Q&A

The patient may have a second entry of Hypertension in their clinical record. There should only be one entry of the diagnosis with a ‘New Episode’ attached to the Read code, if a duplicate entry is made again this will reactivate the reminders for the newly diagnosed Hypertensives

Thanks for your enquiry.  In the indicators mentioned in order to succeed in QOF 2012/13 (providing the patient meets the other indicator criteria) they would need a valid Read Code (in the appropriate timeframe) from the REFERSSSA_COD (Support and refer Stop Smoking Service/Advisor) cluster OR a valid Read Code from the PHARM_COD (Pharmacotherapy) cluster.  Therefore in your example it would be a logical ‘OR’ rather than an ‘AND’ to link your two statements i.e:

 

8CAL.     Smoking cessation advice

 

8IEM.    Smoking cessation drug therapy declined or  8B3Y.Over the counter nicotine replacement therapy or an issue of nicotine replacement therapy

Total population 15 and over.

 

If a lifelong non-smoker they will only need it recorded the once unless under 25 years then its 12 monthly until the year of their 25 birthday. Once recorded as a non-smoker after their 25th birthday then it will not require again unless their status changes.

 

If an ex-smoker, a smoking status is recorded every 24 months unless you record it three consecutive years then it will not be required again unless their status changes.

 

Smokers require their smoking status every 24 months

 

Chronic Disease Registers

 

Patients who are on the disease registers If a lifelong non-smoker they will only need it recorded the once unless under 25 years then its 12 monthly until the year of their 25 birthday. Once recorded as a non-smoker after their birthday then it will not require again

 

If an ex-smoker, a smoking status is recorded every 12 months unless you record it three consecutive years then it is not required again unless their status changes.

 

Smokers require their smoking status every 12 months

 

There is no documentation in the guidance to suggest the advice has to be face to face but to fulfil the set criteria in the book you would need to discuss the options with the patient. This could be done over the telephone and documented as a telephone consultation with evidence of what was discussed.

 

Many practices are struggling with the new smoking indicators, Smoking 6 and Smoking 8.

 

Smoking 6:

 

The percentage of patients with any or any combination of the following conditions: CHD, PAD, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma, schizophrenia, bipolar affective disorder or other psychoses who smoke whose notes contain a record of an offer of support and treatment within the preceding 15 months

 

Smoking 8:

 

The percentage of patients aged 15 years and over who are recorded as current smokers who have a record of an offer of support and treatment within the preceding 27 months.

 

To fulfil both indicators:

 

To be included in the dominator the patient would need to be listed as a ‘current smoker’ (A latest entry of one of the smoking QOF Codes).

 

To achieve the criteria for this indicator (numerator) for those patients in the denominator you have to have a record of being offered support and treatment in the preceding 15 months.

 

The smoking codes are as follows:

 

Version 2 – Advice and Support                                                                                      CTV 3

 

8CAL.      Smoking cessation advice                                                  Ua1Nz     Smoking cessation advice

8HTK.      Referral to stop-smoking clinic                                         XaFw9    Referral to stop-smoking clinic

8HkQ.     Referral to NHS stop smoking service                             XaQT5    Referral to NHS stop smoking service

8H7i.       Referral to smoking cessation advisor                             XaItC       Referral to smoking cessation advisor

8IEK.       Smoking cessation programme declined                        XaIye      Seen by smoking cessation advisor

9N2k.      Seen by smoking cessation advisor                                  XaW0h   Practice based smoking cessation programme start

13p50    Practice based smoking cessation programme start                    date

date                                                                                        XaX5W   Consent given for follow-up by smoking cessation

8IAj.        Smoking cessation advice declined                                                  team

8IEM.      Smoking cessation drug therapy declined                     XaX5X     Declined consent for follow-up by smoking

9Ndf.      Consent given for follow-up by smoking cessation                      cessation team

team                                                                                       XaRFh     Smoking cessation advice declined

9Ndg.      Declined consent for follow-up by smoking                   XaREz      Smoking cessation programme declined

cessation team

 

 

 

Version 2 – Pharmacotherapy  “ advice and support”continued

745H%.  Smoking cessation therapy                                                XaMwY%  Smoking cessation therapy

8B3f.       Nicotine replacement therapy provided free XaIQn     Nicotine replacement therapy provided free

8B2B.      Nicotine replacement therapy                                          XaEKU     Nicotine replacement therapy

8B3Y.      Over the counter nicotine replacement therapy          XaFst       Over the counter nicotine replacement therapy

8IEM.      Smoking cessation drug therapy declined                      XaMlI%   Smoking cessation drug therapy

du3..%    NICOTINE                                                                               XaXpT     Issue of nicotine replacement therapy voucher

du6..%    BUPROPION                                                                          XaZ01     Smoking cessation drug therapy declined

du7..%    NICOTINE 2                                                                           du3..%    NICOTINE

du8..%    VARENICLINE                                                                       du6..%    BUPROPION

du8..%   VARENICLINE

There are two ways in which a patient can be recorded as an ex-smoker.

In the preceding 15 months

Or

On three consecutive years (twelve month period) then there is no need to record again as the patient will be considered as a non-smoker unless their status changes and you enter another status code either during this time or after.

 

 

In the indicators mentioned in order to succeed in QOF 2012/13 (providing the patient meets the other indicator criteria) they would need a valid Read Code (in the appropriate time frame) from the REFERSSSA_COD (Support and refer Stop Smoking Service/Advisor) cluster OR a valid Read Code from the PHARM_COD (Pharmacotherapy) cluster.  Therefore in your example it would be a logical ‘OR’ rather than an ‘AND’ to link your two statements i.e:

 

8CAL.     Smoking cessation advice

And/Or

8IEM.    Smoking cessation drug therapy declined or  8B3Y.Over the counter nicotine replacement therapy or an issue of nicotine replacement therapy

 

You are required to  Read code both the Asthma review and the three RCP questions in the same consultation, I would suggest a quality search identifying patients who have been reviewed without the three RCP questions. This search can be reversed looking at patients with the 3 RCP questions without a review code. If a complete review has taken place and it is only the review Read code missing, you can backdate the Review read code along with the three questions using the original answers to the date of the review. If a review has been coded without the 3 RCP questions then the patient would require another consultation.

A new cancer diagnosis requires a ‘new’ or ‘first’ episode attached to the Read Code. If the diagnosis is entered onto the clinical record by template the entry should have an episode type default as ‘New’ or ‘First’ but if the entry is made via the browser/consultation mode you would need to select the episode type.

Yes, the exclusion for the first three months is to allow practices to arrange the patients care pathway and to call them in, as with any other exclusion if you achieve the indicator it will be superseded. Remember the indication is not just about the diagnosis but also about the therapy prescribed. Without a prescription for a statin having been issued, the patient will not appear in the achieved.

No, the guidance clearly states that it is a primary care face to face review. The review is about the patients wellbeing looking at the:

Discussing DMARS, if relevant

Need for referral for surgery, if relevant

Effects the disease is having on their life, for example work and education

The need to organise appropriate cross-referral within the MDT

 

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