We would recommend following the general premise of:

Spending many hours ploughing through lists of patients trying to chase technicalities to add patients to your disease registers can be counterproductive.  This is because of a number of different factors:

Your prevalence is rebased each year

If every Practice in the country is doing lots of work to improve their prevalence, the national prevalence will go up and so next year the value of your prevalence will be reduced.  Indeed the only way it can work is if your prevalence is consistently above average year on year, which is a challenge.

If you look at prevalence from 2004 to now:

1. Asthma has increased from 5.8% to 6%
2. Cancer has increased from 0.5% to 3.2%
3. COPD has increased from 1.4% to 1.9%
4. Diabetes has increased from 3.4% to 5.8%
5. Heart failure has increased from 0.4% to 0.9% 
6. Hypertension has increased from 11.4% to 13.9%
7. Mental health has increased from 0.5% to 0.9%
8. Stroke has increased from 1.5% to 1.8%

We know that prevalence is increasing year on year, hopefully because Practices are becoming better at clinical coding and appropriately caring for patients, but the overall pot of income for QOF has not gone up (except by negotiated contractual increases). This all means an average Practice will have higher disease registers, be doing more work, but be paid the same.

If you increase your prevalence, you will have more work to do to achieve your indicators 

If you have more patients on a disease register, it follows you will need to do more work to achieve the indicator targets in this area.  In fact the value of QOF points closely follows the amount of work that is needed for that area.

You may also not achieve full marks in that indicator because of the increased workload, which will certainly derail any planned increase in income.

Also if you increase your prevalence in a register with no achievement (e.g. CKD) you may well find that targets appear in future QOF years which you will then find it hard to achieve.

A worked example of the impact of chasing prevalence:

In the following table you can see each of the QOF areas subject to ADPF, with the points for that indicator.  The next column shows the average prevalence for England and if we assume that a Practice achieves a 20% on this, that is shown in the next column.  The increased income from the increased prevalence is seen in the next column.  Looks good right?

Well that’s only half the story.  As with any business turnover is vanity and net profit is sanity, so yes you’ll increase your turnover, but now let’s look at the impact of the additional work.  In the next column you can see the additional number of patients you would need to care (or achieve the target for).  To give a better idea of the work you can see for each of the indicators the income that you would get additionally for each patient.   This is widely variable, but you can also see that the bigger areas are also those where there is more work needed.  For those indicators where there is not much to do, the increase from the prevalence is very little.

Remember we also haven’t costed all the time that has been spent by administrators or clinicians running searches to look at prevalence, chase patients, explain diagnoses and then organise recall for them!

So anybody who tells you increasing prevalence is going to increase your practice income is not telling the whole story.