The Quality and Outcomes Framework (QOF) is a key component of the NHS contract for general practitioners (GPs) in the UK, designed to incentivise and reward high-quality care for patients. Introduced in 2004 as part of the new GMS contract, QOF aimed to improve the quality of healthcare by linking financial rewards to clinical outcomes, patient satisfaction, and practice management.
The development of QOF stemmed from the need for a systematic and transparent approach to measure the quality of services provided by GPs. Prior to its introduction, the quality of care in general practice was largely unmeasured, making it difficult to assess performance and implement improvements. The QOF framework aimed to address this by setting out clear, evidence-based targets across a wide range of clinical areas.
Key Milestones:
2004: The QOF was introduced as part of the new General Medical Services (GMS) contract. It included a set of indicators across four domains: clinical, organisational, patient experience, and patient satisfaction. Practices could earn points by meeting these targets, with financial incentives tied to their performance.
2006: The first significant review of QOF led to the introduction of new indicators, reflecting emerging healthcare priorities. Over time, the framework continued to evolve, with updates to clinical standards, the addition of new disease areas, and changes to the weighting of points.
2014: A significant overhaul of the QOF occurred, with a focus on reducing the burden of reporting and streamlining the framework. Some indicators were retired, while new ones were added to reflect current health priorities, such as mental health, dementia care, and cardiovascular risk management.
2020: The introduction of the ‘COVID-19 Emergency QOF’ saw temporary changes to the framework, ensuring that general practice could remain adaptable during the pandemic. This period marked a shift towards more flexible measures, with an emphasis on remote consultations and innovative service delivery models.
How QOF Works:
QOF assigns points to various clinical and organisational indicators, with the total points determining the financial reward a practice receives. The clinical domain covers conditions such as diabetes, asthma, hypertension, and chronic obstructive pulmonary disease (COPD), among others. These indicators are based on national guidelines and aim to promote evidence-based best practices.
The patient experience domain includes measures of patient satisfaction, ensuring that practices focus not only on clinical outcomes but also on the quality of patient care. The organisational domain encourages practices to implement systems and processes that support high-quality care, such as maintaining electronic health records, improving accessibility, and engaging in continuous staff training.
Impact and Criticism:
While QOF has undoubtedly led to significant improvements in the quality of care in many areas of general practice, it has not been without its critics. Some argue that the financial incentives can lead to a focus on easily measurable outcomes at the expense of more holistic patient care. Others point out that the system can be bureaucratic and may not always reflect the complexities of patient care.
However, despite these criticisms, QOF has played a crucial role in shaping the delivery of primary care in the UK. It has encouraged practices to focus on quality improvement, provided a framework for measuring clinical performance, and incentivised GPs to provide evidence-based care.
Qof for 2025/26
AF006. The percentage of patients with atrial fibrillation in whom stroke risk has been assessed using the CHA2DS2- VASc score risk stratification scoring system in the preceding 12 months (excluding those patients with a previous CHADS2 or CHA2DS2-VASc score of 2 or more)
12
40-90%
AF008. Percentage of patients on the QOF Atrial Fibrillation register and with a CHA2DS2- VASc score of 2 or more, who were prescribed a direct-acting oral anticoagulant (DOAC), or,where a DOAC was declined or clinically unsuitable, a Vitamin K antagonist
12
40-90%
CHD005. The percentage of patients with coronary heart disease with a record in the preceding 12 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant isbeing taken
7
56–96%
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)
33
40-90%
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)
14
46-90%
CHOL003. Percentage of patients on the QOF Coronary Heart Disease, Peripheral Arterial Disease, Stroke/TIA or Chronic Kidney Disease Register who are currently prescribed a statin, or where a statin is declined or clinically unsuitable, another lipid-lowering therapy
38
70-95%
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. For multiple readings on the latest date the LDL reading takes priority
44
20-50%
HF008. The percentage of patients with a diagnosis of heart failure on or after 1 April 2023 which:
1. Has been confirmed by an echocardiogram or by specialist assessment in the 6 months before entering on to the register; or
2. If registered at the practice after diagnosis, with no record of the diagnosis originally being confirmed either by echocardiogram or by specialist assessment, a record of an echocardiogram or a specialist assessment within 6 months of the date of registration
6
50-90%
HF003. In those patients with a diagnosis of heart failure due to left ventricular systolic dysfunction or whose heart failure is due to reduced ejection fraction the percentage of patients who are currently treated with an angiotensin-converting enzyme inhibitor (ACE-I) or Angiotensin II receptor blockers (ARB)
6
60-92%
HF006. The percentage of patients with a diagnosis of heart failure due to left ventricular systolic dysfunction or whose heart failure is due to reduced ejection fraction, who are currently treated with a beta-blocker licensed for heart failure
6
60-92%
HF007. The percentage of patients with a diagnosis of heart failure on the register, who have had a review in the preceding 12 months, including an assessment of functional capacity and a review of medication to ensure medicines optimisation at maximal tolerated doses
7
50-90%
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)
38
40-85%
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)
14
40-85%
STIA007. The percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is being taken
4
57-97%
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)
8
40-90%
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)
6
40-90%
DM006. The percentage of patients with diabetes, on the register, with a diagnosis of nephropathy (clinical proteinuria) or micro-albuminuria who are currently treated with an ACE-I (or ARBs)
3
57-97%
DM012. The percentage of patients with diabetes, on the register, with a record of a foot examination and risk classification: 1) low risk (normal sensation, palpable pulses), 2) increased risk (neuropathy or absent pulses), 3) high risk (neuropathy or absent pulses plus deformity or skin changes in previous ulcer) or 4) ulcerated foot within the preceding 12 months
4
50-90%
DM014. The percentage of patients newly diagnosed with diabetes, on the register, in the preceding 1 April to 31 March who have a record of being referred to a structured education programme within 9 months after entry on to the diabetes register
11
40-90%
DM036. 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)
27
38-90%
DM020. The percentage of patients with diabetes, on the registers, without moderate or severe frailty in whom the last IFCC-HbA1c is 58 mmol/mol or less in the preceding 12 months
17
35-75%
DM021. The percentage of patients with diabetes, on the register, with moderate or severe frailty in whom the last IFCC-HbA1c is 75 mmol/mol or less in the preceding 12 months
10
52-92%
DM034. The percentage of patients with diabetes aged 40 years and over, with no history of cardiovascular disease and without moderate or severe frailty, who are currently treated with a statin (excluding patients with type 2 diabetes and a CVD risk score of <10% recorded in the preceding 3 years) or where a statin is declined or if clinically unsuitable, another lipid-lowering therapy
4
50-90%
DM035. The percentage of patients with diabetes and a history of cardiovascular disease (excluding haemorrhagic stroke) who are currently treated with a statin or where a statin is declined or if clinically unsuitable, another lipid lowering therapy
2
50-90%
AST012. The percentage of patients with a new diagnosis of asthma on or after 1 April 2025 with a record of an objective test between 3 months before or 3 months after diagnosis
15
45-80%
AST007. The percentage of patients with asthma on the register, who have had an asthma review in the preceding 12 months that includes an assessment of asthma control, a recording of the number of exacerbations, an assessment of inhaler technique and a written personalised action plan
20
45-70%
COPD010. The percentage of patients with COPD on the register, who have had a review in the preceding 12 months, including a record of the number of exacerbations and an assessment of breathlessness using the Medical Research Council dyspnoea scale
9
50-90%
DEM004. The percentage of patients diagnosed with dementia whose care plan has been reviewed in the preceding 12 months
14
35-70%
MH002. The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive care plan documented in the record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate
5
40-90%
MH003. The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of blood pressure in the preceding 12 months
3
50-90%
MH006. The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of BMI in the preceding 12 months
3
50-90%
MH007. The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of alcohol consumption in the preceding 12 months
3
50-90%
MH011. The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of a lipid profile in the preceding 12 months (in those patients currently prescribed antipsychotics, and/or have pre- existing cardiovascular conditions, and/or smoke, and/or are overweight (BMI of >=23 kg/m2 or >=25 kg/m2 if ethnicity is recorded as White)) or preceding 24 months for all other patients
7
50-90%
MH012. The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of blood glucose or HbA1c in the preceding 12 months
7
50-90%
NDH002. The percentage of patients with non-diabetic hyperglycaemia who have had an HbA1c or fasting blood glucose performed in the preceding 12 months
18
50-90%
BP002. The percentage of patients aged 45 or over who have a record of blood pressure in the preceding 5 years
15
50-90%
SMOK002. The percentage of patients with any or any combination of the following conditions: CHD, PAD, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma, schizophrenia, bipolar affective disorder or other psychoses whose notes record smoking status in the preceding 12 months
25
50-90%
SMOK004. The percentage of patients aged 15 or over who are recorded as current smokers who have a record of an offer of support and treatment within the preceding 24 months
12
40-90%
VI001. The percentage of babies who reached 8 months old in the preceding 12 months, who have received at least 3 doses of a diphtheria, tetanus and pertussis containing vaccine before the age of 8 months
18
89-96%
VI002. The percentage of children who reached 18 months old in the preceding 12 months, who have received at least 1 dose of MMR between the ages of 12 and 18 months
18
86-96%
VI003. The percentage of children who reached 5 years old in the preceding 12 months, who have received a reinforcing dose of DTaP/IPV and at least 2 doses of MMR between the ages of 1 and 5 years
18
81-96%
VI004. The percentage of patients who reached 80 years old in the preceding 12 months, who have received a shingles vaccine between the ages of 70 and 79 years
10
50-60%
CS005. The proportion of women eligible for screening and aged 25-49 years at the end of period reported whose notes record that an adequate cervical screening test has been performed in the previous 3 years and 6 months
7
45-80%
CS006. The proportion of women eligible for screening and aged 50-64 years at the end of period reported whose notes record that an adequate cervical screening test has been performed in the previous 5 years and 6 months
4
45-80%