Get Ahead of QOF 2026/27 Before the Business Rules Arrive

The QOF 2026/27 business rules have not yet been published. Clinical system suppliers have not released updated templates, and the detailed SNOMED clusters, extraction logic, and exception rules are still to follow.

That makes it easy to assume preparation has to wait. It does not.

Although the technical rules are still pending, the clinical intent behind the new indicators is already clear. Much of it is rooted in NICE guidance and published indicator specifications that have been available for months. That means practices can start preparing now, rather than losing valuable time waiting for the system updates to land.

For QOF leads, clinical pharmacists, nurses, and practice managers, this is the opportunity to clean registers, review coding, check pathways, and identify gaps before the annual rush begins.

The new indicators at a glance

In addition, the three childhood vaccination indicators — VI001, VI002, and VI003 — are being updated to include the MMRV vaccine and a new improvement-based threshold model.

DM037: the indicator most likely to catch practices out

DM037 replaces DM012 and focuses on whether patients with Type 2 diabetes receive all 8 NICE-recommended annual care processes.

The 8 care processes are:

• HbA1c measurement
• Blood pressure measurement
• Serum cholesterol measurement
• Serum creatinine or eGFR
• Urine albumin-to-creatinine ratio (ACR)
• Foot examination
• BMI or weight measurement
• Smoking status recording

For many practices, the biggest risk areas will be urine ACR testing and foot examination, because these require deliberate action rather than being picked up automatically through routine blood testing.

Retinal screening is not included in this indicator. It remains one of the nationally recognised diabetes care processes, but it sits within the screening programme rather than general practice delivery.

HF009: 4-pillar heart failure therapy

HF009 reflects the current NICE approach to optimising treatment for heart failure with reduced ejection fraction. It replaces earlier heart failure indicators and focuses on whether patients with HFrEF are receiving all 4 pillars of evidence-based therapy.

The 4 pillars are:

• ACE inhibitor, ARB, or ARNI
• Beta-blocker licensed for heart failure
• Mineralocorticoid receptor antagonist
• SGLT2 inhibitor

In many practices, the most commonly missing element is likely to be the SGLT2 inhibitor. Many patients were stabilised on older treatment pathways before SGLT2 therapy became a routine part of HFrEF management.

OB004 and OB005: obesity becomes a meaningful QOF area

These two indicators replace the retired Weight Management Enhanced Service and bring obesity management much more directly into the QOF framework.

OB004 measures referral of adults with obesity to a structured weight management programme. In practice, that means referral into Tier 2 or Tier 3 services where these exist locally.

OB005 focuses on shared decision-making and pharmacotherapy in obesity care. This includes a documented clinical conversation and potentially the use of obesity medication where appropriate under NICE guidance and local prescribing criteria.

CD001 and CD002: blood pressure control is being consolidated

CD001 and CD002 replace multiple separate cardiovascular blood pressure indicators with a more consolidated framework. Although the structure is simpler, it creates a new dependency on accurate frailty coding.

These indicators apply to patients aged 79 or under without frailty exclusion. That means incomplete frailty coding could leave inappropriate patients in the denominator, making performance appear worse than it really is.

In practical terms, poor frailty coding can cost points in two ways: it includes patients who may reasonably be excluded, and it distorts the overall achievement rate.

Childhood vaccinations: improvement now matters

The childhood vaccination indicators are changing not only because they now include MMRV, but because they introduce a new improvement threshold mechanism.

Historically, practices have only been able to earn points through fixed national thresholds. For some practices, especially those serving more deprived or vaccine-hesitant populations, those targets have been difficult to reach.

From 2026/27, practices will be able to score through either route:

• the traditional achievement thresholds, or
• an improvement route based on the practice’s own 2-year baseline

Whichever route produces the better result at year-end will apply.

Other QOF changes worth modelling now

Alongside the new indicators, several existing areas are changing in ways that may affect both workload and income.

• CHOL003 falls from 38 to 20 points
• DM034 rises from 4 to 8 points
• DM035 rises from 2 to 8 points
• NDH003 rises from 18 to 20 points and adds gestational diabetes
• AF006 increases its upper threshold from 90% to 95%
• The asthma register now includes patients from age 5
• The COPD register business rules are being updated to address under- and over-recording

These changes may not be as eye-catching as the new indicators, but they could still materially shift a practice’s QOF position and should be included in local modelling.

Preparation timeline

Final thought

The practices that prepare now will have a clear head start over those that wait for the business rules to arrive.

The clinical direction is already clear enough to begin. Register audits can start immediately. Coding quality can be improved now. Referral pathways can be checked now. Vaccination baselines can be modelled now.

The business rules will still matter, but they are more likely to confirm the technical detail than to change the core clinical work required. The teams that move early will enter the new year with cleaner data, better workflows, and fewer surprises.