004C QOF VI searches (Child & Shingles vaccination uptake)
Unlike all other QOF indicators there are no declined codes for childhood vaccination indicators (VI001, VI002, VI003). There are however exclusion criteria to remove patients recently registered with the surgery within the performance searches.
Here is a screenshot of the search folder:
VI (vaccination & immunisation) contains 4 indicators to track the timely uptake of certain vaccinations.
Indicator | Description | Lower age limit | Upper age limit (inclusive) |
VI001 | Babies whose third dose of diphtheria, tetanus and pertussis containing vaccine was administered before they reached 8 months of age | - | Day before 8 months old (247 days) |
| VI002 | Children whose first MMR vaccine was administered from the date they turned 12 months up until 18 months of age | 1 (1st birthday) | 18m10d (558 days) |
VI003 | Children who had two doses of MMR vaccine whilst they were aged at least 1 year and less then 5 years of age, and a booster dose of DTaP/IPV vaccine whilst they were less than 5 years of age | 1 (1st birthday) | Day before 5th birthday |
VI004 | Patients who received a single dose shingles vaccination between 70-79 years (or) Patients who received a two dose shingles vaccination between 70-80 years | 70 (70th birthday) | Day before 80th birthday (or) Day before 81st birthday |
The latest business rules and code cluster lists can be found here on the NHS Digital website.
Vaccination windows
All 4 indicators have specific vaccination windows. Patients cannot be vaccinated outside of the window - even by 1 day - otherwise they will not be included in the indicator achievement despite having done the work. It becomes critical for all staff involved in the process to ensure patients do not attend early for vaccination; this means before before their 1st birthday (VI002); before their 70th birthday (VI004). Whilst the nursing team is likely to administer the vaccinations, it may be the reception team who book the patient so they should be equally aware of the window to avoid a difficult conversation when the patient arrives for their vaccination. This is similar logic as for a number of CQRS extractions related to childhood vaccinations. Bear in mind for VI001 there is no lower age limit, but the 6in1 indicators for CQRS have a minimum 6 week age set.
Some patients may be delayed in receiving their vaccinations for a variety of reasons, and this is outside of a Practice's control. The achievement thresholds takes this into account with targets between 70 and 90%, but this may be an incentive to chase those patients who are behind in their vaccination schedule.
Missed activity
Practices should concentrate on the Missed activity folder, where there are 4 searches. Each search looks at the patients who are excluded from the main indicator; what we may find is that some patients may have been vaccinated, while others been lost to follow up or refused vaccination.
VI001X) Babies without three doses of DTP before 8 months of age
This search includes patients who didn't receive 3 doses of DTP before 8 months of age.
VI001 - the specification calls for 3 DTP containing vaccinations at least 1 day apart which may be a quadrivalent, pentavalent, or hexavalent type.
VI002X) Children without first dose of MMR between 12 and 18 months of age
This search identifies children who didn't have their first dose of MMR between ages 12-18 months old. This criteria has a vaccination window, patients vaccinated outside of the vaccination window (e.g. before their 1st birthday) .
VI002 - historically there are a lot of MMR codes, so these need to be checked carefully to use one that is correct. Remember that there are booster/catch-up codes which are not appropriate to use for the first vaccination.
VI003X) Children without DTaP/IPV and 2 doses of MMR between 1 and 5 years
VI003 looks at both MMR and DTaP/IPV, the report contains declined MMR codes as well as contraindicated codes for both vaccinations. Practices should consider that the coding in the report may be correct, and that 2 contraindicated codes (or one vaccine plus one contraindicated code) are required to remove the patient from the indicator.
VI003 - In testing we found this indicator to yield the most coding errors, not so much in MMR, but with DTaP/IPV. As a completed course will show 3 vaccinations, remember that not all codes are incorrect.
VI004X) Patients who turned 80 without a shingles vaccine between 70 and 79
This search includes patients who have turned 80 but did not have a shingles vaccination between the ages of 70-79.
VI004 - Until recently only a single dose vaccine (Zostavax) has been available. The new two dose vaccination (Shingrix) has a different set of vaccine administration codes, so if Herpes zoster vaccination is used for the first dose then the second dose won't be counted as part of a two dose schedule.
Payment thresholds
The payment thresholds for the Vaccination & Immunisation indicators are very high and a lack of points may surprise Practices who haven't quite achieved the indicator but aren't too far off. Taking the childhood VI indicators 1-3, the upper payment threshold (full points) is 95% for all three, while the lower payment threshold is 90% for VI001 and VI002, while VI003 has a slightly lower figure of 87%. There is clearly an expectation that high uptake is essential, leaving less than 10% of the denominator population to decline vaccination or be lost to follow up. Without declined or no consent codes, it is very important to ensure that as many patients as possible receive the vaccinations.
VI004 for shingles has a better set of payment thresholds at 50% for the lower, and 60% for the higher and allows for patients to decline, so it should feel achievable.
The spread of the payment thresholds is incredibly narrow for QOF, highlighting the importance of inviting as many patients as possible.
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