QOF 2026/27: what’s actually changed, and how to hit targets without adding more pressure

QOF is still here, and in 2026/27 it is clearer than ever where it is heading.

This year’s changes aren’t just technical tweaks. They reflect a continued shift toward prevention, cardiovascular risk management, and proactive long-term condition care.

For Practice Managers, the real question is not just “what’s changed?”It’s “where will the workload actually land, and how do we stay ahead of it?”

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The headline changes for practices

New indicators for 2026/27

Indicator	What it covers	Points	Thresholds	What this means in practice
CD001 & CD002	New combined CVD indicators (CHD + Stroke/TIA BP control, split by age ≤79 and 80+)	61 (combined)	~40–90% / 46–90%	One of the largest indicators in QOF. Major focus area. Frailty cohort removed → broader cohort, more patients to manage
HF009	Four-pillar therapy for HFrEF	12	20–50%	Requires patients to be on all four therapies → significant titration and medication optimisation workload. Lower threshold reflects complexity
DM037	Annual diabetes care processes (8 checks combined)	10	35–75%	Less fragmented, but high reliance on accurate coding and completion of all 8 elements
OB004	Referral to weight management programmes	5	10–30%	Admin-heavy, dependent on local pathways
OB005	Shared decision-making + pharmacotherapy (obesity)	13	50–80%	More complex consultations and potential prescribing workload

Indicators that changed in 2026/27

Indicator	Change	Practical impact
HYP010 / HYP011	Frailty cohort removed, points unchanged	You are now effectively being paid the same points for work spread across a smaller denominator → easier achievement if managed well
AF006	Threshold increased (~90% → 95%)	Requires tighter follow-up and recall discipline
DM034 / DM035	Points increased (4 → 8 each)	Greater financial incentive to optimise statin prescribing
NDH003	Includes gestational diabetes cohort (18 → 20 points)	Larger cohort → more follow-up and register maintenance
STIA indicators	Ticagrelor included	Easier to capture eligible patients correctly
VI001–003 (Vaccinations)	Dual scoring: standard thresholds or improvement vs baseline	More achievable, but requires baseline tracking and focused recall
Asthma rules	Now includes patients aged 5+	Increased register size and review workload

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What actually matters operationally

Looking at these changes, three themes stand out:

1. CVD is now the centre of QOF

With 61 points tied up in CD001/CD002, this becomes one of the largest areas of focus in the framework.

• Broader cohort (frailty removed)

• More patients needing BP control

• Greater reliance on structured recall and medication optimisation 

 If this isn’t tightly managed early, it becomes a major Q4 pressure point.

.2. More clinical work per patient (not just more patients)

• HF009 requires full optimisation across four therapies—not partial completion

• DM037 requires all 8 care processes—not “most of them”

• Obesity indicators require real conversations and decisions, not just coding

This is a shift from:

• “Have we seen the patient?” to“Have we completed everything properly?” 

3. Coding and registers matter more than ever

Particularly for:

• DM037 (diabetes) 

• NDH expansion (gestational diabetes) 

• Asthma age expansion 

Poor coding now directly = missed points

Clean registers = easier achievement with the same workload

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Childhood vaccinations: a practical opportunity

The introduction of improvement-based scoring alongside traditional thresholds is one of the more helpful changes.

Practices can now:

• Achieve via national targets

• Or via improvement against their own baseline

This is especially useful in:

• Areas with lower uptake

• Populations with vaccine hesitancy

  
  

But:

• No exception for informed dissent still creates a ceiling

  
  

Practical approach:

• Focus on patients who are likely to convert 

• Don’t over-invest time chasing hard refusals

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The real shift: from recall lists to prioritisation

Across QOF, PCN DES, and wider NHS policy, there is a clear move toward:

• Risk stratification 

• Population health management 

• Proactive care 

  
  

In practice, this means:

Old model:

• Annual recall (often birthday-based)

• Even workload spread

  
  

New reality:

• Prioritise high-risk patients first 

• Bring forward those most likely to miss targets

• Reduce time patients remain uncontrolled

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So how should practices respond?

The practices that stay in control this year will:

• Start with high-impact cohorts (CVD, diabetes, HF) early

• Combine care into multi-morbidity clinics where possible

• Identify bottlenecks early (bloods, foot checks, medication reviews)

• Standardise recall and follow-up processes

• Keep registers clean from Q1, not Q4 

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A simple 30-day action plan

• Review CD001/CD002 cohort size and current BP control rates

• Identify heart failure patients not yet on full four pillar therapy

• Audit diabetes coding to ensure all 8 processes are captured

• Add gestational diabetes patients to NDH register

• Segment vaccination cohort by likelihood to engage

• Identify operational bottlenecks now (not in winter)

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Final thought

QOF 2026/27 isn’t about doing more work.

It’s about:

• Focusing on the right patients

• Completing care properly

• Organising earlier in the year

The practices that get this right will not just protect income, they’ll reduce pressure across the whole system.