Big Changes are coming to QOF in 2025/26—Here’s what you need to know

The 2025/26 GP contract introduces some of the most significant changes to the Quality and Outcomes Framework (QOF) in years. This isn’t just a technical update. With £298 million in funding reallocated, key indicators retired, and new cardiovascular disease (CVD) targets rolled out, the way practices operate and are funded is undergoing a fundamental shift.

So what’s really changing? And how should general practices respond?

In this post, we break down the key updates, the opportunities they create, and the challenges practice managers and leadership teams need to prepare for.

QOF 2025/26: What’s Changing?

The latest reform is focused on rebalancing priorities, cutting outdated indicators, and ramping up efforts in CVD prevention. Here’s a quick overview:

  • 32 QOF indicators have been permanently retired, many of which were already income-protected
  • This frees up 212 QOF points, equivalent to approximately £298 million
  • Of that:
    • £100 million is moving into the global sum
    • £198 million is being redirected into nine new or revised indicators focused on CVD prevention

This shift signals a move away from broad metric tracking in favour of more targeted clinical outcomes, particularly around blood pressure and cholesterol control.

But fewer indicators does not necessarily mean less complexity.

Opportunities Within the New Framework

Reduced Bureaucracy

Retiring outdated indicators could mean less administrative burden, enabling practices to focus more time on patient care and strategic priorities.

Focus on Prevention

The sharper emphasis on CVD aligns with long-term public health goals. With appropriate support, practices could deliver meaningful outcomes and reduce long-term risk in their populations.

More Predictable Core Funding

The uplift to the global sum provides a level of financial stability that could support better workforce planning and digital investment.

Streamlined Delivery

Fewer, more focused indicators may make it easier to align practice teams around shared goals. Where additional support is available from PCNs or ICSs, delivery could become more efficient.

Key Challenges Practices May Face

Tougher Performance Thresholds

New upper thresholds for cholesterol and blood pressure control may stretch practices, particularly those working with patients who have complex health needs or live in areas with higher deprivation. Delivering consistent follow-up and lifestyle support will be critical — and potentially difficult.

More Concentrated Financial Risk

With funding now tied to a smaller number of high-effort indicators, practices that struggle to meet the new targets may experience increased volatility in income.

Increased Clinical and Administrative Load

Although the overall number of indicators has decreased, those that remain will require more rigorous monitoring, coding, and patient recall. Staff and systems already under pressure may struggle to keep up.

Looking Ahead: Planning is Essential

The QOF 2025/26 changes represent more than just a reshuffling of priorities — they are a clear signal of where the NHS wants to go: fewer tick-box metrics, greater focus on outcomes, and more targeted preventive care.

For some practices, this may be an opportunity to double down on population health and care innovation. For others, especially those already under strain, the demands may feel daunting.

Success will depend on forward planning:

  • Understand how the changes impact your patient population
  • Model financial implications early
  • Review team structures, digital tools, and recall systems
  • Engage with PCNs and ICSs where collaboration can ease delivery

How is your practice approaching the 2025/26 QOF changes?
We’re keen to hear how practices are navigating this shift — and what support or clarity would help most.

If you have any feedback or questions, please don’t hesitate to get in touch at hello@appt-health.co.uk.

Author: Dr Alice Wood - Clinical Lead

References

https://www.england.nhs.uk/gp/investment/gp-contract/quality-on-outcomes-framework-qof-changes/

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