NHS primary care trusts in England and the analogous bodies elsewhere in the UK (Health Boards in Scotland, Regional Boards in Northern Ireland and Local Health Boards in Wales), which make the related payments. Changes to the framework The GMS contract was revised in April 2006 and, in particular, the QOF was adjusted. The clinical domain was extended from 11 to 18 areas and 138 points were reassigned. The total number of points was reduced to 1000 and the 50 points that were previously attainable through "access points" are now folded into an "access" Directed Enhanced Service (DES). The clinical areas now include coronary heart disease, heart failure, stroke and transient ischaemic attacks, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, epilepsy, hypothyroidism, cancer, palliative care, mental health and asthma. Added in 2006 were dementia, depression, chronic kidney disease, atrial fibrillation, obesity, learning disabilities and smoking. QOF version 10 was introduced in July/August 2007, with mainly minor changes to the system, removing, adding or changing codes in the clinical areas to bring them in line with current guidance or to fix typing errors. Further changes to the QOF for 2008 included the addition of new indicators for COPD and smoking cessation. Points have been removed from the access and patient experience domains. Further changes have occurred on an annual basis although no changes took place for the 2010-11 year for all practices to deal with Swine Flu. New indicators are developed and approved by a committee of the National Institute for Health and Clinical Excellence. Approved indicators are presented as a "menu" which is passed to the contract negotiators. In the past year only a minority of the indicators in the menu have actually been put into the framework. QMAS was replaced by the Calculating Quality Reporting Service (CQRS) in 2013. Exception reporting The level of achievement recorded depends on the GP treating the patients with the relevant problem(s). But not all patients are treatable or willing to be treated. In order for the GPs not to lose points on account of circumstances that are outside their control they can exclude those patients from counting towards their achievement by "exception reporting" them. Exception reporting is allowed for: patients who refuse to attend; patients for whom chronic disease reporting is inappropriate (e.g. terminal illness, extreme frailty); newly diagnosed or recently registered patients; patients who do not show improvement; patients for whom prescribing