Q&A

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.

Normally with this type of query you will find a duplicate entry in the patient’s record after the referral date. This entry would supersede the referral and re-activate the alert.

I would also recommend you check the read code used. The following codes are within the QOF cluster:

CTV3                      Version 2

XaKGy                   8Hj0.                     Referral to diabetes structured education programme

XaNTQ                 8Hj3.                      Referral to DAFNE diabetes structured education programme

XaNTS                   8Hj4.                     Referral to DESMOND diabetes structured education programme

XaNTT                   8Hj5.                     Referral to XPERT diabetes structured education programme

XaNTH                  9OLM.                   Diabetes structured education programme declined

XaXkZ                    8IE9.                    Referral to diabetes education and self-management for ongoing and newly diagnosed structured programme declined

XaZuQ                   8IEa.                     Referral to DAFNE diabetes structured education programme declined

Yes. As long as it is not a bulk added message. Guidelines state invitations should be directed at the individual patient,  so I would not use this as the main invitation.  A letter, a phone call (where you actually speak to the patient),  a text message or message on the prescription and a verbal invite while sitting with the clinician (if it is not appropriate to carry out the review at that time) are all acceptable, but need to recorded in an appropriate way and at the point of contact.

There is no exception Code only for the treatment. For this patient I would wait until the end of the QOF year and then only if they are preventing you from achieving the maximal point use the high unsuitable code. All that you will have achieved would supersede the exception code so the work done will still be included.