001 CQRS: Pneumococcal Adult At Risk programme
This article assumes the reader has access to CQRS, and can interpret the descriptions of payment indicators.
The Pneumococcal Adult 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) |
PNEU001 | Monthly count of patients aged 65 years or over who have received a pneumococcal vaccination by the GP practice, within the reporting period. | Age 65 (Born on or before 31st March 1962*) | n/a |
PNEU005 | Monthly count of patients aged 10 years to 64 years and identified as at risk, with at least one clinical code or “requires a pneumococcal vaccination” in the patient’s record, who have received a pneumococcal vaccination by the GP practice within the reporting period. | Under 65 (Born on or after 1st April 1961*) | Age 10 (Born on or before 31st March 2024*) |
* These dates apply to the contract year 2026-27. The years are then moved on for each subsequent contract year. Note that patients aged 65 at the end of the fiscal year will appear in either PNEU001 or PNEU005 depending on their age on the date they were vaccinated.
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 PNEUx. 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 PNEU, this is grouped between age 10-64 years and over 65 at time of vaccination.
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 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.
- Patient was too young. The pneumococcal business rules are unusual in CQRS as an indicator specifying a date of birth (age at end of financial year) and age on date of vaccination. Some patients aged 64 will appear in both cohorts if they are due to turn 65 by 31/03/26 but they can only be vaccinated age 64 if they have an at-risk condition, otherwise they become eligible on their 65th birthday. Under 10s will appear in the Pneumococcal Child service.
- The patient does not have a qualifying condition. Sometimes a clinician may consider the patient to be at risk but the code does not include the patient in the PNEU005 indicator. A code of 'Requires a pneumococcal vaccination' can be added with a date on or before the dose to indicate a clinical decision has been made.
- Booster dose was given "too early". The Green Book specifies that certain patients may receive a booster dose every 5 years, but the pneumococcal business rules are written in a way that payment will only be given for an interval of up to 6 years. For 2026-27 this means that patients will only be recognised for payment if their previous dose was given before April 2021 - if a booster vaccination is given in May 2026 this is only just over 5 years, but in February 2027 this becomes an interval of nearly 6 years. Nurses operating to the Green Book would say a patient is eligible based on a rolling 5 year/60 month interval.
Follow local guidance around disputing automatically extracted data to claim additional patients. - 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 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.
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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