Q&A

You would also need to use the Clopidogrel  contraindicated as the system is looking for both Aspirin or an alternative anti-platelet

CTV 3:    XaJ6Y     Clopidogrel contraindicated

Version 2: 8I2K.    Clopidogrel contraindicated

The indicator is not just looking for a QRISK2 in the preceding 12 months. The patient sitting in work to do will have had a risk of =>20 recorded in their records but have yet been treated with a statin or had a therapy exclusion code entered if a statin is not appropriate. If you record an exclusion, the patient will no longer sit in that indicator and you will be back to zero patients. Excluding a patient will remove them.

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the patients care pathway and to call them in, as with any other exclusion if you achieve the indicator it will be superseded.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.

The register is made up of patients with a new diagnosis of hypertension in the preceding 12 months who don’t have specific pre-existing conditions. This is then adjusted in the indicator to exclude certain age groups and to include patients who specifically have CVD risk assessment (QRISK2) scores >= 20% in the preceding 12 months. Your 49 patients are the newly diagnosed Hypertensives but they will not all fulfil the criteria.

It could be one of three reasons why you have zero patients for CVD-PP001.

  1. The patients have a QRISK2 score in their clinical record but all are below 20%.
  2. The patients do not fall within the criteria of 30yrs – 75 yrs with no pre-existing CHD, Diabetes, Stroke and/or TIA.
  3. Not all the patients have a QRISK2 score saved to their records. This would mean you have not identified those patients with a risk =>20%. This can be done through reviewing of the patients notes. It does not have to be a face to face consultation to record the score but you will need to call the patient in to discuss the results if appropriate. Many clinicians also open the clinical tool but forget to press the save button especially on SystmOne as the button is not obvious!

I would suggest you score a new QRISK2 in the patients record to assess if their risk has changed. This potentially could identify a patient who requires a statin.

With DM014 ‘education for newly DM patients, in the preceding 1 April – 31st March’, the indicator is looking back 21 months (651 day’s*) from 31st March 2016. This is in line with the ‘data set rules’ guidance.

 

This will carry over all patients who were not achieved or declined last year. This has been passed over to the NHS Employers for re-consideration again this year.

The rules differ from the guidance, the reason given is:

 

Consideration has to be made for those patients diagnosed with diabetes within 9 months of the end of the QoF period i.e. the 9 month ‘window’ for the referral would then span 2 years. If the patient has not been referred to a structured education programme then it would be unreasonable for the patient to be considered unsuccessful until the full 9 months are checked which can only be done in the next QOF period.

 

This means that you will have to re-enter the patient’s wishes again if their diagnosis was on or after the 1st July 2015 and they refused the offer. I would suggest if you can, call the patient and ask again but if not  you back date to April of this year the refusal code with free text – patient declined within the QOF criteria see entry on xxxxx’ but insure when entering the Read code it is within nine months of the diagnosis. You can then discuss this again at their annual review.

 

* For a number of indicators, this year the rules will calculate months in days and it will be 31 days per month for ease of the queries calculating the practice achievement.

 

 

The table below is guidance for monitoring patient eGFR and ACR on a yearly basis for those with or at risk of CKD.

GFR ( ml/min/1.73 m^2) and ACR categories and risk of adverse outcomes A1

< 3 mg/mol (normal to mildly increased)

A2

3 -30 mg/mol (moderately increased)

A3

> 30mg/mol (severely increased)

G1 >= 90 ml/min/1.73 m^2

(Normal and High)

check eGFR <=1 time per year check eGFR 1 time per year check eGFR >=1 time per year
G2 60-89 ml/min/1.73 m^2

(Mild reduction related to normal range for young adult)

check eGFR <=1time per year check eGFR 1 time per year check eGFR >=1time per year
G3a 45-59 ml/min/1.73 m^2

(mild-moderate reduction)

check eGFR 1time per year check eGFR 1 time per year check eGFR 2 times per year
G3b 30-44 ml/min/1.73 m^2

(moderate-severe reduction)

check eGFR <=2 times per year check eGFR 2 times per year check eGFR >=2 times per year
G4 15-29 ml/min/1.73 m^2

(severe reduction)

check eGFR 2 times per year check eGFR 2 times per year check eGFR 3 times per year
G5 < 15 ml/min/1.73 m^2

(kidney failure)

check eGFR 4 times per year check eGFR >=4 times per year check eGFR >=4 times per yea

No you cannot use the consultant’s letter as evidence of a review. It clearly states in the guidance the review is a primary care review and has to be a face to face consultation either at the practice or the patient’s home. The review is not about the disease only it is about the patient’s wellbeing and the impact on the carers (if applicable). The five areas that you should consider are:

  • An appropriate physical and mental health review.
  • If applicable, the carer’s needs
  • Patient’s health and social care needs.
  • If applicable, the impact of caring on the care-giver.
  • Communication and co-ordination arrangements with secondary care (if applicable).

 

Yes the nurse is able to do a Dementia review during her visit.  It is important she documents what the review covered on the patient’s record when recording it as a home visit.

When the patient was initially referred to the memory clinic it was to confirm the diagnosis of Dementia as correct, so the answer would be to back date the diagnosis to the time you referred.

Please note – DEM005 – screening blood tests patients diagnosed in the current QOF year – 1st April – 31st March.

The business rules are now looking back 18 months to ensure patients who are diagnosed at the beginning of the QOF year will fulfil the blood screening criteria

With DM014 ‘education for newly DM patients, in the preceding 1 April – 31st March’, the indicator is looking back 21 months from 31st March 2016. This is in line with the ‘data set rules’ guidance.

This will carry over all patients who were not achieved last year. Also it appears that all those who refused last year are asking for a new entry of refusal for this year! This has been passed over to the NHS Employers for re-consideration.

This means that you will have to re-enter the patient’s wishes again if their diagnosis was on or after the 1st July 2014 and they refused the offer. I would suggest you back date to April of this year the refusal code with free text – patient declined within the QOF criteria see entry on xxxxx’ but ensure when entering the Read code it is within nine months of the diagnosis

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