QOF 2026/27 — what changed, and what each domain rewards
A concise, dated summary of the Quality and Outcomes Framework for 1 April 2026 to 31 March 2027: the new and retired indicators, then each clinical domain in a line with a link to the matching protocol.
Last checked: October 2026 · NHS England QOF guidance 2026/27 (PRN02356) · BMA
QOF 2026/27 in one paragraph. England only. Changes were imposed by NHS England after GPC England rejected the 2026/27 contract offer, and add about 18 points (around £25 million). The headline changes: a composite diabetes indicator for all eight NICE care processes, a heart failure "four pillars" indicator for HFrEF, two obesity indicators (weight management referral and medicines optimisation) replacing the Weight Management Enhanced Service, combined cardiovascular BP indicators, a higher upper threshold for AF anticoagulation, and an improvement route for childhood vaccination points (now including MMRV). The year runs 1 April 2026 to 31 March 2027.
Indicator codes and thresholds below are as reported in the 2026/27 guidance and summaries — confirm against the NHS England QOF guidance (PRN02356) and business rules before using them for searches or claims. Scotland no longer has QOF; Wales and Northern Ireland have their own frameworks.
What is new, changed or retired
| Area | 2026/27 change | Replaces / retires |
|---|---|---|
| Diabetes | DM037 (new): people with diabetes who received all eight NICE care processes in the year (HbA1c, BP, cholesterol, serum creatinine, urine ACR, foot check, BMI, smoking status). Missing one process means the patient does not count. | DM012 retired (folded into DM037) |
| Heart failure | HF009 (new): HFrEF patients on the four pillars — ACE inhibitor/ARB/ARNI, beta-blocker, MRA and SGLT2 inhibitor — where tolerated. Only codes stating "heart failure with reduced ejection fraction" count, so check echo coding. | HF003 and HF006 retired |
| Cardiovascular BP | CD001 / CD002 (new): combined BP-target indicators across CHD, stroke/TIA and hypertension. Frailty-based cohorts removed from the hypertension BP indicators. | CHD015, CHD016, STIA014, STIA015 (and the age-split HYP BP indicators) — reallocated points rather than new money |
| Atrial fibrillation | AF006: upper threshold for anticoagulation raised from 90% to 95%. | — |
| Cholesterol | CHOL003 (statin in CVD) reduced from 38 to 20 points; lipid-target indicator continues. | — |
| Obesity | Two new indicators (reported as OB004 and OB005): offering referral to weight management services, and shared decision-making on weight-management medicines where eligible. | Weight Management Enhanced Service retired |
| Childhood vaccination | VI001–VI003: MMRV added; practices receive whichever is higher — points from the usual achievement thresholds, or a sliding scale for improvement against their own two-year baseline. | — |
Indicators by condition quick view with links to our protocols
| Domain | What QOF rewards (summary) | Protocol |
|---|---|---|
| Cardiovascular | ||
| Atrial fibrillation | Register; CHA₂DS₂-VASc recorded; anticoagulation where score is 2 or more (AF006 to 95%). | AF |
| Hypertension, CHD, stroke/TIA | Registers; BP to target (new combined CD indicators); antiplatelet or anticoagulant in CHD, stroke/TIA. | Hypertension Angina TIA/stroke |
| Cholesterol / secondary prevention | Statin in CVD (CHOL003, fewer points); LDL-cholesterol or non-HDL to target. | Lipids Post-MI |
| Heart failure | Register; diagnosis confirmed by echo or specialist; HFrEF on four-pillar therapy (HF009); annual review. | Heart failure |
| Peripheral arterial disease | Register (PAD indicators largely retired in earlier years). | PAD |
| Diabetes, kidney and weight | ||
| Diabetes | All eight care processes (DM037); HbA1c targets (individualised, with frailty considered); statins; ACE inhibitor/ARB with albuminuria; structured education referral. | Type 2 Type 1 |
| Non-diabetic hyperglycaemia | Annual HbA1c or glucose. | Metabolic syndrome |
| CKD | Register (stage 3–5). | CKD |
| Obesity | Register (BMI); new weight-management referral and medicines indicators. | Obesity |
| Respiratory | ||
| Asthma | Diagnosis supported by objective tests; annual review with control assessment and a written plan; second-hand smoke exposure recorded in young people. | Asthma Children |
| COPD | Spirometry-confirmed diagnosis; annual review with MRC dyspnoea score; pulmonary rehabilitation referral where MRC 3 or more. | COPD |
| Mental health and neurology | ||
| Serious mental illness | Care plan; annual physical health checks (BP, BMI, alcohol, lipids, glucose/HbA1c); cervical screening. | Psychosis Monitoring |
| Depression | Review 10–56 days after a new diagnosis. | Depression |
| Dementia | Register; face-to-face care-plan review every 12 months. | Dementia |
| Epilepsy, learning disability | Registers (learning disability health checks are funded separately through the enhanced service). | Epilepsy |
| Other clinical and public health | ||
| Cancer | Register; cancer care review within 12 months of diagnosis, including a support conversation. | NG12 quick view |
| Osteoporosis, RA, palliative care | Fragility fracture register and bone-sparing treatment; RA register; palliative care register. | Osteoporosis RA End of life |
| Smoking | Smoking status recorded; support and treatment offered to smokers with long-term conditions. | Smoking cessation |
| Cervical screening, vaccination | Cervical screening coverage; childhood vaccination (VI001–VI003, improvement route). | Screening Immunisations |
Personalised care adjustments (formerly exception reporting) still apply — record the right reason (patient declined, not appropriate, informed dissent, unsuitable, service unavailable). Good care first: QOF is a floor, not the standard.
Sources (checked October 2026)
- NHS England. Quality and Outcomes Framework guidance for 2026/27 (PRN02356, July 2026 update). england.nhs.uk
- NHS England. Changes to the GP contract in 2026/27. england.nhs.uk
- BMA. GP contract changes England 2026/27; Quality and outcomes framework (QOF). bma.org.uk
- Pulse. GP contract to include QOF "refinements" and additional points worth £25m (2026). pulsetoday.co.uk
- Somerset LMC. Quality and Outcomes Framework (QOF) 2026/27. somersetlmc.co.uk