NHS | Presentation to [XXXX Company] | [Type Date]1

Section sub-heading

Issue November 2013

London Area TeamQOF 2013/14 Practice Guide

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 payment verification

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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.

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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)

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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 patient identifiable data on secondary care activity

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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 submitted both to the local CCG and NHS England.

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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.

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Timetable (Provisional)

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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 June 2014

Timetable (Provisional and subject to CQRS functionality)

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 appeal panel.

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• 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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Pre and Post Payment Verification

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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