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Objective To assess the diagnostic performance of CT fractional flow reserve (CT-FFR) and to assess whether its use in addition to CT coronary angiography (CTCA) changed the investigation and management of patients with suspected coronary artery disease (CAD). Method A retrospective case note review was carried out for 200 consecutive patients at Russells Hall Hospital, Dudley, United Kingdom, who had CTCA sent for Heartflow CT-FFR analysis (HeartFlow, Redwood City, CA) between January 2018 and December 2019. Results Patients with CT-FFR > 0.8 were significantly less likely to require further investigation with coronary angiography (p: < 0.00001) than those with CT-FFR < 0.8. The use of CT-FFR significantly reduced need for further functional imaging (6% vs 26%) (p: 0.00012). A total of 15 patients in this study had both a CT-FFR and an invasive FFR measured, with seven (46.66%) of the CT-FFRs correlating with the invasive FFR. Approximately 54% of patients who had a CT-FFR < 0.8 were found to have an invasive FFR of >0.8. Of the 56 patients who underwent coronary angiography, the CT Coronary Artery Disease-Reporting and Data System (CAD-RADS) and angiography CAD-RADS were the same in 66% of the cases with 82% of CT CAD-RADS results being within ±1 of the angiography CAD-RADS. Conclusion The use of CT-FFR alongside CTCA led to a significant reduction in need for coronary angiography and functional testing. Further studies are required to look at the diagnostic accuracy of CT-FFR in direct comparison with invasive FFR.