Navigating the New QOF Landscape: Your Guide to the 2025/26 Changes for GP Practices

The Quality and Outcomes Framework (QOF) is a cornerstone of general practice funding and quality improvement in England. As you know, it directly impacts practice income and reflects national health priorities. The 2025/26 contract year introduces some of the most significant QOF reforms we've seen, shifting focus dramatically towards preventative care, particularly Cardiovascular Disease (CVD), and aiming to streamline some administrative tasks.

Understanding these changes is crucial for practices. It allows you to plan effectively, allocate resources efficiently, manage your team's workload, and maintain financial stability in the year ahead. This guide breaks down what's changing, why it matters, and offers practical strategies to help your practice navigate the updated framework with confidence.

The Headline Changes: What's In and What's Out?

The biggest shift in the 2025/26 QOF involves retiring many indicators and concentrating funding elsewhere:

1. Indicator Retirement: 32 QOF indicators, which were income-protected during 2024/25, have been permanently retired. This removes 212 QOF points from the framework.

2. Funding Reallocation: The funding tied to these retired points (around £298 million) has been split:

   • Reinvested Elsewhere (71 points, c. £100 million): This money is now outside QOF, bolstering core funding and services. It contributes to:

     • An increase in the Global Sum payment (approx. £70.4 million).

     • Higher fees for childhood vaccinations (Item of Service fee up from £10.06 to £12.06, approx. £17.8 million).

     • Increased locum reimbursement rates for leave/absence (approx. £12 million).

   • Redistributed within QOF (141 points, c. £198 million): These points and funds have been added to nine specific indicators focused on Cardiovascular Disease (CVD) prevention.

This represents a clear change in direction from NHS England. Many retired indicators involved maintaining registers or basic review processes. The funding boost now heavily incentivises achieving measurable clinical targets, especially in managing blood pressure and cholesterol for high-risk patients. While the boost to the Global Sum offers some stability, the guaranteed income from the retired protected indicators is gone. Practices must now actively earn points in the remaining, more demanding areas.

What's Out? The Retired QOF Indicators for 2025/26

It's essential to know which activities are no longer directly incentivised under QOF from 1 April 2025. This allows you to adjust workflows and potentially refocus effort. The following 32 indicators are retired:

(Source: Adapted from NHS England GP Contract documentation)

What's In? The Enhanced Focus on Cardiovascular Disease (CVD)

The significant shift of funding towards CVD prevention aligns with the national goal to reduce premature deaths from heart disease and stroke. QOF is being used as a key lever to improve prevention and management of high blood pressure (hypertension) and high cholesterol.

Key points:

• Increased Points: 141 QOF points (worth c. £198 million) are now concentrated across nine CVD indicators.

• Higher Targets: The upper achievement thresholds (the percentage of patients needing to meet the target to get maximum points) have been significantly increased, often to 85% or 90%.

• Focus Areas: These indicators target blood pressure control (for patients with hypertension, CHD, stroke/TIA, diabetes) and cholesterol management (statin prescribing, achieving target lipid levels).

Comparison: Enhanced CVD Indicators (2024/25 vs 2025/26)

This table shows the scale of change for the nine enhanced CVD indicators:

*Note: DM036 replaces DM033. 2024/25 figures are for the closest equivalent.

(Source: Adapted from NHS England GP Contract documentation and analyses)

Implication: Achieving maximum points now requires managing almost all eligible patients to target. There's very little room for patients not meeting criteria, making proactive management and accurate exception coding (Personalised Care Adjustments - PCAs) absolutely vital. This requires intensive clinical effort, efficient recall systems, and potentially new ways of working (like using clinical pharmacists for medication reviews).

Other Important Indicator Tweaks

Beyond CVD, there are technical updates to align other indicators with current clinical guidelines (like those from NICE - the National Institute for Health and Care Excellence):

• Asthma (AST):

  • AST012 (Objective Diagnosis): Replaces AST011 for new diagnoses. Requires objective testing (wider than just spirometry, reflecting new guidelines) within 6 months around the diagnosis date.

  • AST007 (Asthma Review): Wording updated per new guidelines. No longer explicitly requires a validated questionnaire, but core review elements remain.

• Cholesterol (CHOL):

  • CHOL003 (Statin Prescribing): Technical tweak regarding icosapent ethyl.

  • CHOL004 (Cholesterol Target): Clarifies which reading/target applies if multiple tests are done.

• Diabetes Mellitus (DM):

  • DM036 (BP Control <80): Replaces DM033, explicitly adds age ≤79 criterion.

  • DM034 & DM035 (Statin Prescribing): Wording updated to align with CHOL003 regarding alternatives if statins declined/unsuitable.

• Atrial Fibrillation (AF):

  • AF008 (DOAC Prescribing): Adds 'Invite PCA' coding options for patients invited but not attending.

The asthma diagnosis change (AST012) might require the most significant process adjustment, needing familiarity with newer, more complex diagnostic pathways beyond spirometry.

Key Challenges for Your Practice in 2025/26

These reforms, while aiming for some simplification, bring new pressures:

1. Meeting Tougher Targets: The high 85-90% thresholds for CVD indicators are demanding. This will require optimised pathways and may be harder for practices with complex patient populations.

2. Concentrated Financial Risk: With so much funding tied to just nine CVD indicators, income is more vulnerable to performance fluctuations in these specific areas. Underperformance here has a bigger impact than before.

3. Shift in Workload Intensity: While fewer indicators exist overall, the remaining high-value ones need more intensive management: rigorous monitoring, proactive recalls, medication adjustments, and meticulous coding. This shifts the focus and potentially increases workload intensity for staff involved in chronic disease.

4. Adapting Systems: Practices need reliable IT searches, recall systems, progress tracking, and accurate data capture. This might require optimising clinical systems or adapting administrative workflows.

5. Loss of 'Easy Wins': The income from the 32 retired (previously protected) indicators is gone. All QOF income now needs to be actively earned through current performance in the remaining, often harder, indicators.

These factors could widen the gap between practices. Those with robust systems and resources may adapt well, while others might struggle, potentially impacting income.

Practical Strategies for QOF Success in 2025/26

A proactive approach can help your practice maximise achievement:

• Plan & Prioritise:

  • Recognise the huge financial weight of the nine CVD indicators – focus effort here.

  • Model potential financial scenarios early.

  • Make QOF achievement a team-wide objective.

• Build Robust Systems:

  • Use accurate clinical system searches to identify eligible patients.

  • Implement proactive recall systems, starting early in the QOF year (April/May).

  • Use IT systems for regular performance monitoring (e.g., monthly reports).

  • Consider efficient clinic models (e.g., 'one-stop shops' for long-term conditions).

• Ensure Accurate Coding:

  • Emphasise meticulous SNOMED CT coding for diagnoses, outcomes, and especially valid exceptions/PCAs. Avoid local codes.

  • Train staff on specific exception coding rules (e.g., 'lipid lowering therapy declined' vs. 'statin declined').

  • Ensure accurate diagnosis coding to maintain correct prevalence adjustments.

• Optimise Clinical Management & Team Roles:

  • Focus clinical effort on intensifying treatment for patients not at target (BP, cholesterol).

  • Use the full skill mix – clinical pharmacists for med reviews, HCAs/nurses for recalls/checks.

  • Train relevant staff on the new indicators, thresholds, and guidelines.

• Engage Patients:

  • Offer and document personalised lifestyle advice (smoking, diet, activity, alcohol).

  • Use techniques like motivational interviewing.

  • Provide patient education (e.g., home BP monitoring).

  • Use multiple communication methods for recalls (SMS, letter, app, phone).

• Be Opportunistic:

  • Where appropriate during routine consultations, check for outstanding QOF tasks (e.g., smoking status, BP check).

• Collaborate:

  • Engage with your Primary Care Network (PCN) and Integrated Care Board (ICB) for potential shared resources or support.

Understanding the Financial Bottom Line

Your final QOF payment depends on points achieved, the QOF point value, your practice list size, and disease prevalence adjustments.

• QOF Point Value 2025/26: £225.49

• Contractor Population Index (National Average List Size): 10,184

• Total Available Points: 564 (down from 776)

What if Our Performance Stays the Same as Last Year?

If your practice's clinical activity and achievement percentages remain identical to 2024/25, you will likely see a net decrease in your overall QOF payment for 2025/26.

• Why? The main reason is the loss of income from the 212 retired points (which were previously protected). While you'll earn more points for static performance in the enhanced CVD indicators (because more points are available for them), this gain is unlikely to fully offset the loss of the 212 points. Furthermore, because the CVD thresholds are now much higher, static performance means you likely won't achieve the maximum points available in these valuable areas.

This means maintaining the status quo is not financially neutral. Practices need to adapt and improve performance, especially in CVD management, to mitigate potential income loss.

Looking Ahead

The 2025/26 QOF marks a significant shift, demanding adaptation from GP practices. The focus on high-impact CVD prevention is clear, requiring enhanced clinical performance and efficient systems. While challenging, these changes also offer opportunities to streamline some processes and earn rewards for improving outcomes in a critical area.

Success requires understanding the new rules, strategic planning, robust processes, accurate data, and engaging the whole practice team. Remember, these changes occur within the context of ongoing GP contract negotiations, suggesting further evolution may lie ahead. For now, adapting effectively to the 2025/26 framework is key to delivering high-quality care and ensuring financial sustainability.