A number of specific diseases and medical conditions are measured within the Quality and Outcomes Framework (QOF) within primary care. As part of the General Medical Services contract implemented in 2004, QOF was set out as a means for general practices to measure achievement against a set of clinical and other indicators that reflected the quality of care provided to their patients. A national system was established to support the calculation of GP practice payments according to the achievements against QOF. As well as a number of indicators around establishing a register of patients with specific conditions, there are a number of other indicators relating to the quality of care of these patients diagnosed with medical conditions such as having blood pressure measured annually. These disease registers can be used to measure diagnosed prevalence at a practice level as well as at Clinical Commissioning Group (CCG) level.
In July 2022, Clinical Commissioning Groups (CCGs) ceased to exist and were replaced by the Integrated Care System. Data will still be available at CCG level for some time after July 2022 so this page continues to refer to CCGs and Hull CCG, and continues to present data at the CCG geographical level. Six local CCGs were also combined to form the Humber, Coast and Vale geographical area, which has also ceased to exist. It has been replaced by the Humber and North Yorkshire ICS. However, data will still be available at Humber, Coast and Vale geographical level, and will be presented within our JSNA.
The number of patients registered with Hull GPs is around 305,000 which is higher than the estimated resident population from the Office for National Statistics (which stands at around 260,000). Around 27,000 residents of East Riding of Yorkshire are registered with Hull GPs. Only around 4,000 residents of Hull are registered with GPs outside the Hull area. Estimates of resident population based on the GP registration file are around 24,000 higher than official estimates of the resident population. Thus the QOF data comprises around 91% of Hull residents and around 9% of East Riding of Yorkshire residents. Further discussion around the differences in the population estimates from the Office for National Statistics and the GP registration file can be found within Population Estimates within Population.
Quality of care indicators are also included, and it means that high percentage of the patients diagnosed with the diseases and medical conditions have annual reviews which gives medical staff the opportunity to provide information and encourage their patients to improve their lifestyle behaviours to improve their health, and lower their risk of morbidity and mortality from their condition. The quality of care indicators also assess the numbers of these patient who are on specific medications, have had specific treatments or vaccinations (such as the flu vaccination), and/or who have specific clinical levels (such as blood pressure within an acceptable range). In some cases, the indicator (medication or treatment) is not appropriate for the specific patient due to a contraindication or frailty, or the patient does not attend their reviews. In order for practices not to be penalised financially for this an adjustment is made to the indicator to account for this (Personalised Care Adjustment or previously called exceptions) and further information can be found under Quality and Outcomes Framework.
National QOF data files can be downloaded, and local analysis of the QOF data has been completed for 2020/21 and prevalence was calculated for each of the 32 GP practices.
The diseases and medical conditions covered include (most are for all ages, but others are for specific ages):
- Coronary heart disease (CHD)
- Stroke and transient ischaemic attack (TIA)
- Atrial fibrillation
- Heart failure
- Heart failure due to left ventricular systolic dysfunction (LVSD)
- Hypertension (high blood pressure)
- Peripheral arterial disease (PAD)
- Epilespy (18+)
- Diabetes (17+)
- Non-diabetic hyperglycaemia
- Chronic kidney disease (18+)
- Asthma
- Chronic obstructive pulmonary disease (COPD)
- Cancer diagnosed since 1st April 2003
- Learning disabilities
- Severe mental ill health
- Depression (18+)
- Dementia
- Palliative care
- Osteroporosis (50+)
- Rhematoid arthritis (16+)
- Obesity (18+)
Some of the points that were assigned from achieving specific levels of quality of care targets were subject to income protection during the COVID-19 pandemic so that practices were not penalised financially during this time. The total points available to practices was 567 in 2020/21, and 354 (62%) were subject to income protection based upon historical practice performance and to practices agreeing an approach to QOF population stratification with their commissioner. The four indicators relating to flu coverage for patients with coronary heart disease, chronic obstructive pulmonary disease, stroke / transient ischaemic attack, and diabetes, two cervical screening indicators, and the disease register indicators continued to be paid based on practice performance as well as some quality improvement indicators.
The local analysis file presents the diagnosed prevalence for 2020/21 of these 22 diseases and medical conditions for individual practices, as well as grouped across different practices (by Primary Care Network, deprivation levels of practice patients and age of practice patients), as well as combined at CCG level, and compared with CCGs across Humber, Coast and Vale, and with the England average.
For the practices in Hull, the average deprivation score of patients has been calculated (based on Index of Multiple Deprivation 2019) and the average age of the registered patients has also been calculated. The practices have then been divided into five approximately equal groups (based on total list size) by average deprivation score of registered patients and by average patient age. Thus the diagnosed prevalence can be compared across five deprivation groups and across five age groups to assess if there is a difference in the diagnosed prevalence by deprivation and by age. A statistical test has also been undertaken to assess if the prevalence at practice level is associated with the average deprivation or the average age of registered patients. Furthermore, there are seven Primary Care Networks in Hull. Primary Care Networks are groups of GP practices that are working together to provide care for all their patients (see Primary Care Profiles within Place for more information).
Further details for most of these diseases and medical conditions are covered under specific diseases and medical conditions within Health Factors under Adults or in the case of learning disabilities and mental ill health under Vulnerable Groups.
The Office for Health Improvement & Disparities’ Fingertips also presents most of the indicators as well as additional indicators relating to quality of care of patients at GP practice level, Primary Care Networks, and Clinical Commissioning Group level.
Resources
NHS Digital. Quality and Outcomes Framework. https://qof.digital.nhs.uk/
The Office for Health Improvement & Disparities’ Fingertips. https://fingertips.phe.org.uk/
Updates
This page was last updated on 12 July 2022.
This page is due to be updated / checked in November 2022.