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QOF changes for 2020/21

Medeconomics provides details of changes to the QOF for 2020/21.

Changes to asthma indicators (Photo: Adam Gault/SPL/Getty Images)
Changes to asthma indicators (Photo: Adam Gault/SPL/Getty Images)

The number of QOF points available to practices in England is to increase from 559 to 567 as a result of changes agreed as part of the GP contract for 2020/21. The value of a QOF point will increase from £187.74 to £194.83.

New/retired indicators

  • A new indicator relating to non-diabetic hyperglycaemia, which is worth 18 points, will be introduced. Practices will be expected to offer an annual HbA1c test to these patients with the aim of supporting early identification of patients who would have gone on to develop type-2 diabetes.
  • The current primary prevention of cardiovascular disease indicator CVD-PP001 relating to statin treatment for patients newly-diagnosed with hypertension retired.

Changes to existing domains


  • The asthma register indicator will now specify it covers patients aged 6 years of over.
  • Clinicians will now be expected to use a minimum of two diagnostic tests to confirm an asthma diagnosis.
  • During annual reviews clinicians will be expected to record the number of exacerbations a patient has experienced, assess inhaler technique and provide a written personalised action plan.
  • Practices should record details about exposure to smoking in children and young people under the age of 19 as well as their personal smoking status if applicable.


  • There are changes to the requirements of how patients are included on the register – any patient added to the register after 1 April 2020 will need to have a clinical diagnosis plus a record of post bronchodilator spirometry FEV1/FVC ratio below 0.7.
  • Practices will also now need to record the number of exacerbations a patient has experienced during their annual review.

Heart failure

  • A new indicator worth seven points will cover annual reviews for patients on the QOF heart failure register, during which practices will be expected to review medication and assess functional capacity.
  • There is a change of wording for the heart failure register indicator.

Payment thresholds

Current payment thresholds remain unchanged - they are likely to be updated from April 2021 following a review of how the thresholds are calculated.

Quality improvement domain

The quality improvement (QI) domain for 2020/21 will focus on improving care for patients with learning disabilities and supporting early cancer diagnosis. Both modules have been developed by the RCGP, NICE and the Health Foundation.

Learning disabilities
The QI module for learning disabilities will encourage practices to improve identification of people with a learning disability and increase uptake of annual health checks, medicine optimisation and encourage social prescribing to help patients to maintain health and wellbeing.

Early cancer diagnosis
Practices will be expected to help improve participation in the national breast, cervical and bowel cancer screening programmes, as well as improving referral and safety netting for patients suspected of having cancer. This module will support the primary care network service specification for early cancer diagnosis, which has also been agreed as part of the contract deal.

Future developments

From April 2021, a new QOF domain covering vaccinations will be introduced as part of a wider overhaul of how practices are paid for immunisations. As part of this process it is likely that QOF indicators related to incentivising flu vaccinations will be removed.

These incentive payments will instead be covered at primary care network level and paid for from the new Investment and Impact Fund, which works in a similar way to the QOF and rewards networks for performance.

Read full details of the GP contract 2020/21 here

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