004B Routine QOF work | a Early contract actions

004B Routine QOF work | a Early contract actions


This folder contains a set of searches and reports to help you capture quick QOF wins early in the financial year. Several of these reports surface patients who previously declined treatment, were contraindicated, or were exception coded — making them ideal for early review and either reapplying the correct PCA or completing care delivery.

Warning
The searches have been built to look at the contract year (1st April to 31st March), so it is recommended to run the search WITHOUT a relative run date.

🔍 AF with no CHA2DS2-VASc

Patients with atrial fibrillation who do not have a CHA₂DS₂-VASc score coded.

🧾 CLINICIAN | Asthma - Turning 5 before year end - likely register inclusion

Supports AST_REG
Children aged 4 who are already diagnosed with asthma and have been issued asthma medication in the last 12 months. They will have their 5th birthday during the current contract year (ie: born before 31/03/2022), after which they will be included in the QOF asthma register. 

🧾 CLINICIAN | Cholesterol on alternative lipid-lowering therapy without statin PCA

Supports CHOL003
Patients are on a non-statin lipid-lowering drug (e.g. ezetimibe), but have no PCA code recorded to explain why a statin isn’t being prescribed.


  • If a statin is declined, contraindicated, or not tolerated, add the appropriate PCA code to ensure QOF compliance.

🧾 CLINICIAN | COPD - newly added to register

Supports COPD_REG
Patients who have been added to the COPD register for QOF v51, but they do not have a valid code for the previous register, but do have one or more codes from COPDDIAG_COD or COPDPROC_COD. Patients listed here are most likely going to have codes relating to COPD monitoring or invitations from the past 2 years, either used for other respiratory conditions such as bronchiectasis or accidentally used for recall. 

  1. Use the report to identify the affected codes and consider whether they need to be removed. All instances would need to be actioned to remove a patient from the register. 


🧾 CLINICIAN | COPD - Removed from register

Supports COPD_REG
Patients who have been removed from the COPD register for QOF v51. They do have a code present in COPD_COD, but do not have any codes from COPDDIAG_COD or COPDPROC_COD. 


  • Use the report to identify the affected codes and consider whether other codes need to be added to restore patients to the COPD register.  

🧾 CLINICIAN | Diabetes on alternative lipid-lowering therapy without statin PCA

Supports DM034, DM035
Patients are on a non-statin lipid-lowering drug (e.g. ezetimibe), but have no PCA code recorded to explain why a statin isn’t being prescribed.

  • If a statin is declined, contraindicated, or not tolerated, add the appropriate PCA code to ensure QOF compliance.

🧾 CLINICIAN | DM006 proteinuria or microalbuminuria previously declined ACEI/ARB

Supports DM006.
Patients with diabetes and evidence of proteinuria or microalbuminuria who previously declined or were contraindicated for ACE inhibitors or ARBs within the last 3 years.

  • Review to see if a PCA can be reapplied this year, or if therapy should be reconsidered.

🧾 CLINICIAN | Frailty - Higher Rockwood than diagnosis - consider mod/sev coding

Supports CD001/CD002/DM020/DM021/DM034/DM036/HYP010/HYP011.
Patients whose most recent frailty diagnosis was mild (or none), and the most recent Rockwood score or assessment was at least 6. It is in the Practice’s interest to action patients listed here as they can be removed from the target requirements. 

  1. Add a diagnosis code 'Moderate frailty' or 'Severe frailty' to remove patient from QOF indicator (or move from DM020 to DM021). 

🧾 CLINICIAN | Frailty - Lower Rockwood than diagnosis - consider mild coding

Supports CD001/CD002/DM020/DM021/DM034/DM036/HYP010/HYP011.
Patients whose most recent frailty diagnosis was moderate or severe, but the most recent Rockwood score or assessment was less than 6. These patients would technically already be excluded from the affected indicators, but arguably the more recent Rockwood may suggest the patient is anything but frail. Use the report to review frailty and Rockwood coding, both in terms of dates and scores. Some frailty diagnoses may be many years ago while Rockwood is recent. 

  1. Add the diagnosis code 'Mild frailty' to reinstate patient to QOF indicator (or move from DM021 to DM020)


Idea
Primary Care IT recommends that some action is taken here to ensure the cohort of moderate and severe frailty patients is not overly large to become a national outlier. 

🧾 CLINICIAN | Heart Failure LVSD with ejection fraction recorded

Supports HF009.
Patients with heart failure and LVSD were previously included in the HF2 register. A preserved or mildly reduced ejection fraction has been recorded, or an ejection fraction percentage has been documented which may indicate HFrEF.  

  • Use the report to review coded ejection fractions, paying particular attention to ejection fraction percentages less than 40% which should be coded as a reduced ejection fraction. 

🧾 CLINICIAN | Heart Failure LVSD without reduced ejection fraction

Supports HF009.
Patients with heart failure and LVSD were previously included in the HF2 register. No ejection fraction has been recorded (ie: they only have a code for LVSD). 

  • Use the report to identify the earliest diagnosis dates to locate documents referencing ejection fractions or echos.

🧾 CLINICIAN | Heart Failure No LVSD or reduced ejection fraction

Supports HF009.
Patients with heart failure may not be correctly classified. Review diagnoses for evidence of LVSD or reduced ejection fractions. 

  • Use the report to identify the earliest diagnosis dates to locate documents referencing ejection fractions or echos.

🧾 CLINICIAN | HF006 not on a B-blocker previous PCAs

Supports HF006.
Patients with heart failure and LVSD who are not prescribed a beta-blocker, but had a PCA applied previously.

  • Reassess the patient’s current eligibility. If they remain unsuitable, reapply the PCA.

🧾 CLINICIAN | HF006 not on ACEI/ARB and previously declined

Supports HF006.
Heart failure patients with LVSD not on ACE inhibitors or ARBs due to previous decline, contraindication, or non-tolerance.

  • Review patient status. If still unsuitable, the PCA can be reapplied.

🧾 CLINICIAN | Needs BP (CHD, DM, HYP, STIA) and would have hit surgery target

Supports CHD015/016, DM036, HYP008/009, and STIA014/015.
Patients have had a home or ambulatory BP recorded that would meet the QOF target if it had been taken in surgery.

  • Invite for an in-practice BP check to secure QOF compliance for multiple indicators.

🧾 CLINICIAN | Under 6 on asthma medication - no asthma diagnosis - review

Supports AST_REG
Children under the age of 6 who are (or will be) old enough to be included on the asthma register AST_REG. They have received asthma medication in the past 12 months, but do not have a coded diagnosis of asthma. Review patients to identify whether it is appropriate to diagnose asthma. 

🧾 HCA | Needs BP (CHD, DM, HYP, STIA) no BP reading and last year’s normal

Also supports CHD, DM, Hypertension, and Stroke/TIA BP indicators.
Patients have no BP reading this year, but last year’s reading was within range.

  • These are ideal for opportunistic BP checks — one quick reading could achieve multiple QOF indicators.

🧾 HCA | Obesity - 3 long term conditions with raised BP

Supports OB005
Patient has 3 conditions of ASCVD, type 2 diabetes, obstructive sleep apnoea, dyslipidaemia, and most recent blood pressure is suggestive of hypertension. Their most recent BMI is at least 34 (or 31.5 if BAME background). 

  1. Use the report to review latest values then target patients. Repeating BMI and BP followed by a new diagnosis of hypertension may add patient to OBES2_REG. 

🧾 HCA | Obesity - 3 long term conditions with raised HbA1c

Supports OB005
Patient has 3 conditions of ASCVD, hypertension, obstructive sleep apnoea, dyslipidaemia, and most recent HbA1c is suggestive of type 2 diabetes.  Their most recent BMI is at least 34 (or 31.5 if BAME background). 

  1. Use the report to review latest values then target patients. Repeating BMI and HbA1c followed by a diagnosis of type 2 diabetes may add patient to OBES2_REG.

🧾 HCA | Obesity - 3 long term conditions without dyslipidaemia this year

Supports OB005
Patient has 3 conditions of ASCVD, hypertension, type 2 diabetes, obstructive sleep apnoea, but most recent blood results suggestive of dyslipidaemia not during the contract year. Their most recent BMI is at least 34 (or 31.5 if BAME background). 

  1. Use the report to review latest values, and any lapsed courses of lipid lowering therapy. Repeating BMI and bloods may add patient to OBES2_REG. Issuing 1 course of lipid therapy in the second half of the contract year may be sufficient to make the patient eligible for OB005.

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