Does QOF match NHS priorities?

Some disease areas are under or over-represented in QOF compared with their impact on NHS budgets, analysis shows.

QOF targets for cardiovascular diseases, including BP/hypertension, CHD and peripheral artery disease, make up almost 20% of QOF funding, but only 10% of the total NHS budget.


* Cardiovascular diseases include BP/hypertension, CHD peripheral artery disease. Mental health includes depression. Cancer includes cervical screening.

Greater QOF funding for certain disease areas may be warranted in some cases, particularly if they encourage preventive treatment and cut downstream costs.

But other areas are seemingly under-resourced. Obesity consumes £5bn in direct NHS costs (4.6% of the NHS budget), yet has been allocated just £9m (0.9%) of QOF funding.

This mismatch lends support to calls from public health expert Sir Michael Marmot for a greater number of public health-orientated indicators in QOF.

Disease areas

QOF points

QOF cash

% of QOF

NHS costs

% of NHS budget

Cardiovascular disease*

178

£192,932,428

20%

£11.5bn

10.5%

Diabetes

107

£122,152,484

12%

£13.8bn

12.8%

Smoking

75

£85,620,900

8%

£5bn

4.6%

Mental health*

71

£81,054,452

8%

£6.6bn

6.1%

AF & stroke/TIA<

49

£55,938,988

5%

£2.8bn

2.6%

Asthma

45

£51,372,540

5%

£1bn

0.9%

COPD

35

£39,956,420

4%

£800m

0.7%

CKD

32

£36,531,584

4%

£1.5bn

1.3%

Cancer*

33

£36,340,704

4%

£5.2bn

4.7%

Heart failure

29

£33,106,748

3%

£2.2bn

2.0%

Dementia

26

£29,681,912

3%

£1.4bn

1.2%

Rheumatoid arthritis

18

£20,549,016

2%

£700m

0.6%

Osteoporosis

9

£10,274,508

1%

£1.7bn

1.6%

Obesity

8

£9,132,896

1%

£5bn

4.6%

*Cancer includes cervical screening; mental health includes depression; cardiovascular disease includes BP/hypertension, CHD and peripheral artery disease
Sources: DH, NICE, National Rheumatoid Arthritis Society, Kerr et al 2012, Allender et al 2009, British Heart Foundation, NHS England, UK National Screening Committee, Kanavos et al 2012

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