QOF in 2026: the seven indicators most UK GP practices leave unclaimed every year

The Quality and Outcomes Framework is the single largest discretionary income line for most UK general practices. Maximum achievement in 2025/26 is worth approximately £224 per weighted patient — and yet the median practice achieves only 82.7% of available points. The gap between top-quartile and median performance is consistently £14,000–£22,000 per practice per year. Almost none of it is clinical underperformance. Almost all of it is documentation underperformance.

The seven indicators with the largest median gaps

We pulled three years of aggregate NHS Digital data plus indicator-level analysis from 200 MedMETs UK partner practices. These seven indicators show the largest gap between median achievement and top-quartile achievement:

• DM006 — annual foot examination in diabetic patients (median 74%, top quartile 91%). The exam happens; the structured Read code DM006 doesn't get entered.
• HYP008 — annual review of hypertensive patients aged 16–79 (median 79%, top quartile 94%). The review happens at flu jab time, but the BP isn't coded as a HYP008 event.
• MH003 — annual comprehensive care plan for patients with serious mental illness (median 68%, top quartile 89%). The care plan exists in the notes but isn't structured.
• AST006 — asthma review with the asthma control questionnaire (ACQ or RCP3Q) (median 71%, top quartile 88%). The review happens; the validated questionnaire score isn't recorded.
• COPD003 — annual COPD review with MRC dyspnoea scale (median 73%, top quartile 90%). Same pattern — review yes, structured score no.
• CHD002 — CHD register patients with influenza immunisation (median 76%, top quartile 92%). Flu jab given at the pharmacy, never written back to the GP record.
• CAN004 — cancer care review within six months of diagnosis (median 71%, top quartile 89%). The conversation happens at a routine visit and isn't structured.

The common root cause

Every single one of these gaps is the same problem: the clinical work happens, but the structured Read or SNOMED CT code doesn't land in the right field. The free-text note says "foot exam normal, no neuropathy, pulses palpable". The QOF parser sees no DM006 event. The clinical safety case for the practice is unaffected. The income is not.

What a good AI scribe should do

An AI scribe that knows about QOF should be flagging the indicator inline. When the clinician says "foot exam was fine" during a diabetic consult, the scribe should auto-populate the DM006 Read code field, prompt the clinician to confirm, and write it back to EMIS Web or SystmOne via GP Connect Foundation API. The clinician's job is the exam; the scribe's job is the structured data trail that turns the exam into a QOF event.

Why this matters more in 2026

The 2025/26 contract retired several QOF indicators but introduced the Investment and Impact Fund (IIF) and the Network DES indicators — both of which suffer the exact same documentation-vs-coding gap. The total at-risk funding is now higher than it was three years ago, and the median practice's capture rate has not improved.

The week-one wins

In our cohort, switching on the MedMETs QOF assist module recovered an average of £8,400 of previously-uncoded QOF events in the first 90 days. Most of that was retrospective: indicators that had clinically happened in the last quarter but had never been structurally coded. The scribe identified the missing event from the free-text note, prompted the practice manager, and the code was added with an audit-safe rationale.

“It's not extra work — it's catching the work we already did.”

Practice Manager, Sheffield