NHS England will remove 32 QOF indicators and invest their funding into global sum, childhood vaccinations and cardiovascular prevention as part of the next GP contract.
The indicators that will be removed include establishing and maintaining registers of cancer patients, and of patients with a learning disability, dementia, heart failure, hypertension and arterial disease (see box).
The commissioner wrote to practices today to outline the changes for the 2025/26 contract agreed via a deal ‘in principle’ with the BMA.
NHS England primary care director Dr Amanda Doyle said the 32 QOF indicators which were income protected in 2024/25 will be ‘permanently retired’. This equates to 212 QOF points worth around £298m in 2025/26.
Of the 212 points, 71 points – worth around £100m – will be ‘removed outright’ and will be invested into global sum and into increases in both the Item of Service Fee for routine childhood vaccinations (from £10.06 to £12.06) and the locum reimbursement rates in the Statement of Financial Entitlements (SFE).
Dr Doyle added that the remaining 141 QOF points (about £198m) will be ‘targeted towards cardiovascular disease (CVD) prevention’ to support the Government’s ambition to reduce premature mortality from heart disease or stroke by 25% within a decade.
The points will be redistributed ‘proportionately’ across nine CVD prevention indicators.
While the lower thresholds for these indicators will be maintained at 2024/25 levels to offer the maximum opportunity to earn QOF points, the upper achievement levels will be raised for 2025/26.
QOF changes
DHSC and NHS England will permanently retire the 32 QOF indicators income protected in 24/25. This equates to 212 QOF points worth c.£298 million in 25/26 of which:
In order to support the government’s ambition to reduce premature mortality from heart disease or stroke by 25% within a decade:
- the upper achievement levels will be raised for the CVD prevention indicators that will increase in value for 25/26
- the lower thresholds will be maintained at 2024/25 levels to offer the maximum opportunity to earn QOF points for these indicators.
There will also be a small number of technical changes to QOF indicators that will bring indicators into alignment with NICE guidelines that have been updated and republished since the scheme was last published.
Source: NHS England
A further £12m repurposed from the retired QOF indicators will go towards increasing locum reimbursement payments relating to parental leave, sickness absence, prolonged study leave (including educational allowance payment) and suspended doctors.
Dr Doyle said: ‘These payments were increased by 6% in 2024/25 following the Government response to the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) recommendations but had not been increased for a number of years previously.
‘The payments will increase in line with previous pay uplifts (effectively unwinding the previous freeze) with the new payment amounts set out in the 2025/26 SFE. The overall cost of this will be c£12 million in 2025/26 with funding drawn from a portion of the removed QOF indicators.’
The new contract also includes changes to the routine childhood and adult schedules in 2025/26, including an additional dose of Hib-containing multivalent (6-in-1) vaccine and the second dose of MMR vaccine brought forwards (see box).
There will also be a change to the adult shingles programme, reflecting new evidence on the effectiveness of the vaccination for a broader severely Immunosuppressed (SIS) cohort and a potential introduction of a varicella vaccine, subject to ‘final ministerial agreement’.
Vaccinations and immunisations
Following recommendations by The Joint Committee on Vaccination and Immunisations (JCVI), the following changes will be made to the routine childhood and adult schedules in 2025/26:
- two changes to the childhood vaccination schedule, driven by the discontinuation of the Menitorix (Hib/MenC) vaccine, including:
- an additional dose of Hib-containing multivalent (6-in-1) vaccine, offered at a new immunisation visit at 18 months of age.
- the second dose of MMR vaccine brought forwards from 3 years 4 months to the new immunisation visit at 18 months of age to improve coverage.
- the exchange of MenB and PCV vaccines within the childhood schedule (subject to final ministerial agreement).
- a change to the adult shingles programme, reflecting new evidence on the effectiveness of the vaccination for a broader severely Immunosuppressed (SIS) cohort.
- the potential introduction of a varicella vaccine, subject to final ministerial agreement, in quarter 2 of 2025/26.
- an amendment to the requirement to record the dried blood spot test for at risk babies, allowing that recording to take place between 12 and 18 months.
The detailed changes to the routine childhood schedule will be supplemented with further guidance. All changes (to both the childhood and adult routine schedules) will be included in an amended version of the SFE in 2025/26.
In response to feedback from GPC England and reflecting the key role that general practice plays in efforts to increase uptake in childhood vaccinations, the Item of Service (IoS) fee for routine childhood immunisations that are part of essential services will increase by £2 to £12.06 in 2025/26. There will be an evaluation during 2025/26 of the effect that these changes have on activity, uptake and inequalities in uptake.
The 2025/26 SFE will list all the vaccinations and immunisations which are in scope of the increase in the Item of Service fee. c.£17.8 million of the funding generated through the retired QOF indicators will be used to cover the estimated costs of this increase.
The SFE will also be amended to address inconsistencies in the treatment of patients that move practice. Currently, if a patient receives a vaccination at their practice and subsequently moves to a new practice in month, either only the new practice is paid or no practice is paid, depending on the receiving GP system supplier. The SFE will make clear that the receiving practice will be paid for the intervention. This is consistent with the approach to payments for departing patients taken elsewhere in the GP contract
Source: NHSE
The 2025/26 GP contract will see almost £800m invested into the global sum, as well as changes to the funding for recruiting GPs via the additional roles reimbursement scheme (ARRS) which will no longer be ringfenced.
Medical accountant Andy Pow, adviser to the board of the Association of Independent Specialist Medical Accountants (AISMA), said that practices in England ‘will be relieved’ to hear that funds will be available to cover staff cost uplifts from 1 April 2025 and will welcome the ‘sizeable increase’ in the global sum.
He added: ‘However, the devil will be in the detailed announcements to come and, since the majority of the extra money is going into the global sum, there will be the usual winners and losers among practices.
‘We also need to understand how the funding to cover National Insurance cost increases will work for primary care networks (PCNs).
‘Practices and PCNs need to plan their finances for the year ahead as a matter of urgency, so the full funding announcement can’t come soon enough.’
The 32 QOF indicators that will be removed
| CAN001 | The contractor establishes and maintains a register of all cancer patients defined as a ‘register of patients with a diagnosis of cancer excluding non-melanotic skin cancers diagnosed on or after 1 April 2003 |
| CAN004 | The percentage of patients with cancer, diagnosed within the preceding 24 months, who have a patient Cancer Care Review using a structured template recorded as occurring within 12 months of the date of diagnosis |
| CAN005 | The percentage of patients with cancer, diagnosed within the preceding 12 months, who have had the opportunity for a discussion and informed of the support available from primary care, within 3 months of diagnosis |
| CKD005 | The contractor establishes and maintains a register of patients aged 18 or over with CKD with classification of categories G3a to G5 (previously stage 3 to 5) |
| CHD001 | The contractor establishes and maintains a register of patients with coronary heart disease |
| HF001 | The contractor establishes and maintains a register of patients with heart failure |
| HYP001 | The contractor establishes and maintains a register of patients with established hypertension |
| PAD001 | The contractor establishes and maintains a register of patients with peripheral arterial disease |
| STIA001 | The contractor establishes and maintains a register of patients with stroke or TIA |
| DEM001 | The contractor establishes and maintains a register of patients diagnosed with dementia |
| DM017 | The contractor establishes and maintains a register of all patients aged 17 or over with diabetes mellitus, which specifies the type of diabetes where a diagnosis has been confirmed |
| EP001 | The contractor establishes and maintains a register of patients aged 18 or over receiving drug treatment for epilepsy |
| LD004 | The contractor establishes and maintains a register of patients with learning disabilities |
| DEP004 | The percentage of patients aged 18 or over with a new diagnosis of depression in the preceding 1 April to 31 March, who have been reviewed not earlier than 10 days after and not later than 56 days after the date of diagnosis |
| MH001 | The contractor establishes and maintains a register of patients with schizophrenia, bipolar affective disorder and other psychoses and other patients on lithium therapy |
| MH021 | Percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who received all six elements of the Physical Health Check for people with Severe Mental Illness |
| OB003 | The contractor establishes and maintains a register of patients aged 18 years or over living with obesity, appropriately adjusted for ethnicity in line with NICE guidelines – either with a BMI ≥30 in the preceding 12 months, or a BMI greater than or equal to 27.5 kg/m2 recorded in the preceding 12 months for patients with a South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family background |
| OST004 | The contractor establishes and maintains a register of patients: Aged 50 or over and who have not attained the age of 75 with a record of a fragility fracture on or after 1 April 2012 and a diagnosis of osteoporosis confirmed on DXA scan, and Aged 75 or over with a record of a fragility fracture on or after 1 April 2014 and a diagnosis of osteoporosis |
| PC001 | The contractor establishes and maintains a register of all patients in need of palliative care/support irrespective of age |
| AF001 | The contractor establishes and maintains a register of patients with atrial fibrillation |
| AST005 | The contractor establishes and maintains a register of patients with asthma aged 6 years or over, excluding patients with asthma who have been prescribed no asthma related drugs in the preceding 12 months |
| AST008 | The percentage of patients with asthma on the register aged 19 or under, in whom there is a record of either personal smoking status or exposure to second-hand smoke in the preceding 12 months |
| COPD014 | The percentage of patients with COPD and Medical Research Council (MRC) dyspnoea scale ≥3 at any time in the preceding 12 months, with a subsequent record of referral to a pulmonary rehabilitation programme (excluding those who have previously attended a pulmonary rehabilitation programme) |
| COPD015 | The contractor establishes and maintains a register of: patients with a clinical diagnosis of COPD before 1 April 2023 and patients with a clinical diagnosis of COPD on or after 1 April 2021 whose diagnosis has been confirmed by a quality assured post bronchodilator spirometry FEV1/FVC ratio below 0.7 between 3 months before and 6 months after diagnosis (or if newly registered at the practice in the preceding 12 months a record of an FEV1/FVC ratio below 0.7 recorded within 6 months of registration) and patients with a clinical diagnosis of COPD on or after 1 April 2023 who are unable to undertake spirometry |
| RA001 | The contractor establishes and maintains a register of patients aged 16 or over with rheumatoid arthritis |
| SMOK005 | The percentage of patients with any or any combination of the following conditions: CHD, PAD, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma, schizophrenia, bipolar affective disorder or other psychoses who are recorded as current smokers who have a record of an offer of support and treatment within the preceding 12 months |
