Start as You Mean to Go On: Three Pillars for Proactive Care in the New Financial Year
The new financial year is here. For GP practices, that means a reset on QOF, a fresh set of targets, and a choice about how to approach the next twelve months.
Most practice managers I speak to know what they need to achieve. The challenge is not understanding the targets; it is the way the year tends to unfold: slowly at first, then all at once. A slow start means that reviews begin to pile up. Recalls get deferred. And by January or February, the practice is in catch-up mode, managing a clinical and administrative backlog at exactly the time when seasonal demand is highest.
There is a better way. Starting well in April is not just about hitting the ground running on QOF. It is about setting up a way of working that makes the whole year more manageable, more effective, and more equitable. This piece sets out three pillars that every practice should be thinking about right now.
Pillar One: Effectiveness
Know your numbers. Act on them now.
The 2026/27 QOF year adds 18 new points worth approximately £25 million across the sector.[1] New indicators cover obesity management and structured weight management referrals. The framework continues to place significant weight on cardiovascular disease prevention, with ambitious upper thresholds: 85% achievement required for hypertension indicators and 90% for blood pressure indicators in other disease areas[2] — thresholds confirmed as carried forward into 2026/27 from the prior year.
These are not inconsequential targets. Practices that do not get ahead of CVD recalls in the first half of the year will find themselves chasing a large patient population under time pressure, with less clinical capacity to absorb the workload. The case for putting your best foot forward in April is straightforward.
Practices that launch structured recall campaigns early in Q1 distribute demand across the year rather than concentrating it. Digital outreach tools, when integrated with EMIS or SystmOne, can identify eligible patients automatically and contact them via SMS, email, or NHS App. Industry data from practices using automated recall solutions suggests admin time for outreach can fall by up to 70%. That is time reinvested into patients with more complex needs or who need more support in navigating the system.
Effectiveness at this stage also means getting the basics right. Disease registers need to be accurate. Patients coded incorrectly or not coded at all are invisible to automated recall systems. Practices should also consider holistic clinic models that combine several QOF reviews into a single patient contact. With multiple CVD indicators grouped together, an integrated annual review model can cover diabetes, hypertension, and lipid management in one appointment. This is better for multimorbid patients, who regularly describe being brought into the practice multiple times in quick succession, and far more efficient for the practice, freeing up admin time and unlocking clinical capacity.
Effectiveness is not just about maximising QOF income. Practices that proactively identify and engage patients with poorly controlled long-term conditions reduce the likelihood of unplanned admissions, emergency attendances, and urgent care escalations further down the line. The financial incentives and the clinical case point in the same direction.
Pillar Two: Psychological Impact
Starting well means tracking well throughout.
A 2024 BMA survey of GP registrars found that nearly three-quarters (72.9%) reported experiencing burnout and stress as a direct result of their clinical work.[3] A 2023 BMA survey of NHS doctors found that 44% had considered leaving the profession entirely because of work-related stress.[4] Administrative burden is a primary driver. And research published in the British Journal of General Practice found a direct association between higher administrative load and increased rates of clinical near-misses.[5]
None of this is new information. But it should have a direct bearing on how practices approach the financial year. The familiar pattern of slow progress in Q1 and Q2, followed by a scramble in Q3 and Q4, is not just an operational problem. It is a staff wellbeing problem.
When a practice is on track in April and May, it creates buffer capacity later in the year. Disruptions will come. A key member of staff might be absent. An IT system could go down. A major demand surge will arrive in winter. Practices that are ahead of their trajectory can absorb these shocks without crisis. Practices that are already behind will have a tougher time.
Many practices could benefit from a live management reporting tool that helps them track their performance. Frequent tracking against a simple trajectory model can turn QOF from an annual anxiety event into a routine operational activity. The targets become progress markers that reassure you that you are on track, and can help identify where additional effort is required. The end of the year stops being a cliff edge.
There is also a team dimension to this. Research on psychological safety in primary care teams published in BMC Health Services Research found that psychological safety is a direct predictor of turnover intent and is associated with improved clinical performance and more open error reporting.[6] A practice that is confidently on track halfway through the year has a different team culture than one that is 15 percentage points behind.
Starting well is, in part, a workforce strategy. The practices with the best chance of sustaining performance across the year are those that invest in proactive systems in April, before the pressure arrives. Not in response to it.
Pillar Three: Equity
Achieving your results in a way that closes gaps, not widens them.
The inverse care law is alive and well in QOF. Evidence from BJGP and several systematic reviews confirms that practices serving more deprived populations consistently score lower on QOF, despite having greater clinical need.[7] For 17 of 33 QOF indicators studied, delivered quality — meaning the percentage of all patients with a condition who achieve the clinical target including those who have been excepted — falls with increasing deprivation.[8]
Exception reporting is part of the problem. The existing system means that practices are not financially penalised for patients they exclude from QOF calculations. But it also means that hard-to-reach patients, precisely those with the most complex needs and the greatest health inequality exposure, are systematically removed from the denominator. The practice hits its payment target. The patients who stand to benefit most remain unmanaged.
The 2026/27 framework makes a step in the right direction. NHS England has introduced a sliding scale that allows practices to earn QOF points by improving against their own two-year baseline average, not just by hitting absolute thresholds.[9] Vaccination indicators now include improvement thresholds that specifically recognise deprived-area practices demonstrating meaningful and sustained progress, even where they fall short of the headline target.[9]
This matters. It creates a direct financial incentive to invest in the harder work of reaching the most difficult-to-engage patients.
Reaching underserved patients takes more time and more touchpoints. Patients with language barriers, multiple conditions, chaotic lives, or a history of disengagement from services do not respond to a single SMS booking link sent in their birth month. A practice that begins outreach in April and works systematically through its register over twelve months, prioritising those with the highest deprivation and complexity first, will achieve both better QOF scores and better health outcomes than one that hits the same headline number by concentrating on the easy-to-reach portion of its list.
Equity is not a secondary concern that sits alongside effectiveness. It is built into the definition of a good outcome. A practice that achieves 85% hypertension control by managing 85% of its least complex patients has not necessarily achieved the same thing as a practice that achieves 80% by engaging across its full population, including those most at risk. The numbers look similar. The health impact is very different.
Starting well, in this context, means setting your patient identification and targeting logic so that deprivation and clinical complexity lead, not lag.
Three Pillars. One Approach.
Effectiveness, psychological impact, and equity should not be seen as separate workstreams. They reinforce each other. A practice that starts systematically in April, tracks progress monthly, and prioritises the patients who most need proactive care will perform better on all three dimensions.
The practices that achieve this are not doing something complicated. They are doing something consistent. Structured recall campaigns. Accurate disease registers. Multi-channel patient engagement. Monthly performance tracking. A targeting approach that leads with clinical need and deprivation, not administrative convenience.
The difference between a good year and a difficult one is often made in April and May. Not in February and March.
How Mumo Supports This Approach
Mumo, Appt Health's care coordination service, is built around exactly this kind of proactive, year-round practice model. It automates patient identification and recall, integrates with EMIS and SystmOne, and enables multi-channel engagement across SMS, email, the NHS App, letters, and automated voice to make sure no patient is left behind. It surfaces the patients most at risk, tracks performance against targets in real time, and is designed to support practices working in areas of higher deprivation.
If you are thinking about how to set your practice up for a better year from April onwards, we would like to hear from you. Take a look at appt-health.co.uk to find out more about how the service works and what it looks like in practice.
References
[1] NHS Confederation. GP contract 2026/27: what you need to know. nhsconfed.org/publications/gp-contract-202627-what-you-need-know
[2] NHS England. Quality and Outcomes Framework guidance for 2026/27 (March 2026). england.nhs.uk/wp-content/uploads/2026/03/PRN02356-quality-and-outcomes-framework-guidance-26-27.pdf
[3] BMA. New BMA survey highlights worrying trends of burnout and future concerns from GP registrars (2024). bma.org.uk/bma-media-centre/new-bma-survey-highlights-worrying-trends-of-burnout-and-future-concerns-from-gp-registrars
[4] BMA. Stress on doctors reaches all-time high (2023). bma.org.uk/news-and-opinion/stress-on-doctors-reaches-all-time-high
[5] Hobbs FDR et al. Association of GP wellbeing and burnout with patient safety in UK primary care: a cross-sectional survey. British Journal of General Practice. 2019;69(684):e507. bjgp.org/content/69/684/e507
[6] Robb E et al. Exploring the barriers and facilitators of psychological safety in primary care teams: a qualitative study. BMC Health Services Research. 2021;21:585. link.springer.com/article/10.1186/s12913-021-06232-7
[7] Edwards HB et al. The relationship between Quality and Outcomes Framework scores and socioeconomic deprivation: a longitudinal study. BJGP Open. 2023;7(4). bjgpopen.org/content/7/4/bjgpo.2023.0024
[8] Ashworth M et al. The relationship between social deprivation and the quality of primary care: a national survey using indicators from the UK Quality and Outcomes Framework. British Journal of General Practice. 2007;57(539):441-449. bjgp.org/content/57/539/441
[9] NHS Confederation. GP contract 2026/27: what you need to know. nhsconfed.org/publications/gp-contract-202627-what-you-need-know
