Clinical audits are a way in which to measure and improve the quality of clinical care. This impact toolkit provides suggestions on specific musculoskeletal topic areas for audit – each section includes relevant standards and guidelines to audit performance against and actions to be taken in order to implement the audit.
Guidance on clinical audit process
The diagram below gives an overview of the audit cycle.
Resources on running a high quality clinical audit – including details on the methods, tools, techniques and activities at each stage of a clinical audit – can be found at:
The Quality and Outcomes Framework (QOF)
What is the QOF?
The Quality and Outcomes Framework (QOF) was developed for the GP contract in 2004. It is a voluntary scheme for practices throughout the UK which provides financial incentives to encourage high-quality care.
The QOF is divided into four different domains:
quality and productivity
Every domain has a set of indicators relating to quality standards that can be achieved within that domain grouped under topic-based headings, such as atrial fibrillation or hypertension. Data required should be available from practice clinical systems. In recent years, musculoskeletal indicators have been added to the clinical domain including indicators for rheumatoid arthritis and osteoporosis.
All achievement against quality indicators converts to points. Each point has a monetary value and therefore practices strive to achieve as many quality points as possible to maximise payments. Payments may be adjusted according to the prevalence of the condition in a practice, list size and also factors such as deprivation and rurality. Practice achievement against the QOF is published annually.
Further details can be found at
NICE: About the Quality and Outcomes Framework (QOF).