Asthma diagnosis guidance for the QOF has been updated in 2025/26 so that it no longer conflicts with NICE’s separate UK joint guidelines issued last autumn.
GP practices were left facing confusion last November after long-awaited UK asthma guidance produced by NICE, the British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines Network (SIGN) revealed significant changes to recommendations on testing, which differed from QOF advice.
Now, the two have been reconciled – QOF guidance published last week has replaced indicator AST011 that refers to initial diagnosis with a new one, AST012. Points and targets for the indicator remain unchanged.
The guidance said: ‘This indicator was updated…to reflect the recommendations made within the new combined asthma guideline produced by the BTS, NICE and the SIGN in November 2024.’
‘A combination of a suggestive clinical history and a supporting objective test is needed to diagnose asthma, with different objective testing sequences for adults, and children and young people aged 5 to 16,’ it added.
Effectively, this now means that for adults and over-16s, GPs are advised to use a stepwise series of tests including eosinophil count, FeNO, spirometry and bronchial challenge in patients where the condition is suspected on clinical grounds.
Meanwhile, a QOF expert has warned that GP practices will have to work harder to maintain their QOF income levels under the 2025/26 contract changes.
Swindon GP Dr Gavin Jamie, who runs the QOF database website, told Pulse’s sister title Management in Practice that the changes may prove challenging in some areas as the upper achievement levels have been raised.
From this month, the 32 QOF indicators that were income protected in 2024/25 will be permanently retired. These equate to 212 points worth around £298m in 2025/26.
NHS England also announced that 141 QOF points, worth around £198m, will be redistributed proportionately among the nine cardiovascular disease (CVD) 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.
Dr Jamie said: ‘The effect of this is to increase payment for existing achievement as well as pay for further achievement above the current thresholds. Practices who are at the current thresholds would expect to get about 78% of the transferred points.’
He warned that while practices may change how they do things to adapt to the new targets and maximise points, ‘blood pressure targets, particularly in patients under 80, may prove challenging’.
Dr Jamie added: ‘The cholesterol indicators are probably going to be the most difficult to meet the upper threshold as these were already some of the more challenging indicators, particularly to get cholesterol levels down.
‘Exception reporting will play a part, but this may be limited. Blood pressure and cholesterol treatments are not always popular with patients as the benefits are not visible but side effects can be very apparent’.
All this coupled with the fact that a lot of the points that have been moved are from register indicators where there will be no reduction in the workload means ‘there is certainly going to be more work for practices to maintain income,’ Dr Gavin said.
According to Dr Jamie, the 2025/26 QOF changes will effectively mean there will no longer be indicators for:
- Peripheral arterial disease
- Depression
- Cancer
- Chronic Kidney Disease
- Epilepsy
- Learning disabilities
- Osteoporosis
- Rheumatoid arthritis
- Palliative care
- Obesity.
A recent analysis of the 2025/26 contract by LMCs suggested that practices could lose income due to the QOF changes.
Berkshire, Buckinghamshire and Oxfordshire (BBO) LMCs ‘conservatively’ estimated that the financial loss from the QOF adjustments will range between zero and £1.00 per patient.
A version of this article first appeared in our sister title Management in Practice
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