The QOF changes for 2026/27 are more clinically meaningful than any update in recent years. They reflect genuine alignment with updated NICE guidance and introduce new clinical expectations that will change how chronic disease management is delivered in general practice.
Diabetes: All 8 NICE Care Processes
A new composite indicator requires delivery of all 8 NICE-recommended care processes for patients with diabetes: HbA1c measurement, blood pressure measurement, cholesterol measurement, serum creatinine measurement, urine albumin-to-creatinine ratio, foot examination, BMI measurement, and smoking status assessment.
The practical implication is significant. Missing one process for a patient means that patient does not count toward the indicator, even if seven were completed. This rewards systematic, structured care — practices with robust recall systems and template-driven reviews will perform well. Practices relying on opportunistic management will struggle.
Review your diabetes template now. Ensure every care process has a dedicated prompt. Consider whether your current review workflow reliably captures all 8 in a single or linked appointment sequence. Ask iatroX provides instant access to the full NICE NG28 diabetes management pathway, including the care processes, treatment thresholds, and medication escalation pathways that the QOF indicator is built on.
Obesity: Two New Indicators
Two new obesity-related indicators support referrals into structured weight management programmes and medicines optimisation — including GLP-1 receptor agonist prescribing for eligible patients. The Obesity Enhanced Service is being retired in favour of these QOF indicators.
This reflects the NHS's investment in weight management, including the £25 million programme for patients with severe obesity and comorbidities. Practices will need to identify eligible patients on their register, initiate referrals to structured programmes, and — where appropriate — prescribe or refer for GLP-1 agonist therapy.
Know your local weight management referral pathway. Know the NICE criteria for GLP-1 prescribing in obesity. The Knowledge Centre provides structured access to the relevant NICE guidance.
Heart Failure: Four Pillars
Heart failure indicators are being updated to reflect the NICE-recommended "four pillars" of treatment: ACE inhibitor or ARB (or sacubitril/valsartan), beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor.
Practices that have not yet updated their heart failure management to include SGLT2 inhibitors as a standard component will need to do so. The QOF indicator expects all four pillars to be considered for every eligible patient with heart failure with reduced ejection fraction. If a pillar is not prescribed, there should be a documented clinical reason.
Review your heart failure register. Identify patients not on all four pillars. For each, determine whether there is a contraindication or clinical reason — and document it. For patients who should be on an SGLT2 inhibitor but are not, initiate it or refer to heart failure services.
Childhood Vaccination: Improvement Thresholds
This is the most equitable change in the package. New improvement thresholds for childhood vaccination indicators (VI001, VI002, VI003) allow practices to earn QOF points by improving from their own 2-year baseline — even if they do not meet the absolute threshold.
The improvement requirement is a minimum 5% over the practice's own baseline, with upper ranges expanded to +18-30% depending on the indicator. This directly benefits practices in deprived areas where vaccination uptake has historically been lower, recognising effort and progress rather than only rewarding achievement against a fixed bar.
Check your baseline vaccination data. Calculate what a 5% improvement would require. Target the specific patient cohorts where uptake is lowest — often linked to deprivation, language barriers, or specific community concerns that practice-level interventions can address.
Blood Pressure: Simplified Indicators
New BP indicators replace the previous splits between CHD, stroke/TIA, and other categories. The AF upper threshold increases to 95%. These simplifications reduce administrative complexity while maintaining clinical rigour. Update your hypertension and AF templates to reflect the new thresholds.
What Practices Should Do Now
Review current QOF achievement against the new indicator definitions. Update templates in EMIS or SystmOne to ensure all 8 diabetes care processes are captured in a single workflow. Brief the clinical team on the heart failure four pillars requirement. Identify patients eligible for weight management referral and GLP-1 prescribing. Check childhood vaccination baseline data. And use iatroX to verify that your clinical approach to each QOF domain matches the current NICE recommendation — because the QOF is now explicitly aligned with NICE, and divergence between your practice and the guideline is divergence between your practice and the indicator.