Changes to the QOF framework for 2026/27 were imposed by NHS England, following GPC England’s rejection of the contract offer for that year.
These changes include:
- Updating the childhood vaccination indicators to reflect the introduction of the MMRV vaccine
- Introducing a new diabetes indicator requiring delivery of all 8 NICE recommended care processes
- Adding 2 new obesity related indicators to support referrals into structured weight management programmes and medicines optimisation. (The previous Weight Management Enhanced Service has been retired).
- Updating the heart failure indicators to reflect the NICE recommended ‘4 pillars’ of treatment.
Childhood vaccinations
NHS England has introduced additional improvement thresholds for the 3 childhood vaccination QOF indicators (VI001, VI002 and VI003).
Whilst existing thresholds for these vaccination indicators remain unchanged practices will have an additional opportunity to earn QOF points by improving against their own baseline, calculated as a 2‑year average.
At year‑end, practices will receive whichever points allocation is higher of:
- points based on traditional achievement thresholds, or
- points awarded on a sliding scale for improvement from baseline
The lower improvement threshold is set at 5 percentage points above baseline for all 3 indicators with an expanded range between lower and upper improvement thresholds. The new improvement thresholds are:
- VI001: 5–18 percentage points
- VI002: 5–23 percentage points
- VI003: 5–30 percentage points
The maximum QOF points available for each of these indicator is unchanged.
Obesity indicators
Two new obesity related indicators have been introduced (OB004, and OB005), intended ‘to support referrals into structured weight management programmes and medicines optimisation’, replacing the existing Weight Management DES, which has been retired.
These are based on NICE recommendations on the use of tirzepatide for managing overweight and obesity in adults). NICE proposed the implementation of tirzepetide in ‘Primary Care’ had been proposed in 3 cohorts:
| Funding Variation Years | Estimated Cohort Duration | Cohorts | Cohort Access Groups Comorbidities | Cohort Access Groups BMI |
|---|---|---|---|---|
| Year 1 (2025/26) | 12 months | Cohort I | ≥4 ‘qualifying’ comorbidities hypertension, dyslipidaemia, obstructive sleep apnoea, cardiovascular disease, type 2 diabetes mellitus | ≥ 40 |
| Year 2 (2026/27) | 9 months | Cohort II | ≥4 ‘qualifying’ comorbidities hypertension, dyslipidaemia, obstructive sleep apnoea, cardiovascular disease, type 2 diabetes mellitus | 35 – 39.9 |
| Year 3 (2027/28 and 2028/29) | 15 months | Cohort III | 3 ‘qualifying comorbidities hypertension, dyslipidaemia, obstructive sleep apnoea, cardiovascular disease, type 2 diabetes mellitus | ≥ 40 |
The current changes to QOF implementation from ‘year 2’ and so for the current contractual year covers both cohorts 1 and 2, with cohort 3 covered if retained for 2027/28. GPC England has significant concern about the funding and workload implications of these indicators.
For further information read our ‘Focus on Obesity areas in QOF’.
Table of QOF changes for 2026/27
| Indicator ID | Indicator change | Threshold changes | Points changes |
|---|---|---|---|
| AF006 | Upper achievement threshold increased | Upper threshold ↑ from 90% to 95% | Unchanged – 12 pts |
| CD001 | New blood pressure (BP) control indicator for patients aged ≤79, without frailty, combining and replacing the separate coronary heart disease (CHD) and stroke/TIA (STIA) BP control indicators | New indicator – 40–90% | Reallocated – 41 pts |
| CD002 | New BP control indicator for patients aged 80 or over, without frailty, combining and replacing the separate CHD and STIA BP control indicators | New indicator – 46–90% | Reallocated – 20 pts |
| CHOL003 | Points decreased for consistency with lipid lowering indicators | Unchanged –70–95% | ↓ from 38 to 20 pts |
| DM034 | Points increased for primary prevention statin use in diabetes | Unchanged –50–90% | ↑ from 4 to 8 pts |
| DM035 | Points increased for secondary prevention statin use in diabetes | Unchanged – 50–90% | ↑ from 2 to 8 pts |
| DM037 | New annual diabetes care processes indicator | New indicator – 35-75% | Reallocated – 10 pts |
| HF009 | New indicator for 4-pillar therapy in heart failure with reduced ejection fraction (HFrEF) | New indicator –20–50% | Reallocated – 12 pts |
| HYP010 (previously HYP008) | Adjustment to indicator to remove frailty cohort | Unchanged – 40–85% | Unchanged – 38 pts |
| HYP011 (previously HYP009) | Adjustment to indicator to remove frailty cohort | Unchanged – 40–85% | Unchanged – 14 pts |
| NDH003 (previously NDH002) | Gestational diabetes patient cohort added and points increased | Unchanged – 50–90% | ↑ from 18 to 20 pts |
| OB004 | New referral to weight management programmes indicator for adults living with obesity | New indicator – 10–30% | New – 5 pts |
| OB005 | New shared decision-making and pharmacotherapy indicator for obesity | New indicator – 50–80% | New – 13 pts |
| STIA007 | Ticagrelor included in the list of antiplatelet medications that count towards QOF achievement | Unchanged – 57–97% | Unchanged – 4 pts |
| VI001 | Addition of improvement threshold calculations | Unchanged – 89–96% | Unchanged – 18 pts |
| VI002 | Addition of MMRV and improvement threshold calculations | Unchanged – 86–96% | Unchanged – 18 pts |
| VI003 | Addition of MMRV and improvement threshold calculations | Unchanged – 81–96% | Unchanged – 18 pts |