Some £10m will be added to QOF funding for the introduction of a new indicator relating to non-diabetic hyperglycaemia, which is worth 18 points. Practices will be expected to offer an annual HbA1c test to patients to support early identification of people who would have gone on to develop type-2 diabetes.
The value of a QOF point will increase from £187.74 to £195.83.
The contract agreement also puts forward a number of changes to the asthma, COPD and heart failure domains.
Clinicians will be expected to use a minimum of two diagnostic tests to confirm an asthma diagnosis and also record details about exposure to smoking in children and young people under the age of 19.
For COPD there are changes to the requirements of how patients are included on the register. Any patients added to the register after 1 April will need to have a clinical diagnosis plus a record of post bronchodilator spirometry FEV1/FVC ratio below 0.7. Practices will also need to record the number of exacerbations a patient has experienced in the preceding year during their annual review.
Meanwhile, a new indicator worth seven points will cover annual reviews for patients on the QOF heart failure register, during which practices will be expected to review medication and assess functional capacity.
The quality improvement (QI) domain for 2020/21 will focus on improving care for patients with learning disabilities and supporting early cancer diagnosis. Both modules have been developed by the RCGP, NICE and the Health Foundation.
Practices will be expected to help improve participation in the national breast, cervical and bowel cancer screening programmes, as well as improving referral and safety netting for patients suspected of having cancer. This module will support the primary care network service specification for early cancer diagnosis, which has also been agreed as part of the contract deal.
The QI module for learning disabilities will encourage practices to improve identification of people with a learning disability, increase uptake of annual health checks and medicine optimisation reviews and encourage social prescribing to help patients to maintain health and wellbeing.
A further change to the QOF will see the current primary prevention of cardiovascular disease indicator CVD-PP001, which relates to statin treatment for patients newly diagnosed with hypertension, retired.
Future changes for QOF
Payment thresholds for this year remain unchanged. However, the way thresholds are calculated will be reviewed during 2020, which could lead to changes from April 2021.
From April 2021, a new QOF domain covering vaccinations will be introduced as part of a wider overhaul of how practices are paid for immunisations. As part of this process it is likely that QOF indicators related to flu vaccinations will be removed. These incentive payments will instead be covered at primary care network level and paid for from the new Investment and Impact Fund, which works in a similar way to the QOF and offers additional funding for PCNs based on their performance.
The contract documents also reveal that the BMA and NHS England are looking at whether to include referral to weight management services for patients who are overweight in future years of the QOF. However, this is only likely to happen when such services exist 'universally and in sufficient volume' across England.
From this April there will be a non-contractual obligation for GPs to offer to refer people with obesity into weight management services where clinically appropriate and where the services are available.
An evaluation of the QI domain, which was only added to the QOF in April last year, is currently underway and this will feed into future contract negotiations. Modules covering CVD prevention and detection, shared decision making, anxiety and depression, antibiotic prescribing, wider primary prevention and preventing prescription drug dependency are all under development and will be considered for inclusion in future years of the QOF.