Once the points have been calculated, some parts of QOF are adjusted by the Adjusted Practice Disease Factor (APDF), others are not. APDF is a method of adjusting the value of the QOF point to account for prevalence - which makes sense, because if you have more patients with a condition it follows that you need more funding to provide care for them.
The rest of the indicators are subject to APDF. The Raw practice disease prevalence is the number of patients on the relevant disease register at 31st March in the financial year to which the payment relates divided by the the Contractors Registered Population (CRP) for that date.
Make sure you accurately code all patients, because then they'll be on the correct disease register and you will appropriately care for them and be appropriately funded for them
Spending many hours ploughing through lists of patients trying to chase technicalities to add patients to your disease registers can be counterproductive. This is because of a number of different factors.
The impact of 2025/26 contract changes
The changes in the 2025/26 year which:
- Retire the previously income protected QOF indicators
- Remove disease registers
- Reallocate these points to either Global Sum, or to managing cholesterol and all blood pressure indicators
may have significant changes for some practices. These include:
Practices who have a high prevalence but a low contractors weighted population
These practices are likely to suffer a reduction in funding as the income is transferred from QOF to the contractors weighted population balanced global sum paments.
Practices who have a low prevalence but a high contractors weighted population
These practices are likely to benefit from an income in funding as the income is transferred from QOF to the contractors weighted population balanced global sum payments.
Practices who have previously driven prevalence as a way of increasing income
For the reasons below, this is not an approach endorsed by Primary Care IT, and the 2025/26 changes further add evidence to this thought process. The value of QOF points has moved significantly to focus on cholesterol and blood pressure indicators. The thresholds to achieve nearly all of these indicators has also been increased to make them much harder to achieve (see our
webinar for the year which goes through these in detail). This means that practices who have much higher prevalence will have to work proportionately much harder in order to achieve these indicators. Indeed, 10,000 patient practice that maintains it's 2024/25 performance will lose around £10k because of the threshold changes.
Other factors that mean that chasing prevalence as a way of increasing income is misguided
Your prevalence is rebased each year
If every Practice in the country is doing lots of work to improve their prevalence, the national prevalence will go up and so next year the value of your prevalence will be reduced. Indeed the only way it can work is if your prevalence is consistently above average year on year, which is a challenge.
If you look at prevalence from 2004 to now:
- Asthma has increased from 5.8% to 6%
- Cancer has increased from 0.5% to 3.2%
- COPD has increased from 1.4% to 1.9%
- Diabetes has increased from 3.4% to 5.8%
- Heart failure has increased from 0.4% to 0.9%
- Hypertension has increased from 11.4% to 13.9%
- Mental health has increased from 0.5% to 0.9%
- Stroke has increased from 1.5% to 1.8%
We know that prevalence is increasing year on year, hopefully because Practices are becoming better at clinical coding and appropriately caring for patients, but the overall pot of income for QOF has not gone up (except by negotiated contractual increases). This all means an average Practice will have higher disease registers, be doing more work, but be paid the same (a bit like boiling a frog).
If you increase your prevalence, you will have more work to do to achieve your indicators
If you have more patients on a disease register, it follows you will need to do more work to achieve the indicator targets in this area. In fact the value of QOF points closely follows the amount of work that is needed for that area - and as we've already discussed the 2025/26 changes have really emphasised this.
You may also not achieve full marks in that indicator because of the increased workload, which wiil certainly derail any planned increase in income.
Also if you increase your prevalence in a register with no achievement (e.g. CKD) you may well find that targets appear in future QOF years which you will then find it hard to achieve.
A worked example of the impact of chasing prevalence:
In the following table you can see each of the QOF areas subject to ADPF, with the points for that indicator. The next column shows the average prevalence for England and if we assume that a Practice achieves a 20% on this, that is shown in the next column. The increased income from the increased prevalence is seen in the next column. Looks good right?
Well that's only half the story. As with any business turnover is vanity and net profit is sanity, so yes you'll increase your turnover, but now let's look at the impact of the additional work. In the next column you can see the additional number of patients you would need to care (or achieve the target for). To give a better idea of the work you can see for each of the indicators the income that you would get additionally for each patient. This is widely variable, but you can also see that the bigger areas are also those where there is more work needed. For those indicators where there is not much to do, the increase from the prevalence is very little.
Area |
Points |
Avg Prevalence |
20% uplift |
Increased income |
Additional pts |
Income per patient |
Asthma |
45 |
6 |
7.2 |
1810.44 |
96 |
19 |
AF |
29 |
2 |
2.4 |
1166.73 |
32 |
36 |
Cancer |
13 |
3.2 |
3.84 |
523.02 |
51 |
10 |
CHD |
28 |
3 |
3.6 |
1126.50 |
48 |
23 |
COPD |
19 |
1.9 |
2.28 |
764.41 |
30 |
25 |
Dementia |
44 |
0.7 |
0.84 |
1770.21 |
11 |
158 |
Depression |
10 |
9.8 |
11.76 |
402.32 |
157 |
3 |
Diabetes |
67 |
5.8 |
6.96 |
2695.54 |
93 |
29 |
Epilepsy |
1 |
0.6 |
0.72 |
40.23 |
10 |
4 |
Heart failure |
29 |
0.9 |
1.08 |
1166.73 |
14 |
81 |
Hypertension |
25 |
13.9 |
16.68 |
1005.80 |
222 |
5 |
LD |
4 |
0.5 |
0.6 |
160.93 |
8 |
20 |
MH |
38 |
0.9 |
1.08 |
1528.82 |
14 |
106 |
Osteoporosis |
3 |
0.3 |
0.36 |
120.70 |
5 |
25 |
PAD |
2 |
0.6 |
0.72 |
80.46 |
10 |
8 |
RA |
6 |
0.6 |
0.72 |
241.39 |
10 |
25 |
Stroke |
11 |
1.8 |
2.16 |
442.55 |
29 |
15
|