This article assumes the reader has access to CQRS, and can interpret the descriptions of payment indicators.

The searches are built in a way which means it is not possible to review data in historic months. Practices may consider storing results for future reference.

Indicator	Description	Lower age limit	Upper age limit (inclusive)
6IN1001	Monthly count of the number of patients who are aged at least 6 weeks old but have not yet attained 10 years old who received a DTaP/IPV/Hib/HepB vaccination administered by the GP practice within the reporting period and this vaccine was their first dose of a Diphtheria, Tetanus, and Polio containing vaccine.	42 days (6 weeks)	Day before 10th birthday
6IN1002	Monthly count of the number of patients who are aged 9 weeks but have not yet attained 10 years old who received a DTaP/IPV/Hib/HepB vaccination administered by the GP practice within the reporting period and this vaccine was their second dose of a Diphtheria, Tetanus, and Polio containing vaccine.	63 days (9 weeks)	Day before 10th birthday
6IN1003	Monthly count of the number of patients who are aged 13 weeks but have not yet attained 10 years old who received a DTaP/IPV/Hib/HepB vaccination administered by the GP practice within the reporting period, and this vaccine was their third dose of a Diphtheria, Tetanus, and Polio containing vaccine.	91 days (13 weeks) Previous dose must have been at least 56 days prior	Day before 10th birthday
6IN1004	Monthly count of the number of patients who are aged 3 years 4 months old but have not yet attained 10 years old who previously completed the full primary course of Diphtheria, Tetanus and Polio containing vaccines, who received a dose of either DTaP/IPV or dTaP/IPV as their first booster vaccine administered by the GP practice within the reporting period.	40 months (3 years 4 months)	Day before 10th birthday
6IN1005	Monthly count of the number of patients who are aged 10 years and over who received a Td/IPV vaccination administered by the GP practice within the reporting period and this vaccine was their first dose of a Diphtheria, Tetanus, and Polio containing vaccine.	10 years (10th birthday)	No upper age
6IN1006	Monthly count of the number of patients who are aged 10 years and over who received a Td/IPV vaccination administered by the GP practice within the reporting period and this vaccine was their second dose of a Diphtheria, Tetanus, and Polio containing vaccine.	10 years (10th birthday)	No upper age
6IN1007	Monthly count of the number of patients who are aged 10 years and over who received a Td/IPV vaccination administered by the GP practice within the reporting period and this vaccine was their third dose of a Diphtheria, Tetanus, and Polio containing vaccine.	10 years (10th birthday)	No upper age
6IN1008	Monthly count of the number of patients who are aged 10 years and over who received a Td/IPV vaccination administered by the GP practice within the reporting period and this vaccine was their fourth dose (first booster dose) of a Diphtheria, Tetanus, and Polio containing vaccine.	10 years (10th birthday)	No upper age
6IN1009	Monthly count of the number of patients who are aged 10 years and over who received a Td/IPV vaccination administered by the GP practice within the reporting period and this vaccine was their fifth dose (second booster dose) of a Diphtheria, Tetanus, and Polio containing vaccine.	10 years (10th birthday)	No upper age
6IN1010	Monthly count of the number of patients who are aged 18 months but have not yet attained 10 years old who received a DTaP/IPV/Hib/HepB vaccination administered by the GP practice within the reporting period.	18 months	Day before 10th birthday

PCIT authored reports

Payment Reports

Missed Activity

1. The patient is pregnant. Pregnant women will receive a pertussis containing vaccination which is normally covered under the separate Pertussis in pregnant women service on CQRS, which picks up the code Pertussis vaccination in pregnancy. Pregnant patients may be flagged as potential missed activity for 6IN1 if there are no recent codes indicative of a pregnancy.
   
2. The vaccination was recorded without the GMS qualifier. The business rules require that vaccinations given under GMS should be recorded correctly. Failure to select GMS may lead to the vaccination not being recognised for payment. 
3. The wrong vaccination or part was added. The business rules are accommodating if 2nd 6-in-1 vaccine has been coded twice, but there are some codes which do not count, including the 5-in-1 vaccine. We recommend using a template to minimise the chances of this occurring.
   Using a 4-in-1 (DTaP/IPV) code for the 5th dose 6IN1009 will not count, and likewise a 3-in-1 (Td/IPV) code used for any dose other than the 5th valid dose will be flagged in Missed Activity.
4. The patient has been on an alternative schedule. Children who had their course interrupted or delayed may be kept on a 5-in-1 vaccine which is not counted for 6IN1001-6IN1003. Patients who began their childhood vaccinations abroad may have not followed the sequence required by certain indicators.
   
5. Patient was too old or too young. 6IN1001-6IN1004 and 6IN1010 are exclusively for children under the age of 10; 6IN1005-6IN1009 are for patients aged 10 or older. The older patients should be receiving DT+polio vaccines and not 6-in-1.
   
6. The code was added too early. There are some 21 day, 28 day, 1 month, 1 year minimum intervals which must not be breached. The same principle actually applies to other vaccines such as rotavirus, where payment won't be given if the 2nd dose was given at 27 days.
   
7. The patient's historical record is incomplete. Where codes are missing, patients may fall into the wrong denominator. This is most likely to happen for patients in denominators [6IN1005]-[6IN1007].
   
8. The patient has already received 5 DTP containing doses in their lifetime. Patients over the age of 10, especially those born in the last 40 years, are likely to have received 5 DTP containing doses during their child and adolescent years. Subsequent doses given for post-exposure prophylaxis are unlikely to be recognised in 6IN1009, and instead will be returned in 6IN1x.
   
9. Patients who have received a stem cell transplant. Following a stem cell transplant a patient's immune system is wiped, and an accelerated individualised schedule of childhood type vaccinations is planned. Practices are likely to be asked to deliver these vaccinations, but CQRS is often not designed to accommodate these additional doses.
   

Missed activity data offers some opportunities for learning.   Hopefully most entries highlighted by the Missed Activity reports are due to coding which can easily be fixed. Whilst it isn't possible to 'fix' where a vaccination has been given to an ineligible patient, there is an opportunity for reflection and learning to ensure the same scenario is not repeated.

The Polio Outbreak Campaign in 2022/2023 for children living in London may explain discrepancies between PCIT's 6IN1004 and the figures that CQRS extracts report. The 6IN1x Missed Activity report for under 10s will show patients with no apparent problems with coding or dates.

Children vaccinated as part of the campaign had their 4th DTP containing vaccine much earlier than scheduled. The advice at the time was that the dose was additional, and they should still receive a pre-school booster dose on or after 3 years 4 months. Children are now receiving a 5th dose which is not recognised by 6IN1004. The advice offered to Primary Care IT by NHS Digital was that any additional doses need to be claimed manually.