Skip navigation

Login / Register


0113 202 9799


Interface Helps GP Practice to Identify and Monitor High-Risk Patients

Marsh Medical Practice, a member of East Lincolnshire CCG, has added over 500 patients to their QOF clinical register following a review by Interface Clinical Services.

The QOF clinical register is a collection of 19 different disease registers of high-risk patient populations. The review at the Marsh Medical Practice added 35 new patients to the osteoporosis register, 40 patients to the heart failure register, 103 to the depression register, and 210 to the chronic kidney disease (CKD) register. 26 patients were also added to the learning disability register, which increased the practice’s prevalence in this domain by almost 200%.

By ensuring all relevant patients are included on the relevant disease registers, Interface pharmacists and the Marsh Medical Practice GPs are ensuring that patients receive the best possible care, and are properly monitored for any deterioration or relevant comorbidities. As a result of this partnership the Marsh Medical Practice were able to add over £11,000 to their annual QOF income, and their projected net gain from QOF income over the next two years is over £20,000

Dr Deaney from Marsh Medical Practice commented, “We were delighted that Interface were able to help us identify so many patients being missed off our QOF clinical registers, particularly in such high-risk disease areas as chronic kidney disease and heart failure. We feel that this review has helped us to minimise the number of patients currently missed off clinical registers, increased awareness of the importance of clinical registers, and improved the overall level of patient care in our practice.”

GP practices are increasingly finding that effective monitoring not only helps to improve patient care, but also reduces the resource demand on the NHS at both primary and secondary levels. Interface, who have over 70 pharmacists, have worked with 3,470 primary care practices throughout the UK, and have recently launched an annual QOF refresh service in response to increased demand from GP practices. Interface offer practices a free initial audit to identify potential gaps in patient care, areas where a practice’s prevalence could be improved, and ways to boost QOF point earnings. Following this initial assessment practices can decide whether or not they want to proceed with a full review.

QOF Disease Prevalence Coding Support

Our Clinical Pharmacists are now able to offer coding support across a number of QOF domains

Find out more