QOF
A plain-English guide to the Quality and Outcomes Framework for 2026/27
What is QOF?
In one sentence: QOF is the national incentive scheme that pays your practice for meeting defined quality standards across clinical care, public health, vaccination, and quality improvement.
It works on a points system — approximately 653 points across ~76 indicators in 2026/27. Each point is worth roughly £208, adjusted for your list size and disease prevalence. For an average practice, QOF is typically 8-10% of total income.
Why this matters for 2026/27
- 18 additional points (~£25m) — new obesity indicators, combined CVD indicators, updated heart failure and diabetes measures
- 10 indicators retired — replaced by simpler, combined versions aligned with current NICE guidance
- Vaccination rewards improved— new improvement thresholds mean you're rewarded for progress, not just absolute performance
- Register changes — asthma from age 5, COPD rules updated. Check your registers.
QOF isn't going away
Despite periodic debate about QOF's future, it continues to be a significant income stream for practices. The 2026/27 changes are about modernising and simplifying — aligning indicators with current evidence, combining duplicates, and adding clinically meaningful new areas (obesity, heart failure 4-pillar therapy).
Where the Points Are
Grouped by clinical theme for clarity (the official QOF has 5 formal domains — Clinical, Public Health, Public Health Additional Services, Vaccination, and Quality Improvement). Click any segment to see the indicators and what's changed for 2026/27:
Where to focus
Cardiovascular (178 pts) and Diabetes & Metabolic (106 pts) together account for over 40% of all QOF points — and both have significant 2026/27 changes. These are your highest-value areas to get right.
How Your QOF Money is Calculated
QOF payment isn't just “points × value per point”. Here's the actual pipeline your money flows through:
Points achieved
Your practice earns points for each indicator where you meet the threshold. For most indicators, you earn a proportion of the available points based on where your achievement falls between the lower and upper thresholds.
e.g. CD001 (CVD BP control): lower threshold 40%, upper 90%. If you achieve 65%, you earn roughly half the 41 available points.
Multiply by value per point
Each QOF point has a national monetary value — approximately £208 for 2026/27. This is the starting point for your calculation.
e.g. 587 points achieved × £208.41 = £122,337 (before adjustments)
Adjust for list size
Your payment is scaled by the Contractor Population Index (CPI), which reflects your registered list size relative to the national average. More patients = proportionally more money.
e.g. Practice with 12,000 patients vs. average ~10,171: list factor ≈ 1.18
Adjust for prevalence
For clinical indicators, your payment is further adjusted by the prevalence of each condition in your practice. Higher prevalence = higher payment for that domain — you're treating more patients with that condition.
e.g. Your diabetes prevalence is 8% vs. national 7.3%: prevalence factor ≈ 1.05 for diabetes indicators
Aspiration + achievement split
QOF payments are made in two parts: an aspiration payment at the start of the year (based on prior year performance), and an achievement payment at year-end (the balance based on actual performance). If you under-achieve, you may owe money back.
Typically: 70% paid as aspiration (monthly), 30% settled at year-end based on actual achievement
The aspiration trap
Your aspiration payment (monthly advance) is based on last year's performance. If your achievement drops this year — perhaps because new indicators are harder to meet — you may need to pay money back at year-end. Monitor your QOF dashboard throughout the year, not just in March.
Estimate Your QOF Income
Enter your list size and expected achievement to get a rough estimate of your QOF income for 2026/27:
Estimate Your QOF Income
A rough guide — actual payments depend on prevalence, Contractor Population Index, and aspiration/achievement split. But this gives you the ballpark.
Points achieved
588 / 653
List factor
×0.98
Estimated QOF income
£120,423
Per patient
£12.04
Based on ~£208.41 per point, 653 total points, average list size 10,171. Excludes prevalence adjustment and aspiration/achievement split. For illustrative purposes only.
This is a rough guide
The actual calculation includes prevalence adjustments per domain, the Contractor Population Index, and the aspiration/achievement split. But this gives you the right order of magnitude — useful for budgeting and understanding what's at stake.
What's Changed for 2026/27
The theme is simplification: combine duplicate indicators, align with current NICE guidance, and add clinically meaningful new areas.
| Code | What it measures | Thresholds | Points |
|---|---|---|---|
| CD001 | BP control in CVD patients ≤79 (non-frail) | 40–90% | 41 |
| CD002 | BP control in CVD patients 80+ (non-frail) | 46–90% | 20 |
| DM037 | All 8 NICE diabetes care processes completed annually | 35–75% | 10 |
| HF009 | 4-pillar therapy in heart failure (HFrEF) | 20–50% | 12 |
| OB004 | Referral to weight management programme (BMI ≥30) | 10–30% | 5 |
| OB005 | Obesity: shared decision-making or pharmacotherapy (BMI ≥30) | 50–80% | 13 |
| Code | Change | Thresholds | Points |
|---|---|---|---|
| DM034 | Primary prevention statin — points increased | 50–90% | 4 → 8 |
| DM035 | Secondary prevention statin — points increased | 50–90% | 2 → 8 |
| CHOL003 | Statin therapy in high-risk CVD — points decreased | 70–95% | 38 → 20 |
| NDH003 | Pre-diabetes — gestational diabetes cohort added | 50–90% | 18 → 20 |
| AF006 | Anticoagulation in AF — upper threshold raised | 90→95% | 12 |
| STIA007 | Antiplatelet post-stroke/TIA — ticagrelor added | 57–97% | 4 |
| VI001 | Childhood vaccination — improvement thresholds added | 89–96% | 18 |
| VI002 | Childhood vaccination — MMRV + improvement thresholds | 86–96% | 18 |
| VI003 | Childhood vaccination — MMRV + improvement thresholds | 81–96% | 18 |
| Code | What it was | Replaced by |
|---|---|---|
| CHD015 | BP ≤140/90 in CHD | CD001 |
| CHD016 | BP ≤150/90 in CHD aged 80+ | CD002 |
| DM012 | 3 of 8 diabetes care processes | DM037 (all 8) |
| HF003 | Heart failure specialist referral | HF009 |
| HF006 | ACEi/ARB in HFrEF | HF009 (4-pillar) |
| HYP008 | BP ≤140/90 in hypertension | Renamed to HYP010 (frailty removed) |
| HYP009 | BP ≤150/90 in hypertension aged 80+ | Renamed to HYP011 (frailty removed) |
| NDH002 | Pre-diabetes blood test | NDH003 (updated) |
| STIA014 | BP ≤140/90 post-stroke/TIA | CD001 |
| STIA015 | BP ≤150/90 post-stroke/TIA aged 80+ | CD002 |
Register changes to action now
- Asthma register: Business rules now include patients from age 5. Run a search for children aged 5+ with asthma codes who aren't on your register.
- COPD register: Rules amended to address under-recording and over-recording. Audit your register — are patients with spirometry-confirmed COPD being missed? Are patients without spirometry being over-included?
Net effect on your practice
The retired indicators were worth significant points, but the replacement indicators cover the same clinical ground with fewer, combined measures. The net addition is 18 points (~£25m nationally). The main risk is if your clinical system searches aren't updated for the new indicator definitions — run them early.
Exception Reporting
Exception reporting (formally Personalised Care Adjustment) lets you remove patients from an indicator's denominator when the indicator genuinely doesn't apply. It's not a loophole — it's a safety valve that protects both patients and practices.
Click each category to see when it applies and examples:
Getting exception reporting right
- Document everything: Every exception needs a clinical reason in the patient record — not just a code
- Audit your rates: High exception rates trigger ICB scrutiny. If your practice is an outlier, be able to explain why
- Don't over-exception: It reduces your denominator but also signals potential quality concerns. Use it when genuinely appropriate, not as a shortcut to higher achievement
- Three invitations rule:For “did not attend” exceptions, document three separate invitations before exception-reporting
Glossary
QOF jargon decoded:
QOF
Quality and Outcomes Framework
The national incentive scheme that rewards GP practices for meeting defined quality indicators across clinical, public health, vaccination, and quality improvement domains. Points earned translate to income, adjusted for list size and disease prevalence.
QOF point
The unit of measurement in QOF. Each point has a national monetary value (~£208 for 2026/27), adjusted by your list size and prevalence. The total framework has approximately 653 points across all domains.
Indicator
A specific quality measure within QOF — e.g. 'percentage of patients with diabetes who have had all 8 NICE care processes in the last 12 months' (DM037). Each indicator has a code, definition, lower threshold, upper threshold, and points value.
Domain
A grouping of related indicators. The five QOF domains are: Clinical, Public Health, Public Health Additional Services, Vaccination & Immunisation, and Quality Improvement.
Lower threshold
The minimum achievement percentage at which you start earning points for an indicator. Below this, you get zero points. Typically 25-50% depending on the indicator.
Upper threshold
The achievement percentage at which you earn the maximum points for an indicator. Anything above this doesn't earn additional points. Typically 80-97%.
Prevalence
The proportion of your registered patients on a specific disease register. Higher prevalence increases your QOF payment for that clinical domain — you're managing more patients with that condition. Calculated as the square root of the ratio to national prevalence.
CPI
Contractor Population Index
The adjustment factor based on your registered list size. A practice with more patients receives proportionally more per QOF point. Calculated relative to the national average list size.
Aspiration payment
The advance monthly QOF payment made at the start of the year, based on your prior year's achievement. Typically ~70% of your expected total. The balance is settled at year-end based on actual performance.
Achievement payment
The year-end settlement — the difference between your actual QOF achievement and the aspiration payments already received. Can be positive (you did better than expected) or negative (you may owe money back).
Exception reporting
Personalised Care Adjustment
The mechanism for removing patients from an indicator's denominator when the indicator genuinely doesn't apply — informed dissent, clinical inappropriateness, contraindication, recent registration, non-attendance. Not a loophole — a safety valve.
Disease register
The list of patients in your clinical system coded with a specific condition (e.g. diabetes, COPD, CHD). Register accuracy directly affects your QOF prevalence and therefore your income. Worth auditing regularly.
Business rules
The detailed technical specifications for each QOF indicator — which clinical codes count, time periods, age ranges, exclusions. Published annually by NHS Digital. Your clinical system applies these automatically, but understanding them helps you optimise achievement.
Practice QOF Checklist
Things to review, delegate, or discuss with your QOF lead. Getting QOF right is about starting early, not a year-end scramble.
Start now, not in March
- Run new indicator searches this month — know where you stand on CD001/CD002, DM037, HF009, and the obesity indicators
- Audit your registers — asthma (age 5+) and COPD changes affect prevalence and payment
- Set up obesity pathways — OB004/OB005 are entirely new and need referral routes and templates
Sources:
GP Contract 2026/27 (NHS England, March 2026) | QOF Database (NHS Digital) | QOF Guidance 2026/27 (NHS England) | QOF Achievement Data (NHS Digital)
Built by an NHS GP. Last updated: April 2026.