Quality and outcomes framework (QOF)

QOF is a voluntary annual reward and incentive programme for GP practices in England, Wales and Northern Ireland. Find the latest frameworks for 2020/21.

Location: England Wales Northern Ireland
Audience: GPs Practice managers
Updated: Monday 18 January 2021
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COVID adjustments

Our guidance on COVID funding for practices summarises any changes to QOF during the pandemic.

Find the latest changes to the quality and outcomes framework (QOF) or equivalent by nation.

QOF has not been in operation in Scotland since 2016.


Changes to the framework in England 2020/21

The value of a QOF point is £194.83

NHSE/I has agreed to adopt a more relaxed approach to QOF and to protect income in response to COVID-19.

Changes from April 2020

97 points were recycled into 11 more appropriate indicators. This, with an additional £10m investment from NHS England, brings the total available points to 567.

Changes to existing domains

A number of changes have been made to the asthma, COPD and heart failure domains, including:


  • A requirement to establish and maintain a register of patients aged six years and over with a diagnosis of asthma, in line with NICE guidance.
  • The use of a minimum of two diagnostic tests to confirm an asthma diagnosis. These tests should be performed up to three months before any date of diagnosis and up to six months after this date.
  • The content of the asthma review has been amended to incorporate aspects of care positively associated with better patient outcomes and self-management.
  • Practices will be required to record smoking exposure in children and young people under the age of 19 years.


  • Entry to the COPD register will be determined by the presence of a clinical diagnosis plus a record of post bronchodilator spirometry FEV1/FVC ratio below 0.7 recorded between three months before or six months after diagnosis in diagnoses made on of after 1 April 2020.
  • The annual review will include a requirement to record the number of exacerbations in order to help guide future management and potentially avoidable emergency admissions.

Heart failure

  • Any new diagnosis of heart failure should be confirmed by an echocardiogram or specialist assessment between three months before or six months after diagnosis.
  • Changes to the denominator for treatment with beta-blockers.
  • An annual review indicator has been agreed to provide a focus upon functional assessment and the up-titration of medication to address symptoms.

New indicators

A new indicator has been added to incentivise practices to offer an annual HbA1c test for people known to have non-diabetic hyperglycaemia.

Quality improvement

In 2019/20 a new 74-point quality improvement domain was added, comprising two modules on prescribing safety and end of life care. These modules have now been replaced, though NHS England encourages practices to continue to bed-down improvements made in line with these.

Two new quality improvement modules have been added, on early cancer diagnosis and the care of people with a learning disability.

Ongoing amendments

NHS England and the BMA GP committee agreed to an ongoing programme of indicator review in key priority areas, including mental health, in 2020/21.