001A CQRS: 6-in-1 searches
This article assumes the reader has access to CQRS, and can interpret the descriptions of payment indicators.
There are ten 6in1 indicators to report on, which have a complex set of rules. Technically the entire service looks at vaccines containing diphtheria, tetanus, and polio rather than the indicated hexavalent vaccine.
The 6in1 indicators are extracted automatically from your system approximately 10 days after the end of the monthly reporting period. The searches will return data for the claim month from the 25th of the month, until the 24th of the following month (eg: for activity performed in the month of April, use the searches between 25th April and 24th May). This is intended to provide sufficient time for Practices to check and update their data prior to extraction, and review activity once figures are available to declare on CQRS.
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.
Service Indicators
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
Primary Care IT has built a set of searches to support the 6in1 extraction. The main searches closely mirror the business rules, and it is expected that these will forecast the volume of activity recognised for payment by the CQRS count.
Missed Activity
Additional "Missed Activity" searches are provided to highlight additional patients who have not already been counted by the CQRS counts. They are identified by the prefix 6IN1x. Missed Activity searches are NOT built to return a specific service indicator but to capture likely activity based on vaccinations recorded during the month, grouped by a certain characteristic. In the case of 6IN1, this is grouped between under 10s and over 10s.
There are several reasons why a patient may appear in a "Missed Activity" report instead of a "Payment" report, and these all need to be considered.
- 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.
- 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.
- 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. - 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.
- 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.
- 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.
- 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].
- 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.
- 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.
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.
The Missed Activity searches have been built around vaccinations, while the business rules allow for codes OR medication issues. Using vaccinations in SystmOne helps to offer a more precise vaccination history, but some patients may present with a mixed code and vaccination history especially if they were previously registered with a GP surgery using EMIS Web or Vision.
Valid codes
6IN1001 - 6IN1003
1082441000000108 - First diphtheria, tetanus and acellular pertussis, inactivated polio, Haemophilus influenzae type b and hepatitis B vaccination
1082451000000106 - Second diphtheria, tetanus and acellular pertussis, inactivated polio, Haemophilus influenzae type b and hepatitis B vaccination
1082461000000109 - Third diphtheria, tetanus and acellular pertussis, inactivated polio, Haemophilus influenzae type b and hepatitis B vaccination
6IN1004 - requires valid primary dose codes (see above) to qualify. Bearing in mind the limited codes specified for QOF VI003 only use the below codes despite the CQRS indicator having a broader set of valid codes.
247821000000102 - Booster diphtheria, tetanus, acellular pertussis and inactivated polio vaccination
390865008 - Administration of booster dose of diphtheria and acellular pertussis and poliomyelitis and tetanus vaccine
6IN1005 - 6IN1009
868267006 - Administration of first dose of diphtheria, poliomyelitis, and tetanus vaccine
868266002 - Administration of second dose of diphtheria, poliomyelitis, and tetanus vaccine
868268001 - Administration of third dose of diphtheria, poliomyelitis, and tetanus vaccine
866227002 - Administration of booster dose of diphtheria, poliomyelitis, and tetanus vaccine
Having run the top folder, check that the report 6IN1000X - medication issued but no codes is empty; all of the claiming searches have been built primarily around codes rather than medication issues, and this search/report will identify any patients who had a medication issue last month but there was no corresponding clinical code in the same period. The reason for this is to support good practice of coding vaccinations; not only does this make future reporting easier, it ensures whenever the patient requests their vaccination history that everything is included from the vaccination filter in Care History.
Reports to help review potential data can be found in the Missed Activity folder, named with the indicator code followed by an X. If the searches have run, highlight the report and press View Results from the ribbon or right click for the quick menu.
The missed activity reports for CQRS have been designed in a standard fashion for ease of understanding.
CHECK - data in the CHECK column means that the codes used are correct, but the patient was either too old or young, or a subsequent dose was given too early or too late. It may be necessary to refer to the ES business rules to confirm appropriate age ranges and intervals between doses.
INVALID - data in the INVALID column means that activity has been found but with a different code that may indicate claimable activity. This column only focuses on the code and not on the age or the interval, meaning the report may need to be re-run or work out the time criteria yourself offline.
There may be a few scenarios where data appears in both CHECK and INVALID columns due to the way missed activity reports have been configured; prioritise CHECK before considering wither INVALID contains claimable activity.
Always check the 0% searches to ensure that single patients from the denominator are not missed!
The Full Hierarchy button on the ribbon can make checking the parent searches of 0% searches easier.
Review the CQRS article for points to consider when using these searches.
The business rules and code cluster lists for enhanced services can be found on the NHS Digital website.
While the main searches have been built to closely mirror the business rules, there is a creative element to the Missed Activity searches. Where patients appear in the Missed Activity searches, don't discount that there are other factors which erroneously brought the patient into the search. PCIT is always happy to hear about problems, but is unable to assist with every query why a specific patient is/isn't included.
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