001 CQRS: Shingles vaccination programme
This article assumes the reader has access to CQRS, and can interpret the descriptions of payment indicators.
The Shingles 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) |
SHROU012 | Monthly count of the number of registered immunocompetent patients aged 70-79 (inclusive) at the point of vaccination, who have a record of receiving a first dose of Shingrix carried out by the practice within the reporting period. | 70 years (70th birthday) | Day before 80th birthday |
SHROU013 | Monthly count of the number of registered immunocompetent patients aged 70-80 (inclusive) at the point of vaccination, who have a record of receiving a second dose of Shingrix between 6 to 12 months after the first dose carried out by the practice within the reporting period. | 70 years (70th birthday) | Day before 81st birthday |
SHROU014 | Monthly count of the number of registered immunocompetent patients aged 70-80 (inclusive) at the point of vaccination, who have a record of receiving a second dose of Shingrix more than 12 months after the first dose carried out by the practice within the reporting period. | 70 years (70th birthday) | Day before 81st birthday |
| SHROU015 | Monthly count of the number of registered immunocompetent patients who turn 65 or 66 in the reporting year and who have a record of receiving a first dose of Shingrix carried out by the practice within the reporting period whilst aged at least 65. | 65 years (65th birthday) | Born after 01/09/1958 (inclusive) |
| SHROU016 | Monthly count of the number of registered immunocompetent patients who turn 65 or 66 in the reporting year and who have a record of receiving a second dose of Shingrix between 6 to 12 months after the first dose carried out by the practice within the reporting period whilst aged at least 65. | 65 years 6 months | Born after 01/09/1958 (inclusive) |
| SHROU017 | Monthly count of the number of registered immunocompetent patients who turn 65 or 66 in the reporting year and who have a record of receiving a second dose of Shingrix more than 12 months after the first dose carried out by the practice within the reporting period whilst aged at least 65. | 66 years | Born after 01/09/1958 (inclusive) |
| SHROU018 | Monthly count of the number of registered severely immunocompromised patients aged 18 and over at the point of vaccination, who have a record of receiving a first dose of Shingrix carried out by the practice within the reporting period. | 18 years (18th birthday) | No upper age |
| SHROU019 | Monthly count of the number of registered severely immunocompromised patients aged 18 and over at the point of vaccination, who have a record of receiving a second dose of Shingrix 8 weeks to 6 months after the first dose carried out by the practice within the reporting period. | 18 years (18th birthday) | No upper age |
| SHROU020 | Monthly count of the number of registered severely immunocompromised patients aged 18 and over at the point of vaccination, who have a record of receiving a second dose of Shingrix more than 6 months after the first dose carried out by the practice within the reporting period. | 18 years (18th birthday) | No upper age |
SHROU021 | Monthly count of the number of registered patients aged 18 and over at the point of vaccination, who are identified as severely immunocompromised by a clinical code indicating that the patient requires a shingles vaccination, who have a record of receiving a first dose of Shingrix carried out by the practice within the reporting period. | 18 years (18th birthday) | No upper age |
SHROU022 | Monthly count of the number of registered patients aged 18 and over at the point of vaccination, who are identified as severely immunocompromised by a clinical code indicating that the patient requires a shingles vaccination, who have a record of receiving a second dose of Shingrix 8 weeks to 6 months after the first dose carried out by the practice within the reporting period. | 18 years (18th birthday) | No upper age |
| SHROU023 | Monthly count of the number of registered immunocompromised patients aged 18 and over at the point of vaccination, who are identified as severely immunocompromised by a clinical code indicating that the patient requires a shingles vaccination, who have a record of receiving a second dose of Shingrix more than 6 months after the first dose carried out by the practice within the reporting period. | 18 years (18th birthday) | No upper age |
PCIT authored reports
Payment Reports
Primary Care IT has built a set of searches to support the Shingles 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 SHROUx. 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 shingles, this is grouped between immunocompetent and immunocompromised patients.
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. Mixing Zostavax and Shingrix will not be recognised for payment. The first part of Shingrix must be recorded for the first dose.
- Patient was too old or too young. There are now multiple cohorts to think about; patients must be at least 70 years of age to receive their first shingles vaccination (Zostavax or Shingrix) and before their 80th birthday, or patients must be exactly 65 years of age, or for immunocompromised patients they may be at least 50 years of age. The second dose of Shingrix may be given to immunocompetent patients aged 80 if their first dose was administered within 6 months of their 80th birthday.
- The code was added too early or late. For immunocompromised patients the second dose of the double dose Shingrix vaccine must not be given until at least 8 weeks after the first dose. Immunocompetent patients cannot have their second dose until at least 6 months after the first dose. There is no maximum interval between doses for payment (as long as the immunocompetent patient has not had their 81st birthday. There are recommendations in the Green Book about a suitable window for the second dose.
- 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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