Q&A

There is no exclusion code for resolved for this indicator. We suggest you enter the ‘ACE/ARB ‘not indicated’ Codes. Please remember to use all the ‘not indicated’ codes as if you exclude the patent from and ACE the system will then look for an ARB

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 2017 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

Because the practice is a SystemOne user, a filter was set on the journal hiding the community data. The patients had been reviewed in the community and both BP’s had been recorded after their average BP reading. The results were higher than the 140/80 criteria. It is important you remove the journal filter when checking data for the QOF, for many indicators the system is looking for the latest reading entered into the patient’s record regardless of who entered it.

Hospital cared DM patients cannot be excluded because the clinic did not review those areas of care.  If you find they have had all the care with the exception say for example their foot check. I would suggest you send a letter stating ‘you are aware they have had their annual review at the hospital but it would appear that their feet were not check’. Explain the importance of it in the body of the letter and then ask if they would make a ten minute appointment with the appropriate nurse/HCA. You will receive a  far better response than sending a generic letter

Not just for diabetes but for 95% of the QOF, if you receive correspondence from secondary care, community care or even private care you should enter all the relevant information into the patients record using where at all possible a QOF read code if it is part of the QOF criteria.

This information includes BP, bloods, feet check, diagnostic test and blood tests etc. You are not expected to duplicate work that has already been done.

The thing to remember about the QOF is it does not matter where the intervention took place – primary care, community or secondary care as long as the patient receives all interventions that are appropriate for their care and well-being and the practice ensures the results are acted upon, if required.

The areas you cannot use secondary/community care information is

Cancer Review

Dementia review

RA review

Depression

Asthma

Yes the patients require a test to identify those DM patient who have a diagnosis of either nephropathy (clinical proteinuria) or micro albuminuria but the indicator itself is only looking for those patients with confirmation of nephropathy (clinical proteinuria) or micro albuminuria who are currently treated with an ACE or ARB, not those who have had the test done and are negative. I have checked two practices and for example one practice had 222 patients on their register of which only 59 appear in DM006 as they are the only ones with a confirmed diagnosis and of the 59 patients the practice has achieved the indicator for 52 patients as they are currently being treated with an ACE-I or ARB.

The exception code for patients who have declined to give a urine specimen

CTV3                   Version 2

Xaa3v                     9RX..               Declines to give urine specimen

: We asked a professor of Renal Medicine and the answer received was as follows:

I think the reasons for repeat testing of MA in DM even after establishing its presence are:

– In 30% of T1DM at least (T2DM less clear) MA will regress and disappear

– In some patients MA progresses to macroalbuminuria

Both of these events have implications for a patient’s renal function in the long term – one good, one bad – so probably some merit in knowing what’s happening in order to keep patient informed and health care staff on their toes in dealing with other modifiable risks as appropriate.

There is no specific register for depression. The register sits in the background for calculating prevalence payments. To verify the register you would need to search for all patients who have an active diagnosis of depression who do not have a ‘New’ episode attached to the Read code. For patients to appear as part of the prevalence, patients will require a “New” or “First” episode attached to the Read Code.

You would need to record the patient as depression resolved and this will remove the patient from the QOF. The read code for this is:

Version 2                                                                                                  CVT3

212S.     Depression resolved                                   XaLG0   Depression resolved

No, it is important all area of care is covered. I would suggest that you review the practice recall letters for this group of patients. If you call a patient in for an annual review and they have been seen at the hospital, the uptake will be low due to the patient having already been reviewed. If you send a letter for example stating ‘we are aware you have had your diabetic review at the hospital but at the time of the review your feet were not examined. This is an import part of your Diabetes care and would like to invite you to make an appointment with the Practice Nurse ……….’.

This has increased the attendances in practice that have adopted this process for their secondary care DM patients.