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QOF Quality Improvement (QI) Modules – What’s it all about?

Published: 29th August 2019

Once we have all recovered from the flurry of activity around working out which Primary Care network we will be in, submitted the paperwork and started to plan activities, it might be time to look at some of the other aspects of the new contract we need to get our teeth into.

One of these is the introduction of QI into the QOF. I thought it might be helpful to provide a bit of background into why NHSE is trying out a change of direction in how it financially rewards high quality care.  Remember, this is just my take on it, but I sit on the National steering group for the QI in QOF modules, so it’s a pretty well informed view.

Since the introduction of QOF in 2004 we have been rewarded for achieving targets for certain disease areas, or practice processes.  Unfortunately, the results in terms of improving patient outcomes turned out to be a bit disappointing. Practices became adept at ‘jumping through hoops’ but didn’t necessarily get any better at the skills needed for continuous improvement.

The idea behind introducing ‘QI Modules’ rather than targets is that practices can be flexible and, mostly, work on a project that is specific to their patient needs, aiming towards an outcome that is valued by the patients and the practice, and using sound QI methods.

The first 2 modules introduced this year are Prescribing Safety and End of Life Care. There will be a more to come in future years, so it’s worth getting to grip with the basic principles, as they will all follow a similar line.

This link goes through what is meant by QI methods in more detail.

If you haven’t got time at the moment to read the whole document, I’ll try to explain in a few paragraphs, using the prescribing safety module as an example.

First – Check your context

This means allocating some time for the work, and to involve your whole team. This includes your PCN, as the modules require us to discuss and share our QI work across our network, so someone will need to ensure these meetings get scheduled and take place.

Second – Work out what you need to improve

In the prescribing safety module, we have been instructed to look at our NSAID, Lithium and Valproate in women with child-bearing potential. If we have no patients on lithium then we need to choose another potentially risky drug.  We need to look at what we are currently doing to see where there is room for improvement.

Third – Understand the problem

Use some tools to work out why the problem occurs, and what systems might be making it difficult to do the right thing, or to sustain improvements you may have made in the past.

Fourth – Plan and test out some changes

Share ideas with your PCN and learn from each other.  Gather data to see if you are improving things

Fifth – Report your project

There is a one-page template to do this from

If you want to know about opportunities for GPs, GPNs , Practice managers and support staff to find out more about QI and build their skills then contact the GP Excellence team on


Joanna Bircher

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