Q&A

Since the update to V45 , many practices have seen their Asthma review achievement  reverted back to zero.

It would appear that the Asthma Management plan Code used by many practices is not on the list of the QOF codes, the two acceptable SNOMED codes are:

XaRFi  Patient has a written asthma personal action plan (SNOMED 527171000000103)

XaYZB Asthma self-management plan review (SNOMED 810901000000102).

Also not all areas of the review may have been completed due to the present situation.

To achieve the review indicator, the Review code, Exacerbation code, ACT questionnaire, Self-management plan and the inhaler Technique should be coded on the same day, during the same consultation.

Many patients would not have had their Inhaler technique completed due to the reviews having been a Telephone consultation. The Asthma review indicator sits within the protected payment list (See the latest Guidance) and where it has not been possible to fulfil an indicator,  this should be written in your plan for managing the care delivered. Going forward for patients you have yet to review who are uncontrolled Asthmatics or are hard to reach, a Video consultation to review the patients inhaler technique may be an option if face to face is not possible.

Hi Jill

With regard to the above support call, the reason that the Recurrent wheezy bronchitis codes are included in extract is because of the way that SNOMED CT codes map to Read codes:

•           Recurrent wheezy bronchitis is a synonym for the SNOMED code 195949008 Chronic asthmatic bronchitis. Our clinicians have confirmed this SNOMED code is a valid COPD code, therefore this code has to be retained in the code cluster COPD_COD for QOF version 41. This does mean that patients with H30.. Recurrent wheezy bronchitis will continue to be included on COPD registers.

We recommend checking whether your system supplier or your regional NHS England Team have provided any guidance regarding how to manage these patients.

If they have not provided any guidance and your clinicians have determined that these patients are not suitable to follow the QOF COPD care pathway then these patients would need to be exception reported for the purposes of QOF

Many thanks.

Regards.

Service Management Practitioner

I have sent a query to NHS Digital regarding the following two error on behalf of practices who have queried the following issues identified due to the Code matching to SNOMED for SystmOne practices:

I wonder if you are able to advise me please,  we have a patient with Essential thrombocythaemia the Read code is X20FX. This Read code was excluded on V37, it sits within the Coagulation Disorder chapter under the platelet disorder on the CTV3 browser but on V41 it sits with in the Primary malignant neoplasm (372087000) and has been included within the Cancer codes. It has  now carried this patient over on to the Cancer Register, although very small in number this has not been included in the past, can you clarify if this will be corrected please.

 We also have the issue with the CTV3 Read codes where patients with Post-concussion syndrome are now sitting on the Dementia register since the release of V41, these patients do not have Dementia and do not belong on the register. Is this going to be corrected too as it is not appropriate to compete a dementia review with these patients.

Hopefully we can have clarification if this will be updated before 31st March

Your help with this would be very much appreciated

I have sent the following query to NHS Digital regarding patients who are not sitting on the COPD register who does not belong there and am awaiting a reply. There is a small number of practices who have changed the historic  entry to a Bronchitis Read code which is not part of the COPD Cluster:

Could you please advise , on SystmOne there is a historic Read code H30..  Bronchitis:[ unspecified(& chect infect)] or[recur wheezy] – wheezy (other episode) which is no longer in use but there are many patients who have this in their records from historic entries and are now sitting on the COPD due to the code sitting within the  H3.. chapter due to the matching of SNOMED with CTV3 codes. The code did not sit within the COPD diagnosis cluster in the past

 As this data is historic, can it be excluded from the SNOMED COPD cluster or is this going to have to be a change of code by the practices, it does appear to be quite a number who have had this code entered in the past?

You can locate the link on your home page on CQRS or through the NHS Digital link below

https://digital.nhs.uk/services/general-practice-gp-collections

If the patient cannot tolerate an anti-coagulation drug or anti-platelet therapy you will need to exception report the patient from Warfarin, Aspirin, Clopidogrel and Dipyridamole to remove them from the indicator.

It does not say it has to be a face to face review. It can be done as a notes review. On SystmOne and Vision it is made easier as incorporated in the clinical system is a Chad2 tool which you would need to save to the records but if done by a non-clinician you would have to evidence you have followed-up the score if not appropriately prescribed.

Chads2 is a risk stratification scoring system used to assess a patient’s risk of a Stroke. The scoring system works as follows

• C = congestive heart failure 1 point

• H = hypertension 1 point

• A = aged 75 years or over 1 point

• D = diabetes mellitus 1 point

• S2 = previous stroke 2 points

The treatment considered should be as follows:

Score 0 = low risk (Aspirin)

Score 1 = moderate risk (Aspirin or Warfarin)

Score 2 or more = high risk (Warfarin)