SUMMARY OF CHANGES TO QOF 2014/15 - ENGLAND KEY No change Indicator Business Exception 14/15 QOF NICE ID Indicator wording Threshold Threshold timeframe timeframe timeframe (months) (months) (months) CLINICAL Atrial Fibrilation (AF)
The contractor establishes and maintains a register of patients with atrial
The percentage of patients with atrial fibrillation in whom stroke risk has been assessed using the CHADS2 risk stratification scoring system in the
preceding 12 months (excluding those whose previous CHADS2 score is greater than 1)
In those patients with atrial fibrillation in whom there is a record of a
2 score of 1 (latest in the preceding 12 months), the percentage of
patients who are currently treated with anti-coagulation drug therapy or
anti-platelet therapyIn those patients with atrial fibrillation whose latest record of a CHADS2
score is greater than 1, the percentage of patients who are currently
Secondary prevention of coronary heart disease (CHD)
The contractor establishes and maintains a register of patients with
coronary heart diseaseThe percentage of patients with coronary heart disease in whom the last
blood pressure reading (measured in the preceding 12 months) is 150/90
mmHg or lessThe percentage of patients with coronary heart disease whose last
measured total cholesterol (measured in the preceding 12 months) is 5
mmol/l or lessThe percentage of patients with coronary heart disease who have had
1 Aug to 31
influenza immunisation in the preceding 1 August 1 September to 31 1 Aug to 31 Mar
March The percentage of patients with coronary heart disease with a record in
the preceding 12 months that aspirin, an alternative anti-platelet therapy,
or an anti-coagulant is being taken The percentage of patients with a history of myocardial infarction (on or after 1 April 2011) currently treated with an ACE-I (or ARB if ACE-I
intolerant), aspirin or an alternative anti-platelet therapy, beta-blocker and
Indicator Business Exception 14/15 QOF NICE ID Indicator wording Threshold Threshold timeframe timeframe timeframe (months) (months) (months) Heart failure (HF)
The contractor establishes and maintains a register of patients with heart
failureThe percentage of patients with a diagnosis of heart failure (diagnosed
on or after 1 April 2006) which has been confirmed by an echocardiogram
or by specialist assessment 3 months before or 12 months after entering
on to the registerIn those patients with a current diagnosis of heart failure due to left
ventricular systolic dysfunction, the percentage of patients who are
currently treated with an ACE-I or ARBIn those patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction who are currently treated with an ACE-I or
ARB, the percentage of patients who are additionally currently treated
with a beta-blocker licensed for heart failure
Hypertension (HYP)
The contractor establishes and maintains a register of patients with
established hypertensionThe percentage of patients with hypertension in whom the last blood
pressure reading (measured in the preceding 12 months) is 150/90
The percentage of patients aged or under with hypertension in whom the
last blood pressure reading (measured in the preceding 9 months) is
140/90 mmHg or lessThe percentage of patients with hypertension aged 16 or over and who
have not attained the age of 75 in whom there is an assessment of
physical activity, using GPPAQ, in the preceding 12 months
The percentage of patients with hypertension aged 16 or over and who have not attained the age of 75 who score ‘less than active’ on GPPAQ
in the preceding 12 months, who also have a record of a brief intervention in the preceding 12 months
Peripheral arterial disease (PAD)
The contractor establishes and maintains a register of patients with
The percentage of patients with peripheral arterial disease in whom the
last blood pressure reading (measured in the preceding 12 months) is
150/90 mmHg or lessThe percentage of patients with peripheral arterial disease in whom the
last measured total cholesterol (measured in the preceding 12 months) is
5 mmol/l or lessThe percentage of patients with peripheral arterial disease with a record
in the preceding 12 months that aspirin or an alternative anti-platelet is
Indicator Business Exception 14/15 QOF NICE ID Indicator wording Threshold Threshold timeframe timeframe timeframe (months) (months) (months) Stroke and transient ischaemic attack (STIA)
The contractor establishes and maintains a register of patients with stroke
or TIAThe percentage of patients with a stroke or TIA (diagnosed on or after 1
From 1 April
April 2008 2014) who have a record of a referral for further investigation
between 3 months before or 1 month after the date of the latest recorded timeframe change
stroke or the first TIA
The percentage of patients with a history of stroke or TIA in whom the last
blood pressure reading (measured in the preceding 12 months) is 150/90
mmHg or lessThe percentage of patients with stroke or TIA who have a record of total
The percentage of patients with a stroke shown to be non-haemorrhagic,
or a history of TIA whose last measured total cholesterol (measured in the
The percentage of patients with stroke or TIA who have had influenza
1 Aug to 31
immunisation in the preceding 1 August 1 September to 31 March 1 Aug to 31 Mar
The percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record in the preceding 12 months that an
anti-platelet agent, or an anti-coagulant is being taken
Diabetes mellitus (DM)
The contractor establishes and maintains a register of all patients aged
17 or over with diabetes mellitus, which specifies the type of diabetes
The percentage of patients with diabetes, on the register, in whom the
last blood pressure reading (measured in the preceding 12 months) is
150/90 mmHg or lessThe percentage of patients with diabetes, on the register, in whom the
last blood pressure reading (measured in the preceding 12 months) is
140/80 mmHg or less The percentage of patients with diabetes, on the register, whose last
measured total cholesterol (measured within the preceding 12 months) is
The percentage of patients with diabetes, on the register, who have a
record of an albumin:creatinine ratio test in the preceding 12 months The percentage of patients with diabetes, on the register, with a
diagnosis of nephropathy (clinical proteinuria) or micro-albuminuria who
are currently treated with ACE-I (or ARBs)The percentage of patients with diabetes, on the register, in whom the
last IFCC-HbA1c is 59 mmol/mol or less in the preceding 12 months
The percentage of patients with diabetes, on the register, in whom the
last IFCC-HbA1c is 64 mmol/mol or less in the preceding 12 months
The percentage of patients with diabetes, on the register, in whom the
last IFCC-HbA1c is 75 mmol/mol or less in the preceding 12 months
Indicator Business Exception 14/15 QOF NICE ID Indicator wording Threshold Threshold timeframe timeframe timeframe (months) (months) (months) Diabetes mellitus (DM).cont.
The percentage of patients with diabetes, on the register, who have had
1 Aug to 31
influenza immunisation in the preceding 1 August September to 31 1 Aug to 31 Mar
MarchThe percentage of patients with diabetes, on the register, who have a
record of retinal screening in the preceding 12 months
The percentage of patients with diabetes, on the register, with a record of a foot examination and risk classification: 1) low risk (normal sensation, palpable pulses), 2) increased risk (neuropathy or absent pulses), 3) high
risk (neuropathy or absent pulses plus deformity or skin changes in
previous ulcer) or 4) ulcerated foot within the preceding 12 months
The percentage of patients with diabetes, on the register, who have a
record of a dietary review by a suitably competent professional in the
preceding 12 monthsThe percentage of patients newly diagnosed with diabetes, on the
register, in the preceding 1 April to 31 March who have a record of being
referred to a structured education programme within 9 months after entry
on to the diabetes register The percentage of male patients with diabetes, on the register, with a
record of being asked about erectile dysfunction in the preceding 12
monthsThe percentage of male patients with diabetes, on the register, who have a record of erectile dysfunction with a record of advice and assessment of
contributory factors and treatment options in the preceding 12 months
Hypothyroidism (THY)
The contractor establishes and maintains a register of patients with
hypothyroidism who are currently treated with levothyroxine
The percentage of patients with hypothyroidism, on the register, with
thyroid function tests recorded in the preceding 12 months
Asthma (AST)
The contractor establishes and maintains a register of patients with
asthma, excluding patients with asthma who have been prescribed no
asthma-related drugs in the preceding 12 monthsThe percentage of patients aged 8 or over with asthma (diagnosed on or
after 1 April 2006), on the register, with measures of variability or
reversibility recorded between 3 months before and anytime after
The percentage of patients with asthma, on the register, who have had
an asthma review in the preceding 12 months that includes an
assessment of asthma control using the 3 RCP questionsThe percentage of patients with asthma aged 14 or over and who have
not attained the age of 20, on the register, in whom there is a record of
smoking status in the preceding 12 months
Indicator Business Exception 14/15 QOF NICE ID Indicator wording Threshold Threshold timeframe timeframe timeframe (months) (months) (months) Chronic obstructive pulmonary disease (COPD)
The contractor establishes and maintains a register of patients with
COPDThe percentage of patients with COPD (diagnosed on or after 1 April
2011) in whom the diagnosis has been confirmed by post bronchodilator
spirometry between 3 months before and 12 months after entering on to
From 1 April 2011 COPDSPIR -3 3 (REG/DIAG)
The percentage of patients with COPD who have had a review, undertaken by a healthcare professional, including an assessment of
breathlessness using the Medical Research Council dyspnoea scale in
the preceding 12 monthsThe percentage of patients with COPD with a record of FEV1 in the
The percentage of patients with COPD and Medical Research Council dyspnoea grade ≥3 at any time in the preceding 12 months, with a record
of oxygen saturation value within the preceding 12 months
The percentage of patients with COPD who have had influenza
1 Aug to 31
immunisation in the preceding 1 August September to 31 March 1 Aug to 31 Mar Dementia (DEM)
The contractor establishes and maintains a register of patients diagnosed
The percentage of patients diagnosed with dementia whose care has
been reviewed in a face-to-face review in the preceding 12 months
The percentage of patients with a new diagnosis of dementia recorded in
the preceding 1 April to 31 March with a record of FBC, calcium, glucose,
renal and liver function, thyroid function tests, serum vitamin B12 and
folate levels recorded between 6 months before or after entering on to
Depression (DEP)
The percentage of patients aged 18 or over with a new diagnosis of depression in the preceding 1 April to 31 March, who have had a bio-
psychosocial assessment by the point of diagnosis. The completion of the
assessment is to be recorded on the same day as the diagnosis is recordedThe percentage of patients aged 18 or over with a new diagnosis of
depression in the preceding 1 April to 31 March, who have been
reviewed not earlier than 10 2 days weeks after and not later than 35 8days weeks after the date of diagnosis Indicator Business Exception 14/15 QOF NICE ID Indicator wording Threshold Threshold timeframe timeframe timeframe (months) (months) (months) Mental Health (MH)
The contractor establishes and maintains a register of patients with
schizophrenia, bipolar affective disorder and other psychoses and other
patients on lithium therapyThe percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive care plan documented
in the record, (in the preceding 12 months) agreed between individuals,
their family and/or carers as appropriateThe percentage of patients with schizophrenia, bipolar affective disorder
and other psychoses who have a record of blood pressure in the
preceding 12 monthsThe percentage of patients aged 40 or over with schizophrenia, bipolar
affective disorder and other psychoses who have a record of total
cholesterol:hdl ratio in the preceding 12 monthsThe percentage of patients aged 40 or over with schizophrenia, bipolar
affective disorder and other psychoses who have a record of blood
glucose or HbA1c in the preceding 12 monthsThe percentage of patients with schizophrenia, bipolar affective disorder
and other psychoses who have a record of BMI in the preceding 12
monthsThe percentage of patients with schizophrenia, bipolar affective disorder
and other psychoses who have a record of alcohol consumption in the
preceding 12 monthsThe percentage of women aged 25 or over and who have not attained
the age of 65 with schizophrenia, bipolar affective disorder and other
psychoses whose notes record that a cervical screening test has been
The percentage of patients on lithium therapy with a record of serum
creatinine and TSH in the preceding 9 months
The percentage of patients on lithium therapy with a record of lithium
levels in the therapeutic range in the preceding 4 months
Cancer (CAN)
The contractor establishes and maintains a register of all cancer patients defined as a ‘register of patients with a diagnosis of cancer excluding non-
melanotic skin cancers diagnosed on or after 1 April 2003’
The percentage of patients with cancer, diagnosed within the preceding 15 months, who have a patient review recorded as occurring within 3 6
months of the contractor receiving confirmation of the diagnosis
Indicator Business Exception 14/15 QOF NICE ID Indicator wording Threshold Threshold timeframe timeframe timeframe (months) (months) (months) Chronic kidney disease (CKD)
The contractor establishes and maintains a register of patients aged 18
or over with CKD (US National Kidney Foundation: Stage 3 to 5 CKD)
The percentage of patients on the CKD register in whom the last blood
pressure reading (measured in the preceding 12 months) is 140/85
mmHg or lessThe percentage of patients on the CKD register with hypertension and
proteinuria who are currently treated with an ACE-I or ARB
The percentage of patients on the CKD register whose notes have a
record of a urine albumin:creatinine ratio (or protein:creatinine ratio) test
Epilepsy (EP)
The contractor establishes and maintains a register of patients aged 18
or over receiving drug treatment for epilepsy
The percentage of patients aged 18 or over on drug treatment for
epilepsy who have been seizure free for the last 12 months recorded in
the preceding 12 monthsThe percentage of women aged 18 or over and who have not attained the age of 55 who are taking antiepileptic drugs who have a record of
information and counselling about contraception, conception and pregnancy in the preceding 12 months
Learning disability (LD)
The contractor establishes and maintains a register of patients aged 18
The percentage of patients on the learning disability register with Down’s Syndrome aged 18 or over who have a record of blood TSH in the
preceding 12 months (excluding those who are on the thyroid disease
Osteoporosis: secondary prevention of fragility fractures (OST)
The contractor establishes and maintains a register of patients: 1. Aged 50 or over and who have not attained the age of 75 with a record of a fragility fracture on or after 1 April 2012 and a diagnosis of
osteoporosis confirmed on DXA scan, and 2. Aged 75 or over with a record of a fragility fracture on or after 1 April 2012The percentage of patients aged 50 or over and who have not attained the age of 75, with a fragility fracture on or after 1 April 2012, in whom
osteoporosis is confirmed on DXA scan, who are currently treated with an
The percentage of patients aged 75 or over with a diagnosis of osteoporosis, with a fragility fracture on or after 1 April 20142, who are
currently treated with an appropriate bone-sparing agent
Indicator Business Exception 14/15 QOF NICE ID Indicator wording Threshold Threshold timeframe timeframe timeframe (months) (months) (months) Rheumatoid arthritus (RA)
The contractor establishes and maintains a register of all patients aged
The percentage of patients with rheumatoid arthritis, on the register, who
have had a face-to-face review in the preceding 12 months
The percentage of patients with rheumatoid arthritis aged 30 or over and who have not attained the age of 85 who have had a cardiovascular risk
assessment using a CVD risk assessment tool adjusted for RA in the preceding 12 monthsThe percentage of patients aged 50 or over and who have not attained the age of 91 with rheumatoid arthritis who have had an assessment of
fracture risk using a risk assessment tool adjusted for RA in the preceding 24 months
Palliative care (PC)
The contractor establishes and maintains a register of all patients in need
of palliative care/support irrespective of age
The contractor has regular (at least 3 monthly) multidisciplinary case
review meetings where all patients on the palliative care register are
PUBLIC HEALTH Indicator Business Exception 14/15 QOF Indicator wording Threshold Threshold timeframe timeframe timeframe (months) (months) (months) Cardiovascular disease - primary prevention (CVD-PP)
In those patients with a new diagnosis of hypertension aged 30 or over and who have not attained the age of 75, recorded between the
preceding 1 April to 31 March (excluding those with pre-existing CHD,
CVD-PP001 CVD-PP001
diabetes, stroke and/or TIA), who have a recorded CVD risk assessment
score (using an assessment tool agreed with the NHS CB) of ≥20% in the
preceding 12 months: the percentage who are currently treated with
statins The percentage of patientsdiagnosed with hypertension (diagnosed after on or after 1 April 2009) who are given lifestyle advice in the preceding 12
months for: smoking cessation, safe alcohol consumption and healthy diet
Blood pressure (BP)
The percentage of patients aged 40 45 or over who have a record of Obesity (OB)
The contractor establishes and maintains a register of patients aged 16
or over with a BMI ≥30 in the preceding 12 months
Indicator Business Exception 14/15 QOF Indicator wording Threshold Threshold timeframe timeframe timeframe (months) (months) (months) Smoking (SMOK)
The percentage of patients aged 15 or over whose notes record smoking
The percentage of patients with any or any combination of the following
conditions: CHD, PAD, stroke or TIA, hypertension, diabetes, COPD,
CKD, asthma, schizophrenia, bipolar affective disorder or other
psychoses whose notes record smoking status in the preceding 12
The contractor supports patients who smoke in stopping smoking by a
strategy which includes providing literature and offering appropriate
therapyThe percentage of patients aged 15 or over who are recorded as current
smokers who have a record of an offer of support and treatment within
The percentage of patients with any or any combination of the following conditions: CHD, PAD, stroke or TIA, hypertension, diabetes, COPD,
CKD, asthma, schizophrenia, bipolar affective disorder or other
psychoses who are recorded as current smokers who have a record of an
offer of support and treatment within the preceding 12 months
Cervical Screening (CS)
The contractor has a protocol that is in line with national guidance agreed with the NHSCB for the management of cervical screening, which
includes staff training, management of patient call/recall, exception
reporting and the regular monitoring of inadequate sample rates
The percentage of women aged 25 or over and who have not attained
the age of 65 whose notes record that a cervical screening test has been
The contractor ensures there is a system for informing all women of the
The contractor has a policy for auditing its cervical screening service, and performs an audit of inadequate cervical screening tests in relation to
individual sample takers at least every 2 years
Child Health Surveillance (CHS)
Child development checks are offered at intervals that are consistent with
national guidelines and policy agreed with the NHS CB
Maternity Services (MAT)
Antenatal care and screening are offered according to current local
Contraception (CON)
The contractor establishes and maintains a register of women aged 54 or under who have been prescribed any method of contraception at least
once in the last year, or other clinically appropriate interval e.g. last 5
years for an IUSThe percentage of women, on the register, prescribed an oral or patch contraceptive method in the preceding 12 months who have also
received information from the contractor about long acting reversible
methods of contraception in the preceding 12 months
The percentage of women, on the register, prescribed emergency hormonal contraception one or more times in the preceding 12 months by
the contractor who have received information from the contracator about
long acting reversible methods of contraception at the time of or within 1
QUALITY AND PRODUCTIVITY Indicator Business Exception 14/15 QOF Indicator wording Threshold Threshold timeframe timeframe timeframe (months) (months) (months)
The contractor reviews data on secondary care outpatient referrals, for
patients on the contractor's registered list, provided by the NHS CB
The contractor participates in an external peer review with other contractors who are members of the same clinical commissioning group
to compare its secondary care outpatient referral data with that of the
other contractors. The contractor agrees with the group, areas for commissioning or service design improvementsThe contractor engages with the development of and follows 3 care pathways, agreed with the NHS CB, for improving the management of
patients in the primary care setting (unless in individual cases they justify
clinical reasons for not doing this) to avoid inappropriate outpatient referralsThe contractor reviews data on emergency admissions, for patients on
the contractor's registered list, provided by the NHS CB
The contractor participates in an external peer review with other contractors who are members of the same clinical commissioning group
to compare its data on emergency admissions with that of the other
contractors. The contractor agrees with the group, areas for commissioning or service design improvementsThe contractor engages with the development of and follows 3 care pathways, agreed with the NHS CB, (unless in individual cases they
justify clinical reasons for not doing this) in the management and treatment of patients in aiming to avoid emergency admissionsThe contractor reviews data on accident and emergency attendances, for patients on the contractor's registered list, provided by the NHS CB. The
review will include consideration of whether access to clinicians in the
contractor's premises is appropriate, in light of the patterns on accident and emergency attendanceThe contractor participates in an external peer review with other contractors who are members of the same clinical commissioning group to compare its data on accident and emergency attendances with that of the other contractors. The contractor agrees an improvement plan with
the group. The review should include, if appropriate, proposals for
improvement to access arrangements in the contractors premises in order to reduce avoidable accident and emergency attendances and may also include proposals for commissioning or service design improvements.
The contractor implements the improvement plan that aims to reduce
avoidable accident and emergency attendances. PATIENT EXPERIENCE Indicator Business Exception 14/15 QOF Indicator wording Threshold Threshold timeframe timeframe timeframe (months) (months) (months)
The contractor ensures that the length of routine booked appointments with doctors in the surgery is not less than 10 minutes. If the contractor routinely admits extras patients during booked surgeries, then the average booked consultation length should allow for the average number of extras seen in a surgery session such that the length of the booked appointments is not less than 10 minutes. If the extras patients are seen at the end of surgery, then it is not necessary to make this adjustment.
For contractors with only an open surgery system, the average face-to-face time spent by the GP with the patient is not less than 8 minutes. Contractors that routinely operate a mixed economy of booked and open surgeries should ensure that the length of the booked appointments is not less than 10 minutes and the length of the open surgery appointments is not less than 8 minutes
Clin. Psychol. Psychother. 5, 126±144 (1998)Michelle L. Van Etten1 and Steven Taylor2*1Department of Psychiatry, University of Michigan, USA2Department of Psychiatry, University of British Columbia, Vancouver, CanadaA meta-analysis was conducted on 61 treatment outcome trials for post-traumatic stress disorder (PTSD). Conditions included drug therapies(TCAs, carbamazepine, MAOIs, SSRIs, and
Electric Vehicle Incentive Guidelines, Dealerships, and Vehicles Application Guidelines 1. Applicant must be an Austin Energy electric customer. 2. Applicant intends to live in the Austin Energy service area for a minimum of five years. 3. Five (5) qualifying electric vehicles, of any combination, per applicant are eligible. 4. Qualifying all-electric vehicle must be new and purchased from
SUMMARY OF CHANGES TO QOF 2014/15 - ENGLAND