QOF Plus Year 1 - Imperial College London

The low level of remuneration for cervical screening (£2.75 per patient) was also a significantconcern, given the consistently poor performance of Hammersmith and Fulham practicescompared to national levels of attainment ( see Graph A3.3.6.1, p123).Point allocation for the revised QOF+ target aimed to tackle this discrepancy by introducing ascaling factor to normalise like-for-like indicators (CHD 8 and DM 17 now reward at ~£60 perpatient). An element of empirical judgement must also be acknowledged, reflecting experiencefrom practising GPs with the group and their perceptions around the difficulty of attaining eachindicator. Revision was performed through the use of an indicator-specific scaling factor ,applied to the original points-per-percent allocation (equation 5). The concept of a uniformscaling factor , was discussed, reflecting the idea that higher attainment becomesdisproportionately more difficult in a uniform way, but ultimately discounted (so = 1).(5)Table A2.5 shows the adjusted £-per-patient after application of the correction in equation 5.It was originally planned that the number of QOF+ points Qp i, would reflect the distance betweenthe QOF+ threshold and the upper QOF thresholds :(6)However, given the large numbers of practices exceeding the existing QOF upper threshold foreach indicator (see Table A2.1) it was felt that this approach would not adequately reflect thetrue workload to practices. A revised formula was used instead, which is based on the mediandistance to the QOF+ threshold, introduced above:̃ (7)When the lower Tolerance threshold was introduced after consultation with practices, the pointsallocated under this method were divided evenly across the two thresholds (except for non-evenpoint allocations, where the Tolerance threshold receives the remainder).108