Blog › QOF childhood immunisation improvement route
QOF 2026/27 · Childhood immunisation · SFE Amendment No. 4
Who gains from QOF's new childhood immunisation improvement route?
From April 2026 the three childhood immunisation indicators, VI001 to VI003, pay on whichever is higher: the old standard thresholds, or improvement on the practice's own two-year baseline. The rule change arrived on 1 October in the fourth amendment to this year's Statement of Financial Entitlements. Using the published 2024/25 and 2025/26 QOF data for every practice in England, this post asks who was getting nothing under the old rules, what their baselines look like, and where in England the new route will actually pay.
By Dr Yogasakaran Arjuna · 18 October 2026 · VI001–VI003 · 6,145 practices · 36 ICBs · England
01What changed on 1 October
The GMS Statement of Financial Entitlements (Amendment) (No. 4) Directions 2026 insert a new Section 4A into Part 2 of the SFE. It applies to VI001, VI002 and VI003 only, and it has effect from 1 April 2026, so it covers the whole of the 2026/27 QOF year.
For each of the three indicators CQRS will now run two calculations and pay the higher. The standard calculation is the one every practice knows: points are earned on a straight line between a minimum and a maximum threshold, and nothing is earned below the minimum. The improvement calculation ignores the national thresholds and looks instead at how far the practice has moved from its own baseline, defined as the average of its 2024/25 and 2025/26 achievement. A gain of five percentage points earns the first improvement points; a gain at or above the improvement maximum earns the full 18.
| Indicator | What it measures | Points | Standard thresholds | Improvement thresholds |
|---|---|---|---|---|
| VI001 | Three doses of a DTaP-containing vaccine by 8 months | 18 | 89–96% | +5 to +18 pts |
| VI002 | One dose of MMR or MMRV between 12 and 18 months | 18 | 86–96% | +5 to +23 pts |
| VI003 | Second dose of MMR or MMRV before age 5 | 18 | 81–96% | +5 to +30 pts |
Where a baseline cannot be established, because the practice has no achievement recorded in one or both of the two years and nothing can be approximated from other data, only the standard calculation applies (4A(7)). The official baseline will be published to each practice in CQRS. The baselines used throughout this post are an Arjus estimate built from the published QOF achievement data (underlying achievement net of personalised care adjustments), and they may differ from the CQRS figure where a practice merged, re-coded or had exceptions re-stated.
One wrinkle in the drafting. Section 4A(6) defines "improvement achievement" as the gain over baseline minus the five-point improvement minimum, and 4A(8) then compares that figure with the minimum and maximum thresholds again and scales it as improvement achievement ÷ (maximum − minimum) × 18. Read literally, a practice would need a ten-point gain before earning anything. Read as the thresholds table clearly intends, points begin at a five-point gain and reach 18 at the maximum, which is the reading Arjus uses: (gain − 5) ÷ (maximum − 5) × 18. CQRS will settle which reading is applied at year end; until then, treat improvement-route estimates in the band just above a five-point gain with caution.
02Who was getting nothing
The case for an improvement route rests on how many practices sit below the standard minimum with no realistic prospect of reaching it. The 2025/26 publication shows how large that group is.
Practices scoring zero points, 2025/26
Number of practices in England with no points on each indicator · share of the 18 available points that went unpaid nationally in brackets
In 2025/26, 2,670 practices, 43% of the 6,145 in England, scored zero on at least one of the three indicators, and 915 scored zero on all three. Only 392 earned the full 18 points on all three. Of the 54 points available to each practice, 53% went unpaid nationally: 175,871 points out of 331,830, worth about £40.1 million at the national point value. VI002, the first MMR dose, is the weakest of the three: 1,988 practices (32%) earned nothing and 57% of its points went unpaid. VI003's 81% minimum is the lowest bar, and it has the fewest zero-point practices (1,516, 25%), but England coverage for the second MMR dose is also the lowest of the three at 85.6%.
The picture is deteriorating. In 2024/25 the zero-point counts were 1,234, 1,479 and 1,433; a year later they had risen by 44%, 34% and 6%, and mean practice achievement fell on all three indicators, by 1.4, 2.1 and 0.6 percentage points. Section 4A was written against that backdrop: a growing group of practices for whom the standard thresholds had stopped functioning as an incentive at all.
03The baseline, and how far each practice has to move
Under the new rule the question for a practice below the standard minimum is no longer "can we reach 81%", but "can we move five points from where we were". For many practices those are very different questions.
Estimated baseline by practice, 2026/27
Average of 2024/25 and 2025/26 achievement (net of PCAs) · practices grouped in 10-point bands · the standard minimum for each indicator is shown in the legend
| Indicator | Practices with a baseline | Mean baseline | Baseline below standard minimum | More than 5 pts below (improvement the only route) | Could reach the improvement maximum before the standard minimum |
|---|---|---|---|---|---|
| VI001 · 89–96% | 6,112 | 91.9% | 1,391 | 558 | 57 |
| VI002 · 86–96% | 6,112 | 88.8% | 1,632 | 899 | 74 |
| VI003 · 81–96% | 6,114 | 86.1% | 1,407 | 922 | 54 |
A baseline could be estimated for 6,112 to 6,114 practices; the 31 to 33 without a value in one of the two years, typically new practices or mergers, are standard-route only unless NHS England approximates a baseline for them. Across the three indicators, 2,127 practices have a baseline below the standard minimum on at least one indicator, and for 1,260 of them it sits more than five points under on at least one indicator (365 on all three). These are the practices for whom a five-point gain is a realistic ambition while the national threshold is not, and they are where the new route will pay. A practice in that position earns its first improvement points while still below the old threshold. The last column shows the extreme case: practices whose baseline is so far down that the improvement maximum, a 30-point gain on VI003, arrives before the standard minimum, so the full 18 points are available without ever meeting the national threshold.
The shape differs by indicator. On VI001 the shortfall is shallow: 1,391 practices have a baseline under 89%, but only 558 are more than five points under, so for most the old target is still the nearer one. On VI003 it is deep: 922 of the 1,407 practices below 81% are more than five points below it.
One warning in the data. Coverage is falling, and a falling practice carries a baseline above its current level. Of the practices below the standard minimum in 2025/26, 81% on VI001, 80% on VI002 and 66% on VI003 had gone backwards year on year. For them the first improvement point needs a recovery from the 2025/26 level of about 7.5, 7.8 and 6.9 percentage points respectively. On VI001 that is further than the 6.2-point average gap to the old standard minimum; on VI003 it is much less than the 11.2-point gap. Had every practice simply repeated its 2025/26 result, the improvement route would have paid 1,564 points across the whole of England, under 1% of what went unpaid. The new route rewards recovery, not standing still.
04Where in England the new route pays
Childhood immunisation coverage is strongly geographic. The ICBs with the most practices below the standard minimum are the ones where the improvement route redistributes the most money.
Share of practices below the standard minimum on VI003, 2025/26, by ICB
Second MMR dose before age 5 · 36 ICBs as published in the 2025/26 QOF data · England 24%
| ICB | Practices | Below std minimum, VI001 | VI002 | VI003 | Mean baseline VI003 | Unpaid points 25/26 | Indicative £ |
|---|
The four London ICBs hold 18% of England's practices and 25% of the unpaid points. In South East London two-thirds of practices (66%) were below the 81% minimum on VI003 in 2025/26 and 79% of the three indicators' points went unpaid; in Birmingham and Solihull it was 63% and 86%; in West and North London, the largest ICB with 510 practices, 62% and 73%, with 20,001 unpaid points worth about £4.6 million at the national point value. At the other end, Dorset and Somerset had no practice below the VI003 minimum, and Devon, Norfolk and Suffolk, and Thames Valley had fewer than 2%.
So the improvement route is largely a London and big-city measure. Mean VI003 baselines of 74% to 79% in the four London ICBs and Birmingham and Solihull put most of their practices squarely in the band where a five-point gain pays and the 81% threshold does not. The indicative money in the table is unpaid 2025/26 points at the national average point value: a ceiling on what the route could redistribute, not a forecast, because a practice only collects it by gaining five or more points on its own baseline.
05A worked example from north London
Two practices in the same north London PCN show the two faces of the new rule. Both were below the standard minimum in 2025/26. For one the improvement route is worth almost nothing; for the other it is the only route to any points at all. Figures are rounded and the practices are not named.
Practice A, VI002. First MMR dose by 18 months: 81% in 2024/25, 80% in 2025/26, so an estimated baseline of 80% against a standard minimum of 86%. The improvement thresholds for VI002 happen to span 18 points (5 to 23), so each point of gain beyond the first five is worth exactly one QOF point. But the practice is only six points under the standard minimum, and the standard line is steeper: 1.8 points per percentage point above 86%. The two routes cross at about 87%. Below 85% the practice earns nothing either way; between 85% and 87% the improvement route pays, but at most about two points; above 87% the old standard route is the better one again. For Practice A the new rule changes very little. The target is still 86%.
Practice B, VI003. Second MMR dose before age 5: 68% then 57%, an estimated baseline of 63% against a standard minimum of 81%. Here the improvement route is the whole story. Nothing is earned under the standard calculation until 81%; under the improvement calculation the first points arrive at 68% and the full 18 at 93%, and the improvement route pays more than the standard route at every achievable level of coverage. At 75% the practice would earn about 5 points where the old rule paid none; at 85% about 12 points against 5 under the old rule.
Standard route versus improvement route at plausible 2026/27 achievement levels
Points earned out of 18 · Arjus reading of Section 4A · baselines are Arjus estimates from published QOF data
| Practice · indicator | 2026/27 achievement | Gain on baseline | Standard pts | Improvement pts | Paid | Route | Indicative £ |
|---|
Indicative income uses the 2026/27 national average of £227.95 per point. A practice's actual value per point is adjusted for its child population, so the pounds will differ; the points will not.
Model your own practice: the Arjus QOF calculator for 2026/27 now carries an improvement-route estimator for VI001 to VI003. It shows your estimated baseline, lets you enter an expected 2026/27 achievement for each indicator, and works out standard points, improvement points and the higher of the two at your practice's own value per point.
06The rest of Amendment No. 4
Section 4A is the part most practices will notice, but the Directions, signed on 30 September 2026 and in force from 1 October, change four other things.
- GP Reimbursement Scheme rewritten (Section 14A). The scheme now has four claim routes: a new salaried GP, extra sessions for an existing salaried GP, extra sessions for a locum (new), and continuation of a post previously funded through Capacity and Access Payments or the PCN Test Sites Programme. A GP whose previous employment with the practice began on or after 24 February 2026 still counts as new. The salary cap is £152,900 (£155,698 with London weighting). Extra salaried sessions and all locum sessions are capped at £78.41 an hour (£79.84 London); the original £90.61 (£92.27 London) survives only for extra salaried sessions agreed between 30 April and 24 June 2026. The practice cap is £4.57 times the adjusted population at 1 January 2026, practices with more than 3,500 patients per GP need NHS England approval to take part, and a practice may now transfer all or part of its entitlement to any other practice in writing, not only to a core member of the same PCN.
- MMRV catch-up row (Section 19(3), table 1). From 1 November 2026 the childhood schedule gains a call for children aged 3 years 4 months to under 6 on 31 December 2025 who have not had two doses of a varicella-containing vaccine and no chickenpox infection: one dose of MMRV, upper arm, with no requirement on the practice to check the medical history of those who respond.
- Pneumococcal rows (Section 19(6), table 2). The rows for people aged 2 to 64 in a clinical risk group, people aged 16 to 64 experiencing homelessness, and everyone at 65 are replaced: PPV until stocks are depleted, then PCV when PPV is depleted or unavailable. Call and recall arrangements are unchanged.
- Dispensing fee scales (Annex G). New banded fees per prescription from 1 October 2026 and again from 1 April 2027, for both authorised dispensing contractors (239.1p down to 211.8p across the bands from October; 236.6p to 209.6p from April) and contractors not authorised to dispense (249.2p to 221.8p; then 246.6p to 219.5p).
The Directions and the consolidated 2026 SFE are on the GOV.UK Statement of Financial Entitlements page.