QOF 2026/27 – Key Changes Your Practice Must Act On

Introduction

The 2026/27 QOF changes are driven by:

👉 Eligibility precision, structured delivery, and correct coding

Success this year depends on:

• Identifying the correct patient cohorts
• Applying specific eligibility criteria
• Delivering and coding complete clinical pathways

This guide focuses on the highest-impact areas that will directly affect performance, workload, and income.

Obesity Indicators (OB004 & OB005)

Techinical Document Link:

1. OB004 – Referral Within 90 Days of Raised BMI
   

Summary:

Indicator Definition

• Patients aged 18+
• BMI:
  • >30, or
  • >27.5 (BAME)
• Must be referred to a weight management programme within 90 days of BMI recording

Key Operational Rule

👉 The 90-day window starts from the BMI recording

What must be recorded

• Referral to weight management
  OR
• A valid reason why not (patient declined, unsuitable, service unavailable)

Exclusions

• Patient declined (after 2 invites, 7 days apart)
• Care unsuitable / service unavailable
• Newly registered or diagnosed late in year

Practice Actions

• Ensure BMI recording triggers follow-up
• Build a 90-day recall and tracking process
• Ensure referral or PCA is coded

💡 PCIT Insight

This is a time-bound pathway indicator

Common failure:

• BMI recorded
• No follow-up action

OB005 – Pharmacotherapy / Complex Obesity Management

Techinical Document Link:

1. OB005 – Pharmacotherapy / Complex Obesity Management
   

Eligibility Criteria

• BMI:
  • >35, or
  • >32.5 (BAME)
• PLUS at least 4 of the following:
  • Cardiovascular disease
  • Hypertension
  • Dyslipidaemia
  • Obstructive sleep apnoea
  • Type 2 diabetes

Important Eligibility Detail

👉 Patients can become eligible during the year based on blood results

Dyslipidaemia includes:

• On a statin
  
• LDL > 4.1
  
• Triglycerides > 1.7
• HDL <1 (male) / <1.3 (female)

What must be done

All of:

• Prescribed pharmacotherapy (coded)
• Referral to behavioural support
• Shared decision-making recorded

Practice Actions

• Monitor new blood results
• Identify patients becoming eligible
• Ensure intervention is coded

💡 PCIT Insight

👉 This is a dynamic cohort indicator

Without active tracking:

• Patients become eligible unnoticed
• Achievement is lost

🧪 Diabetes (DM037) – 8 Key Care Processes

Techinical Document Link:

1. Diabetes (DM037) – 8 Key Care Processes

Summary:

Indicator Definition

All diabetic patients must have:

1. BMI
2. Blood pressure
3. HbA1c
4. Cholesterol
5. Smoking status
6. Foot check
7. Urine ACR
8. eGFR

Key Rule

👉 All 8 must be completed

Exclusions

• Bilateral amputation
• Care unsuitable / declined
• Diagnosis or registration late in the contract year

Practice Actions

• Track partial completion
• Recall patients missing any process
• Ensure each component is coded

💡 PCIT Insight

👉 This is an all or nothing, there are no individual PCAs (exceptions)

7 out of 8 = no achievement

💰 Point Redistribution – Diabetes Now Higher Priority

Techinical Document Links:

1. CHOL003 - Patients on a statin or other lipid lowering drug
2. DM034 - Diabetes (with no history of CVD or frailty) on a statin or other lipid lowering therapy
3. DM035 - Diabetes (with a history of CVD) on a statin or other lipid lowering therapy
   

Summary:

• CHOL003 reduced from 38 → 20 points
• Diabetes indicators increased:
  • DM034: 4 → 8 points
  • DM035: 2 → 8 points

👉 Diabetes is now:

• Higher value
• A key strategic priority

❤️ Heart Failure (HF009) – 4 Pillars

Techinical Document Link:

1. Heart Failure (HF009) – 4 Pillars

Summary:

Indicator Definition

Patients must be prescribed (within last 6 months):

• ACEi / ARB / ARNI
• Beta blocker
• Mineralocorticoid receptor antagonist
• SGLT2 inhibitor

Critical Eligibility Rule

👉 Only patients with Heart Failure with Reduced Ejection Fraction (HFrEF) are included

What this means

You must:

1. Identify the correct cohort (HFrEF only)
2. Ensure patients are on all 4 treatments
   

Exclusions

• Contraindications
• Patient declined
• Not on licensed beta blocker
• Late diagnosis/registration

Practice Actions

• Validate HF register:
  • Remove HFpEF patients
  • Ensure EF is coded
• Identify patients not on all 4 drugs
• Build follow-up processes

💡 PCIT Insight

👉 This is a high-effort, high-reward indicator

Failure points:

• Incorrect register
• Missing one treatment

🩺 Blood Pressure Indicators (CD001 / CD002 / HYP010 / HYP011)

Techinical Document Links

1. CD001 - Cardiovascular disease, age <80, no frailty BP 140/90 mmHg or less (or equivalent)
   
2. CD002 - Cardiovascular disease, age 80+, no frailty BP 150/90 mmHg or less (or equivalent)
   
3. HYP010 - Hypertensive, age <80, no frailty BP 140/90 mmHg or less (or equivalent)
   
4. HYP011 - Hypertensive, age 80+, no frailty BP 150/90 mmHg or less (or equivalent)
   

Summary:

Indicator Definition

CVD (CHD/STIA) without frailty

• <80 years: <140/90
  

• 80+: <150/90
  

Hypertension without frailty

• Same thresholds apply

Critical Eligibility Rule

👉 Patients with moderate or severe frailty are excluded

🚨 Key Risk – Frailty Coding

Many practices use:

• Rockwood scores

👉 These do NOT meet QOF requirements

Exclusions

• Frailty (moderate/severe)
• Maximal therapy reached
• Patient declined care
• No BP + 2 invites
• Late diagnosis/registration

Practice Actions

• Review frailty coding
• Apply correct QOF frailty SNOMED codes
• Validate BP cohort
• Ensure follow-up of raised BP

💡 PCIT Insight

👉 This is a high-impact data quality opportunity

Correct coding:

• Reduces workload
• Improves performance

🫁 COPD Register – Updated Entry Rules

Techinical Document Link:

1. COPD Technical links
   

Summary:

New Rule

Patients are included if:

• COPD diagnosis at any time
  OR
• COPD procedure code within the last 2 years

Key Risk

👉 Procedure-only patients may:

• Incorrectly inflate the register
  
• or be missed when they would previously have been on the register
  

Practice Actions

• Identify procedure-only patients
• Confirm diagnosis
• Update coding accordingly

💡 PCIT Insight

👉 This is a denominator control issue

🧠 NDH (NDH003) – HbA1c monitoring

Techinical Document Link

1. NDH003 - HbA1c monitoring

Summary:

Indicator Definition

• Patients with NDH or gestational diabetes
• Must have HbA1c recorded

Importance of register

👉 Must also review:

• Gestational diabetes coding

Exclusions

• Patient declined blood test
• Care unsuitable / declined
• 2 invites completed
• Late diagnosis/registration

Practice Actions

• Build NDH register
• Validate gestational diabetes coding
  
• Understand volume of additional patients that will need blood tests
• Implement recall system

💡 PCIT Insight

👉 This is a new workload generator

📈 Other Key Changes

Vaccinations

Techinical Document Links:

• Achievement based on:
  • Same as last year
    OR
  • Improvement of at least 5%

Atrial Fibrillation

Techinical Document Link

Summary

• AF006 Anticoagulation in AF threshold increased:
  • 90% → 95%

Asthma

Techinical Document Link

Summary

• Now includes:
  • Children aged 5+ (previously 6+)

📊 Summary – What Actually Matters

Core Theme: Work the Right Patients

Across all indicators:

👉 Eligibility, coding, and completion now drive success

Your Priorities

1. Get eligibility right
   
2. Ensure teams know about new requirements for BP, obesity, heart failure and diabetes
3. Track dynamic cohorts (obesity)
4. Validate registers (HF, COPD)
5. Align coding with QOF rules

⚡ What Should You Do Now?

• Inform your team
• Calculate your eligible populations
• Implement recall systems early

💡 Final Thought

2026/27 is not about doing more.

👉 It’s about doing the right work, on the right patients, at the right time

➡️ Next Steps

• Use PCIT tools to:
  • Identify eligible patients
  • Track gaps
  • Prioritise workload

Whole Service Summary

The 2026/27 QOF introduces eligibility-driven indicators across obesity, heart failure, blood pressure, COPD, and NDH, alongside a shift toward diabetes-focused value. Success depends on accurate cohort identification, correct coding, and structured recall systems, ensuring effort is focused where it delivers the greatest clinical and financial impact.