The Quality and Outcomes Framework (QOF) is a component of the General Medical Services (GMS) contract, introduced in 2004. It is a voluntary annual reward and incentive programme for all general practices in England, designed to remunerate practices for good quality care provision for their patients and provide funding to further improve quality of healthcare delivered. The QOF contains the following domains: Clinical, Public Health, Public Health — Additional Services and Quality Improvement. Each domain comprises of a set of achievement measures, known as indicators, against which practices attain points depending on level of achievement attained.

Since 2013, the QOF has varied across England and the devolved administrations. In January 2019, NHS England agreed a new five-year framework for GP contract reform to implement The NHS Long Term Plan; this included several improvements to the QOF in line with the recommendations of the QOF Review which was published in July 2018.

In 2022/23 when post-Covid pandemic QOF requirements were fully reinstated, there were no significant changes to the QOF except topics for the Quality Improvement (QI) domain, nor were there changes to QOF indicators or payment thresholds.

2023/24 is the final year of the five-year framework agreement, outlined in Investment and Evolution. The current QOF system will be reviewed during 2023/24 so it becomes more “streamlined and focused”, with a revised model launched next year. Views from GPs, patients and “the broader system” will be sought and considered “to determine the most appropriate form” for QOF in 2024/25. This will build on the Fuller Stocktake report (2022) which set out next steps towards integrating primary care.

The 2023/24 proposed contract changes by the Department of Health and Social Care (DHSC) and NHS England (NHSE) were rejected by the BMA and GP Committee England, and according to BMA, imposed by the Government. There will be minor changes to indicator wordings and values in 2023/24. 

All disease register indicators will be income protected for the year, with funding paid to practices based on 2022/23 performance monthly once the 2022/23 QOF outturn is finalised. The Quality Improvement (QI) modules for 2023/24 will focus on workforce wellbeing and optimising demand and capacity. 

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