Practices will have work harder to maintain their QOF income levels under the 2025/26 GP contract, according to a QOF expert.
Swindon GP Dr Gavin Jamie and who runs the QOF database website has warned that the changes may prove challenging in some areas.
From April, the 32 QOF indicators that were income protected in 2024/25 will be permanently retired. These equate to 212 points worth around £298m in 2025/26.
Meanwhile, NHS England also announced that 141 QOF points, worth around £198m, will be redistributed proportionately among the nine cardiovascular disease (CVD) indicators.
While the lower thresholds for these indicators will be maintained at 2024/25 levels to offer the maximum opportunity to earn QOF points, the upper achievement levels will be raised for 2025/26 (see table).
Dr Jamie said: ‘The effect of this is to increase payment for existing achievement as well as pay for further achievement above the current thresholds. Practices who are at the current thresholds would expect to get about 78% of the transferred points.’
He warned that while practices may change how they do things to adapt to the new targets and maximise points, ‘blood pressure targets, particularly in patients under 80, may prove challenging’.
He added: ‘The cholesterol indicators are probably going to be the most difficult to meet the upper threshold as these were already some of the more challenging indicators, particularly to get cholesterol levels down.
‘Exception reporting will play a part, but this is may be limited. Blood pressure and cholesterol treatments are not always popular with patients as the benefits are not visible but side effects can be very apparent’.
All this coupled with the fact that a lot of the points that have been moved are from register indicators where there will be no reduction in the workload means ‘there is certainly going to be more work for practices to maintain income,’ Dr Gavin said.
‘There is nothing here that practices they have not done already, there is just more of it to do.’
Dr Jamie said that the QOF changes for this year effectively mean that there will no longer be indicators for:
- Peripheral arterial disease
- Depression
- Cancer
- Chronic Kidney Disease
- Epilepsy
- Learning disabilities
- Osteoporosis
- Rheumatoid arthritis
- Palliative care
- Obesity.
Meanwhile, a separate analysis has shown that since remaining QOF points are more difficult to attain with increased maximum thresholds, practices could see a loss of income.
The calculations carried out by Berkshire, Buckinghamshire and Oxfordshire (BBO) LMCs have shown that if practices did not achieve anything additional toward the increased maximum thresholds when compared with 2024/25, the net loss of income would be around £1.07 per patient (as a worst case scenario estimate).
However, it added that as practices are ‘unlikely to leave their QOF practices unchanged’ next year, by increasing their workload, the loss of income would be lower.
‘We would therefore conservatively estimate the true financial loss to be a range between zero and up to a maximum of £1.00 per patient,’ the analysis said. The LMCs did acknowledge that the impact on practices of QOF changes is very difficult to assess collectively.
The 2025/26 upper thresholds and points for CVD prevention indicators under QOF
Indicator Lower threshold 2025/26 (remain unchanged) Upper threshold 2025/26 (figure in brackets is for last year) QOF points (figure in brackets is for last year) CHOL003 Percentage of patients on the QOF Coronary Heart Disease (CHD), Peripheral Arterial Disease (PAD), Stroke/ Transient Ischaemic Attack (TIA) or Chronic Kidney Disease (CKD) Register who are currently prescribed a statin, or where a statin is declined or clinically unsuitable, another lipid-lowering therapy 70% 95% (unchanged since last year) 38 (14) CHOL004 Percentage of patients on the QOF Coronary Heart Disease (CHD), Peripheral Arterial Disease (PAD), or Stroke/Transient Ischaemic Attack (TIA) Register, with the most recent cholesterol measurement in the preceding 12 months, showing as ≤ 2.0 mmol/L if it was an LDL (Low-density Lipoprotein) cholesterol reading or ≤ 2.6 mmol/L if it was a non-HDL (High-density Lipoprotein) cholesterol reading. 20% 50% (35%) 44 (16) HYP008 The percentage of patients aged 79 years or under with hypertension in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less (or equivalent home blood pressure reading) 40% 85% (77%) 38 (14) HYP009 The percentage of patients aged 80 years or over, with hypertension, in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less, (or equivalent home blood pressure reading) 40% 85% (80%) 14 (5) STIA014 The percentage of patients aged 79 years or under, with a history of stroke or TIA, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less (or equivalent home blood pressure reading) 40% 90% (73%) 8 (3) STIA015 The percentage of patients aged 80 years or over, with a history of stroke or TIA, in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less, (or equivalent home blood pressure reading) 46% 90% (86%) 6 (2) CHD015 The percentage of patients aged 79 years or under, with coronary heart disease, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less, (or equivalent home blood pressure reading) 40% 90% (77%) 33 (12) CHD016 The percentage of patients aged 80 years or over, with coronary heart disease, in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less, (or equivalent home blood pressure reading) 46% 90% (86%) 14 (5) DM036 Note that DM036 replaces DM033 from last year. The percentage of patients with diabetes, on the register, aged 79 years and under without moderate or severe frailty in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less (or equivalent home blood pressure reading) 38% 90% (78%) 27 (10) Source: NHS England Some of this article was first published by our sister title Pulse
