Intro: The Quality and Outcomes Framework (QOF) remains a significant source of income for most practices but it's under increasing pressure. This year brings notable changes to indicators and targets, but behind the headlines lies a growing inequality in how QOF rewards are distributed. In this post, I’ll highlight what’s changed, explain how funding is calculated, and explore practical ways to protect and improve your QOF earnings.
What’s New in 2025/26
NHS England has updated several QOF indicators this year, primarily within cardiovascular disease and diabetes. Key changes include:
Cholesterol control: For patients with CVD, the LDL ≤2.0 mmol/L or non-HDL ≤2.6 threshold now attracts more points, and has a higher upper target of 50%, reflecting NICE guidance and statin optimisation.
HbA1c targets: More weight is now given to tighter glycaemic control. Practices will need to focus on the percentage of non-frail patients achieving <58 mmol/mol.
Hypertension, CHD and Stroke: Targets for blood pressure control have increased, and more points are now available.
The total QOF points has reduced by 71, with funding moved to Global Sum and Childhood Immunisation DES payments.
How QOF Income Is Calculated (and Why It’s Not Always Fair)
QOF funding is not based on raw point scores alone. Instead, payments are adjusted in two key ways:
List size: Payments are based on your registered population, but this figure is weighted using the CPI (Correction Factor) which accounts for workload. If your list size hasn't kept pace with the national average increase, your income per point can fall, even if your actual workload has risen.
Disease prevalence: For most clinical indicators, QOF payments are also adjusted for practice-level prevalence. The higher your recorded prevalence of CVD, hypertension, diabetes, AF, asthma or COPD, the more you're paid per point in those areas. But this creates a major issue: Many practices are recording falling or static prevalence while patient complexity and comorbidity are rising. This mismatch means QOF income doesn't always reflect the true burden of care.
What You Can Do About It
Achieving maximum points is the obvious way to maximise QOF income, and that will be more difficult this year. However, your disease registers matter, and so does the quality of coding. Here are two proactive steps to maximise your QOF returns:
1. Audit Your Registers
Use EMIS or SystmOne searches to identify patients who may meet diagnostic criteria but are not on registers. For example:
Patients with multiple raised HbA1c results (≥48 mmol/mol) who aren’t coded as diabetic
Patients with AF on ECGs but no AF diagnosis
Patients with persistent high blood pressure readings without a hypertension code
Patients on inhalers without an Asthma or COPD diagnosis
Patients on cardiovascular drugs without any cardiovascular disease
2. Consider Register Validation Services
Several companies now offer disease register validation, running searches across your clinical system to spot miscoded or missed diagnoses. These services often pay for themselves in the additional QOF income they uncover, and they can also improve your long-term LTC management by ensuring accurate records.
Resources to Help You Hit the Targets
Two of my recent blog posts can support your QOF efforts in 2025/26:
Cholesterol Management – Covers statin optimisation and how to safely aim for the lipid target.
HbA1c Control – Outlines practical steps to tighten diabetic control while avoiding over-treatment.
Together, these posts offer both clinical and operational strategies to boost your QOF performance in the areas where it matters most this year.
Final Thoughts
QOF still offers a vital income stream, but practices that don’t monitor prevalence and disease register accuracy may find themselves earning less for doing more. With a few simple steps, some internal, some outsourced, you can make sure your hard work translates into fair rewards.