Tips to maximise income from QOF in 2025/26

Dr Gavin Jamie summarises the changes to QOF for this year and provides tips for practices on achieving maximum points and income

Changes to the Quality and Outcomes Framework (QOF) have now become an annual tradition and this year is no exception.

This year is a little unusual as most of the changes are about financial rewards rather than the requirements themselves. One thing that has not changed is the effective cash value of points which has been frozen since at least 2018. In effect, QOF payments have fallen as a proportion of total income over that time.

Overview of changes

For the last couple of years, a number of indicators have been ‘income protected’. This meant that the points awarded were based on historical figures from previous years and practices were almost guaranteed to receive the payment for those indicators.

This year, all 32 of these protected indicators have been abolished and the money associated with them moved to other places – releasing 212 points.

A third of those points, about £1.50 per patient, will go into the global sum and to help fund a rise to Item of Service fee childhood vaccination and the locum reimbursement rates.

Another 43% of those points will be relatively simple for practices to earn as part of QOF. The final 25% (about 50 points) will require new levels of achievement.

We also see some minor changes to indicators to bring them up to date with current clinical guidance. There are no new indicators this year so there are not likely to be any new processes for practices to implement, but some existing indicators are now significantly more challenging and may require existing processes to be more robust.

What’s been removed?

All disease register indicators have been removed. These were those that were typically worded as, ‘the practice establishes and maintains a register of patients with …’

There were many disease areas that had, over the years, been pared down to just having a register indicator, and so these have disappeared completely. These include:

Peripheral arterial disease
Depression
Cancer
Chronic kidney disease (CKD)
Epilepsy
Learning disability
Osteoporosis
Rheumatoid arthritis
Palliative care
Obesity.

Most of these will have a minimal impact on practices, but some are covered by other parts of the contract. The learning disability directed enhanced service will continue this year, and carried most of the cash associated with the assessments.

Cancer has lost all of its indicators, which included reviews and assessment of patients with cancer. Obesity previously rewarded annual body mass index checks on patients with a BMI of over 30. This will no longer be incentivised and could potentially be stopped.

The Quality Improvement indicators, which never really took off, have now been finally abolished. The specific indicator for smoking cessation interventions in patients with chronic disease has been removed but the more general indicator for smoking cessation advice in the general population remains, although it earns much less reward.

Which areas have increased points?

Some of the cash from the QOF points has moved into the global sum, and to fund increases to locum reimbursement rates and the immunisation IoS payment.

However, 141 points have been moved to cardiovascular disease (CVD) prevention indicators – or blood pressure targets and cholesterol targets. The blood pressure targets are spread across the hypertension, stroke, coronary heart disease (CHD) and diabetes areas. These have been accompanied by increases in the upper threshold of the indicators – higher levels of achievement will be needed in order to earn maximum points.

These now stand at 85% for targets in the hypertension area and 90% for blood pressure targets in the other disease areas (the box below sets out the former upper thresholds).

The additional points more than cover the increased thresholds, meaning that there are extra points available even at the old threshold. Think of this as a points boost for the old indicator plus extra points on top for achieving the new higher threshold. So, in the case of hypertension indicators, if your practice hit the top thresholds exactly in the past, you can expect to get around three quarters of the transferred points.

As an example, the former upper threshold in the hypertension area of patients under 80 was 77%, to earn the maximum 14 points. This year, the upper threshold has increased to 85% but the points that can be gained have also risen to 38. If a practice only hits the target at the old threshold (77%), it means that this year it would receive over 31 points – more than double than in 2024/25.

How to meet the targets

To achieve the full points, including those for the increased threshold, practices will require an efficient system to identify patients whose blood pressure is not controlled to target – that is clinic readings 140/90 for patients under 80 years old and 150/90 for patients aged 80 or older. Equivalent home or ambulatory targets are 135/85 and 145/85.

Starting this process earlier in the year allows time to adjust treatment and retest. In some cases, exception reporting may apply where maximum treatment is reached or where the treatment is unsuitable or is declined by the patient.

The cholesterol indicators have also received a substantial increase in points. The indicator for prescribing statins to patients with cardiovascular disease has increased from 14 to 38 points with the upper threshold remaining at 95%.

All practices should expect their points total to more than double for this indicator. The average achievement by practices in 2023/24 was around 91%, so it may require some work to get the full points. This can be awkward to code as, if a statin is declined or not suitable, then a prescription for an alternative cholesterol reducing therapy (bempedoic acid, ezetimibe, inclisiran or PCSK9 inhibitor) is required. More general exclusions such as lipid reducing therapy being unsuitable are permitted.

The second cholesterol indicator, for treatment to target, also has a jump from 16 to 44 points but there is also a rise in the upper threshold from 35% to 50% of patients.

The targets remain at ≤ 2.0 mmol/L for LDL and ≤ 2.6 mmol/L. There is a small change this year so that the most recent of either will count. In 2023/24, the average achievement in this area was 39% so attaining the upper threshold may require some effort for many practices. Once again identifying patients with higher cholesterol earlier in the year will allow time to increase treatment and retest. There are exception codes for maximum tolerated treatment or ‘lipid lowering therapy declined’. Simply declining statins is not enough to except patients from this indicator.

This movement of points also affects prevalence calculations. The payment per patient for coronary heart disease (CHD) has roughly doubled to £41 per patient on the register, if you earn full points.

There is probably greater scope to increase the hypertension register and the payment per patient at full points has again doubled to around £8. Identifying patients with hypertension and making sure that they have a hypertension diagnosis code will be more valuable this year.

What clinical changes have been made?

There are a couple of changes to the requirements of individual indicators. These reflect updates to NICE guidance rather than new priorities. The indicator for achieving the target blood pressure in patients with diabetes previously excluded patients with moderate or severe frailty. This exclusion has now been expanded to also include all patients 80 years and older, whatever their frailty status. This will mean fewer patients qualify for this indicator and, along with the increase in points, every patient who qualifies will be worth more.

NICE updated its asthma guidelines at the end of 2024. There are many changes but for QOF the relevant parts are to do with confirming the diagnosis. Previously two objective tests were needed to be used together to meet the QOF requirements. The new guidelines use objective tests in sequence rather than in combination and are different for adults and children.

While we don’t have the full business rules for the QOF indicator yet the guidance states that any test will mark a patient as having achieved this indicator. This is a simplification of what was previously quite a complicated indicator but practices should consider the whole of the updated NICE guidelines as well as the QOF requirements.

Conclusion

The changes to QOF will make the processes a little simpler for practices. Financially, money has been taken from indicators with almost universal achievement and we have been given more challenging targets set to earn it back.

There is a bit less cash in QOF this year, inflation has eroded its value, and it will be harder work to achieve maximum points. Practices looking for financial gains should look elsewhere in the contract.

Dr Gavin Jamie is a GP in Swindon and runs the QOF database website

Key points

A total of 564 points are available under QOF for 2025/26.
The value of a QOF point for 2025/26 is £225.49.
The Contractor Population Index, which reflects the national average practice list size and is used to calculate QOF payments for 2025/26 is 10,184.

Indicator	Lower threshold 2025/26 (remain unchanged	Upper threshold 2025/26 (figure in brackets is for last year)	QOF points (figure in brackets is for last year)
CHOL003 Percentage of patients on the QOF Coronary Heart Disease (CHD), Peripheral Arterial Disease (PAD), Stroke/ Transient Ischaemic Attack (TIA) or Chronic Kidney Disease (CKD) Register who are currently prescribed a statin, or where a statin is declined or clinically unsuitable, another lipid-lowering therapy	70%	95% (unchanged since last year)	38 (14)
CHOL004 Percentage of patients on the QOF Coronary Heart Disease (CHD), Peripheral Arterial Disease (PAD), or Stroke/Transient Ischaemic Attack (TIA) Register, with the most recent cholesterol measurement in the preceding 12 months, showing as ≤ 2.0 mmol/L if it was an LDL (Low-density Lipoprotein) cholesterol reading or ≤ 2.6 mmol/L if it was a non-HDL (High-density Lipoprotein) cholesterol reading.	20%	50% (35%)	44 (16)
HYP008 The percentage of patients aged 79 years or under with hypertension in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less (or equivalent home blood pressure reading)	40%	85% (77%)	38 (14)
HYP009 The percentage of patients aged 80 years or over, with hypertension, in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less, (or equivalent home blood pressure reading)	40%	85% (80%)	14 (5)
STIA014 The percentage of patients aged 79 years or under, with a history of stroke or TIA, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less (or equivalent home blood pressure reading)	40%	90% (73%)	8 (3)
STIA015 The percentage of patients aged 80 years or over, with a history of stroke or TIA, in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less, (or equivalent home blood pressure reading)	46%	90% (86%)	6 (2)
CHD015 The percentage of patients aged 79 years or under, with coronary heart disease, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less, (or equivalent home blood pressure reading)	40%	90% (77%)	33 (12)
CHD016 The percentage of patients aged 80 years or over, with coronary heart disease, in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less, (or equivalent home blood pressure reading)	46%	90% (86%)	14 (5)
DM036 Note that DM036 replaces DM033 from last year. The percentage of patients with diabetes, on the register, aged 79 years and under without moderate or severe frailty in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less (or equivalent home blood pressure reading)	38%	90% (78%)	27 (10)
Source: NHS England