QOF guidance sets out new obesity indicators and rules on vaccine uptake

GP practices will be eligible for up to 18 QOF points under new indicators for taking part in obesity management, guidance from NHS England has set out.

Under the new contract which came into force yesterday (1 April), five points are available for new referrals to weight management programmes for adults with obesity and a further 13 set aside for shared decision making around weight loss drugs.

To meet the target for referral, practices will need to hit between 10-30% of patients aged 18 or over living with obesity, who have been referred to a weight management programme within 90 days of BMI being recorded.

The definition of obesity follows NICE guidance of a BMI greater than or equal to 30 kg/m2 recorded in the preceding 12 months, or a BMI of 27.5 kg/m2 for patients with a South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family background.

The greater number of points is for 50-80% of eligible patients who fall into the cohorts agreed under the funding variation for the staggered role out of weight loss jabs with a recorded shared decision-making discussion about the management of obesity who have been offered ‘NICE approved medicines for use in a primary care setting with accompanying referral to suitable behavioural support programme, in the preceding 12 months’.

To achieve these points GPs will need to hit a target of 50-80% of patients, the guidance states.

In June 2025 GPs were given the go ahead to start prescribing tirzepatide (Mounjaro) for obesity under strict criteria.

In the first year this is patients with a BMI over 40 and four or more weight-related comorbidities such as hypertension, sleep apnoea, dyslipidaemia or cardiovascular disease.

The second cohort to be prescribed tirzepatide must have a BMI of 35 – 39.9 and four or more comorbidities; the third cohort must have a BMI over 40 and three or more comorbidities.

Earlier this month, an investigation by Pulse’s sister title, The Pharmacist, revealed that some ICBs are imposing their own thresholds for prescribing weight-loss drug tirzepatide through primary care that go further than the national thresholds.

NHS England has also published more detail on how practices will be incentivised for improving up take of childhood vaccines, not just hitting herd immunity targets.

It follows years of declining vaccination uptake and ongoing outbreaks of measles and whooping cough.

Public health officials had told Pulse that GP practices working to improve uptake of MMR vaccination in deprived areas will be key to stopping ongoing outbreaks of measles. 

The existing QOF vaccination thresholds will still apply, but for the first time there will be an additional route for practices who have historically missed out on immunisation indicators if they can show ‘significant improvement’ against their baseline.

For the standard QOF calculation, practice achievement will need to fall within the lower – which varies between 81-89% depending on the indicator and upper thresholds of 96%.

But there will also be an improvement calculation which will require a minimum increase of 5 percentage points from the two-year average baseline to start qualifying for QOF points set on a sliding scale.

For example, a practice with a baseline of 71% with an achievement figure of 82% has seen an improvement of 11 percentage points, it noted.

Practices will achieve the points of whichever calculation is greater. It should mean that practices who have never hit the QOF immunisation targets but have shown improvement will be rewarded, the guidance said.

But practices who ‘consistently achieve within the standard QOF thresholds’, will continue to be incentivised to do so, NHS England said.