QOF 2025/26 · Disease Register Prevalence · England

The registers grew by 1.88 million. The population didn't.

The 2025/26 QOF publication landed on 27 August, and the England-level story is all on the diagnosis side: long-term condition registers added 1.88 million entries (+3.7%) in a year when the registered population actually shrank slightly. Hypertension crossed ten million for the first time, pre-diabetes and heart failure grew fastest — and one register quietly went the other way.

By Dr Yogasakaran Arjuna · 31 August 2026 · 21 clinical registers · 6,145 practices · England

01A bigger caseload, not a bigger population

The denominator moved the wrong way for a demographic explanation: the registered population edged down 0.14% (63.77m → 63.67m) as practices merged (6,188 → 6,145). So essentially all of the register growth below is more diagnosis and better recording — 1.88 million more entries representing real people found, coded and now countable in recall systems.

Around +2.5 to +3% looks like this year's "background" recording growth — dementia, stroke/TIA, learning disability and SMI all cluster there. Anything above that band is being actively hunted; anything below it is flat or falling in real terms.

02The cardiometabolic case-finding push is visible

The two fastest-growing registers are heart failure (+7.7%) and non-diabetic hyperglycaemia (+7.3%) — exactly where national programmes have been pointing. NDH added 349,000 people, the largest absolute rise of any register: nearly one in ten adults now carries a pre-diabetes code, and that register feeds the diabetes register (itself up 129,000) for years to come. Heart failure's jump has the signature of improved diagnostic pathways — NT-proBNP-led referral working through — and this year's publication breaks out an LVSD sub-register within the HF sheet for the first time, a hint of where the recording focus sits. Chronic kidney disease (+4.8%) and atrial fibrillation (+4.0%) complete the cardiometabolic set, both well above background.

03Two registers added a third of a million people each

Hypertension added 326,000 people and crossed the ten-million mark for the first time — 15.76% of the entire registered population, up half a percentage point in a single year. Set against estimates of true adult hypertension prevalence, though, a substantial undiagnosed pool remains: the case-finding headroom has not been exhausted. Depression added 327,000 and now covers 14.9% of adults — the steep post-pandemic climb continuing with no sign of flattening. Obesity (+232,000, now 14.3% of adults) completes the trio of registers with adult prevalence in the teens.

04The outliers: asthma stalls, osteoporosis shrinks

Two registers broke from the pack, in opposite directions — and neither move is really about disease.

Asthma is flat (+0.1%, +2,141 people) — a clear outlier among the chronic conditions. That is consistent with the tightened requirement for objective diagnostic confirmation on new asthma diagnoses working through the system: new additions are roughly balancing register cleaning, so the register has effectively stopped growing while every other respiratory and chronic register climbs.

Osteoporosis is the only register that fell (−7,826, −2.8%) — and it fell while its 50+ denominator grew. A register that shrinks as its at-risk population ages usually means register validation rather than less disease: unconfirmed or miscoded entries being removed against DXA-confirmation requirements. Worth remembering when a practice's osteoporosis prevalence "drops" year on year in the dashboard — at England level it dropped too.

At the quiet end of the growth table, coronary heart disease (+1.5%) and peripheral arterial disease (+0.5%) sit well below background recording growth — the long-run decline in recorded CHD continuing beneath a thin layer of new coding. And cancer's +5.1% needs its mechanical caveat: it is a cumulative register of diagnoses since 2003, so it grows almost by construction.

05Every register, year on year

All 21 clinical registers, 2025/26 against 2024/25, sorted by relative change in prevalence. Register growth is not "performance" in either direction — for most conditions a rising register means better detection, and for some (osteoporosis this year) a falling one means better data quality.