QOF business rules 24/25: 5 key updates your practice needs to know

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Primary Care

QOF business rules 24/25: 5 key updates your practice needs to know

With every year comes changes to how QOF is awarded. And following significant updates to the GP contract 24/25, NHS England has published its QOF business rules for the next 12 months. Our short read breaks down changes in 5 key areas and what impact it could have on practices.

1. Cholesterol invites

Cholesterol targets (re-named as CHOL003 and CHOL004) are now able to be exception reported based on invites. There are no new codes at present, and a selection of existing codes will be accepted from April 1st. New QOF specific codes have been applied for by NHSE and will likely be added later in the year.

For indicator CHOL004, invites need to be after a latest cholesterol blood test. This is expected and in line with all other invite coding rules such as HYP008 and DM020.

The Suvera take: This could significantly reduce the difficulty of achieving cholesterol targets for practices. A major positive.

2. Other cholesterol exception reports

Patients with a haemorrhagic stroke will be automatically removed from both cholesterol targets. Additionally, a number of exception reports that previously only applied to the statin related target, will now also apply to the blood test target.

This includes:

  • Patients on maximum tolerated therapy
  • Patients where cholesterol care has been recorded as unsuitable
  • Patients who decline cholesterol quality indicator care. Note that declining a statin or lipid lowering therapy does not remove the blood test target
  • Patients who were added to the CHOL register in the last 9 months of the year are automatically exception reported if not complete. Note this only applies to the blood test target, and not the statin target

The Suvera take: This will mostly affect blood test targets. However, if the max payment threshold increases for this target it could present a significant area of opportunity for practices.

3. CHOL004 (blood test) detailed changes

In 2023/24 a “Non-HDL” blood test was primarily used to assess CHOL002. If this was missing, only then would an “LDL” blood test be looked at. This will be reversed for 2024/25. “LDL” is now the primary blood test, and “Non-HDL” is only used if this is missing. Additionally, thresholds have been raised:

  • Non-HDL used to have a normal range of up to 2.5 (exclusive). This is now up to 2.6 and inclusive
  • LDL used to have a normal range of up to 1.6 (exclusive). This is now up to 2.0 and inclusive

The Suvera take: Significantly higher thresholds could be beneficial. However, changes to the LDL target may prove to be harder to hit than the previous non-HDL target which was based on anecdotal data from admin clinics. We also expect the maximum payment threshold for CHOL004 to be raised. A case of watch this space.

4. Updates to ambulatory BP readings

Ambulatory BP readings will now be assessed against ‘home’ BP targets (5 lower). This applies to HYP008, HYP009, DM033 and a number of other targets.

The Suvera take: This is unlikely to make a noticeable difference.

5. Asthma

Despite reports that AST008 (smoking status in patients aged 19 and under) was to be removed from QOF, it remains present in the business rules.

The Suvera take: This target has historically not been a difficult one to achieve with exception reporting on invite.

Looking to get a head start on QOF 24/25?

Suvera is here to help and can deliver virtual clinics to support attainment of chronic disease targets. Whether you’re a practice, PCN or ICB, we have a range of services to suit your needs.

To find out more, contact our team on partnerships@suvera.co.uk or book a meeting here.

Or watch how we helped Shrewsbury PCN achieve their QOF goals in our film.