 3 to 5) this is the same Read codes as last year so the register is the same. All the
other CKD indicators have been removed.
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Obesity register will now include patients aged 18 and over (changed from 16 and over)
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It is still necessary for you to have 3 registers for HF:
 HF001 Register of patients with HF
 Register 1 for HF002 The percentage of patients with a diagnosis of heart failure (diagnosed
on or after 1 April 2006)
 Register 2 for HF003 & HF004 patients with a current diagnosis of heart failure due to left
ventricular systolic dysfunction (LVSD)
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GMS Contract Changes 2015/16
The changes include the following:
The global sum payment has increased by 3% for 2015/16 to £75.77 per patient and will be
increased again in October 2015.
New:
 A named, accountable GP for all patients (including children) who will take lead responsibility for the
co-ordination of all appropriate services required under the contract. A report on website by 31 March
2016 and in practice leaflet saying all patients have a named GP. Named accountable GP for people
aged 75 and over is unchanged.

Publication of GP net earnings - practices will publish average net earnings (to include contractor and
salaried GPs) relating to 2014/15, as well as the number of full and part time GPs associated with the
published figure, on their website by 31 March 2016.

GPC, NHS England and NHS Employers will work together to develop more consistent guidance for
the provision of enhanced minor surgery services

Changes to registration regulations will allow for armed forces personnel to be registered with a GP
practice. Registration will be allowed up to a maximum of 2 years with global sum payments during
that period. As a minimum GP practices will get a summary of the medical records.

There will be a 15% reduction in the total seniority payments as agreed in 2014/15. (They will finish in
2020 and no new entrants)
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Assurance on out of hours provision has been agreed to ensure that all service providers are
delivering out of hours care in line with the National Quality Requirements (or any successor quality
standards). Practices not opted out of providing OOH care to provide information to the CCG, so they
can ensure they are providing in line with National Quality Requirements.
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Improved maternity/paternity arrangements have been agreed, to cover both external locums and
cover provided by existing GPs within the practice who do not already work full time.
o
All practices will be entitled to reimbursement of the actual cost of GP locum cover for
maternity/ paternity/ adoption leave of £1,113.74 for the first two weeks and £1,734.18
thereafter (or the actual costs, whichever is the lower.) Such reimbursement is intended to
cover both external locums and cover provided by existing GPs within the practice who do
not already work full time.
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NHS England and GPC will work together on workforce issues including the retainer /returner scheme,
the flexible careers scheme, and recruitment problems in specific areas. (e.g. remote and rural areas)

GPC, NHS Employers and NHS England will have a broader strategic discussion about the primary
care estate, especially to support the transfer of care into a community setting

NHS England and GPC will re-examine the Carr-Hill formula with the aim of adapting the formula to
better reflect deprivation

Correction factor funding moving into global sum will be reinvested, with no out of hours deduction
applying; NHS England has agreed that any funding released from PMS reviews will be invested in
primary medical care services
Empowering patients and the public
Access to medical record online.
From April 2015, practices will be required to also offer online access to all detailed information, i.e.
information that is held in a coded form within the patient's medical record.
 GPs will have the option and configuration tools to withhold coded information where they judge it
to be in the patient's interests or where there is reference to a third party.
 GPs can withhold access to free text
Online appointment booking.
The GMS contract will be amended to expand the number of appointments patients can book online and
to ensure that there is appropriate availability of appointments for online booking.
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Other NHS IT.
GPC have committed to actively promote the use of NHS IT services and will issue joint promotional
guidance and good practice with NHS England, signaling a change in the way practices and NHS England
do business on NHS IT issues. The following will be jointly promoted in guidance:
 Improving the offer of electronic transmission of prescriptions – encourage all prescriptions
to be transmitted electronically using Electronic Prescription Services Release 2 unless the patient
asks for a paper prescription or the necessary legislative or technical enablers are not in place.
NHS Employers and the GPC have agreed that 60% of practices will be expected to be
transmitting prescriptions electronically using EPS Release 2 by 31 March 2016.
 Offer patients secure electronic communication with practice - GP practices to promote and
offer the facility for patients to receive consultations electronically, either by email, video
consultation or other electronic means. GPC and NHS England will jointly promote the use of new
technology, especially where it would bring benefits to both GP practices and patients.
 Referral management – GP practices to make referrals electronically, using the NHS E-Referrals
system unless the secondary provider has not made slots available, there is a clinical imperative to
refer to the provider, or patients have indicated their choice to be referred to that provider. It is
agreed that 80% of elective referrals will be made electronically using the NHS E-referral system
by 31 March 2016.
 Information governance – the parties will actively promote the completion of the Health and
Social Care Information Centre information governance toolkit including adherence to the
requirements outlined within it.
Alcohol-related risk reduction scheme (From QOF into contract)
The alcohol-related risk reduction enhanced service will end and associated funding will be reinvested into
global sum. From 1 April 2015 it will be a contractual requirement for all practices to identify newly
registered patients aged 16 or over who are drinking alcohol at increased or higher risk levels
There is just one new code you can use:
6897. Anxiety screening
Everything else is the same
Patient Participation (From QOF into contract)
The patient participation enhanced service will end and associated funding will be reinvested into global
sum. From 1 April 2015, it will be a contractual requirement for all practices to have a patient participation
group (PPG) and to make reasonable efforts for this to be representative of the practice population
Staying:
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NHS number must be included on all clinical correspondence
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Submit data to SCR

Friends and Family Test

Choice of GP Practice

Minor surgery LES is unchanged

Violent Patient LES is unchanged
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Named GP for all patients (New)
With the introduction of a named GP for all patients, in addition to the existing code practices are also
required to use the code ‘patient notified of named general practitioner’ for named GP for patients
aged 75 and over or AUA for reporting the allocation of a named accountable GP.
Practices are required to use the new code ‘patient allocated named accountable general practitioner’
to confirm the practice has allocated a GP to each patient, who was on the practice list prior to 1st April
2015, by the 30 June 2015, or within 21 days if aged 75 or over or newly registered.
For all patients (excluding patients aged 75 and over and those on the AUA register who have been
informed under 14/15 provisions or within 21 days), practices have until 31 March 2016 to notify
individual patients as appropriate.
You need to add:
9NN60 Patient allocated named accountable General Practitioner
And when you inform patients add the Read code:
67DJ. Informing patients of named accountable General Practitioner
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Where the patient expresses a preference as to which GP they have been assigned, the
practice must make reasonable efforts to accommodate this request.

Where any patient has confirmed they do not want a named accountable GP and the contractor
has recorded this in their patient record, the requirement to allocate a named accountable GP
does not apply.

By 31 March 2016 all practices will include on their website and in the practice leaflet, reference
to the fact that all patients have been allocated a named GP and information about patients’
options.

The website and the practice leaflet should inform patients that they have a named GP who is
responsible for patients’ overall care at the practice, that they should contact the practice if they
wish to know who this is, and that if they have a preference as to which GP that is, the practice
will make reasonable efforts to accommodate this request.
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Enhanced Services 2015/2016
The Extended Hours, Dementia and Learning Disabilities enhanced services will be extended and
unchanged for a further year.
Avoiding Unplanned Admissions ES 2015/16 (extended for a further year with changes including
revisions to the reporting process and changes to the payment structure, you may also have to do a patient
survey, but you will be given everything required)
For any health check you do on Patients aged 75 or over, add the Read code:
69DA. Over 75 health check
This ES will commence on 1st April 2015 for one year (subject to review). Practices must be invited to
participate by 30th April 2015 and sign up no later than 30th June 2015 (via CQRS/GPES). Once signed
up, practices will qualify for component one payment. A reporting template must be completed twice a year,
no later than 31st October 2015 and 30th April 2016. Practices will be able to include patients in their 2%
register who have recently died or moved practice just prior to the reporting dates, manually. - The template
will assess performance against the five key requirements of the scheme:
1. GP practice availability
2. Proactive case managements and personalised care planning
3. Reviewing/improving hospital discharge process
4. Internal practice review taking account of both internal and external practice processes
5. Patient survey (subject to feasibility study)
This enhanced service will also now require at least one care review during the year for any patient on the
register from the previous year. Subject to a review of feasibility, this enhanced service may also be
modified to include a patient survey.
By 30th June 2015, or within 21 days if aged 75 or over or newly registered, as well as using the Read
code:
67DJ. Informing patients of named accountable General Practitioner
You need to add:
9NN60 Patient allocated named accountable General Practitioner
This is also for the Patients aged 75 and over.
There is now a Read code available if the patient declines a review of their care plan:
8IAe3 Admission avoidance care plan review declined
These Read codes have only been released in April, so they won’t be available in your clinical systems as
yet.
If a newly registered patient has been on the case-management register at their previous practice, then the
new practice will need to review their care plan, update the care plan, and add the code
8CSB. Admission avoidance care plan agreed.
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Extended Hours Access: (Unchanged)
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The provision of additional clinical sessions (routine appointments including emergency
appointments), provided outside of core contracted hours.
Opening hours for providing those routine appointments must be in line with patient expressed
preferences.
The additional period of the routine appointments provided by the practice must, as a minimum,
equate to weekly extended hours access of 30 minutes per 1,000 registered patients.
Routine appointments must be provided by the practice in continuous periods of at least 30 minutes.
Extended hours access must be provided on a regular basis in full each week
Where a practice provides OOH services, it must not limit access to any of these clinical sessions
Learning Disabilities Health Check Scheme: (Unchanged)
Patients aged 14 and over with Learning disabilities.
You can now code if the patient has declined an annual health check
9HB6. Learning disabilities annual health assessment declined
Facilitating timely diagnosis and support for people with Dementia scheme (Unchanged)
For the initial questioning for memory concern, you can still use:
38C15 Initial memory assessment
8IE50 Initial memory assessment declined
But they have also added the following codes, probably to emphasise what they mean by initial questioning
for memory concern:
38Qj. DemTect scale
38Qv. Everyday Cognition questionnaire
388m. Mini-mental state examination
3AD3. Six item cognitive impairment test
38Dv. GPCOG - general practitioner assessment of cognition
The only other new code is:
918f0 No longer carer of patient with dementia
Don’t forget if you have to manually enter data onto CQRS because GPES isn’t capable of doing it,
put zero’s for all the management indicators
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Vaccination Programmes (Payment counts on CQRS)
Hepatitis B – no change
MMR – no change
Pertussis (Pregnant women) vaccination – no change
Rotavirus (childhood routine Immunisation) vaccination – no change
Pneumococcal polysaccharide – no change
Shingles (routine aged 70 immunisation) – there will be changes
Shingles (catch-up) vaccination – there will be changes
Seasonal Influenza – they say details will follow, so they must be going to make some changes
Childhood Influenza vaccination – there will be changes
HPV booster vaccination Programme –now item of service payment
New Read Code added:
65Fa. Human papillomavirus vaccination given by other healthcare provider
Meningococcal C Fresher and booster (now item of service payment) vaccination:
New Procedure codes added:
657J. Meningitis ACW & Y vaccination
657J4 Meningitis ACW & Y vaccination given by other healthcare provider
8I23Q Meningitis ACW & Y vaccination contraindicated
657J5 Meningitis ACW & Y vaccination declined
New Vaccine Codes:
n4l7. ACWY VAX injection
n4lA. NIMENRIX powder and solvent for solution for injection
n4l9. MENVEO GROUP A+C+W135+Y conjugate vaccine injection
Childhood immunisations - Men C just 1 dose for the calculation of achievement.
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