Starting with the 2026/27 GP contract, English general practices earn Quality and Outcomes Framework (QOF) points for two new obesity indicators. QOF is the voluntary, points-based scheme that has topped up practice income since 2004, for meeting defined clinical targets.
According to the British Medical Association’s own QOF guidance, the two new indicators carry 18 points combined:
- OB004 (5 points): referring between 10% and 30% of adults recorded with obesity to a weight-management programme.
- OB005 (13 points): holding a recorded shared decision-making conversation about pharmacotherapy with between 50% and 80% of patients who are eligible for it.
Eligibility for that pharmacotherapy, tirzepatide (brand name Mounjaro), is itself set out on a schedule. Under NICE’s interim commissioning guidance for technology appraisal TA1026, access is phased in by cohort:
- Cohort I, already running in 2025/26: BMI of 40 or above, with at least four qualifying weight-related comorbidities.
- Cohort II, opening in 2026/27: BMI of 35 to 39.9, still requiring at least four comorbidities.
- Cohort III, from 2027/28: BMI of 40 or above, but only three comorbidities required.
Both NICE and NHS England state that these BMI thresholds are lowered by 2.5 kg/m² for patients from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean backgrounds, reflecting evidence that cardiometabolic risk rises at a lower BMI in those groups.
What we could not confirm
Several UK press reports (among them coverage citing the BBC) describe a specific payment structure: up to £3,000 a year for practices tied to weight-loss drug prescribing, plus a further £1,000 for referrals into weight-management programmes, drawn from a ring-fenced £25 million pot. We read that reporting and looked for it in NICE’s TA1026 documentation, NHS England’s interim commissioning guidance, and the BMA’s own QOF summary. None of the three states a GBP figure. The BMA document gives point values, not their cash equivalent; the actual payment per point is set annually and published separately, and we did not find that publication in time for this piece. So the number that keeps getting repeated in headlines is not one we can attach to a primary source here. Readers who want the practice-level payment figure should treat the £3,000 as press-reported, not as something we verified.
Why the points matter regardless of the pound figure
Whatever a point is worth this year, the structure itself is worth reading closely, because it turns two things doctors already do into things they are scored on.
A referral rate of 10 to 30% is not a target of “refer everyone.” It is a corridor: practices lose points if they refer too few, but they do not gain anything for referring more than 30%. The same banding applies to the shared decision-making conversation, capped at 80%. Read one way, this is sensible measurement design, an achievement range prevents practices from chasing a ceiling that isn’t clinically meaningful for every patient. Read another way, it means a conversation about a patient’s weight has become an input to a scorecard, alongside blood pressure checks and diabetic reviews, whether or not that patient asked for it.
The BMI thresholds, meanwhile, are not new. What is new is that meeting them is now something a practice’s income depends on, in a way it didn’t before this contract year. A patient’s number on a scale determines which cohort they fall into, which determines whether their GP has a scored reason to raise the subject at all. Our article on NICE’s TA1152 looked at how a related NICE appraisal keeps the BMI as an entry criterion for a cardiovascular indication, even after saying in its own text that the benefit shows up independently of weight loss. This is the same door, at a different level: national rationing policy and now, on top of it, a financial incentive layered directly onto GP behaviour.
None of this tells us whether tirzepatide is a reasonable thing for an eligible patient to take. That question is between a patient and a clinician, and it isn’t ours to answer. What the QOF structure changes is something upstream of that: whether the conversation gets raised, and how often, is now partly a function of a practice’s points target rather than only of clinical judgement in the room.
Sources: BMA, Quality and Outcomes Framework (QOF); NHS England, interim commissioning guidance for TA1026; NICE, technology appraisal guidance TA1026. Read 25 September 2026.