025B PCN DES
Primary Care IT has again produced a comprehensive set of searches to support the PCN DES 2024/2025 requirements.
These are based on and built according to the business rules originally published by NHS Digital on 4th April 2023 and referencing the Network Contract Directed Enhanced Service guidance.
The current version of 025B PCN DES is v3.4
PCN DES searches
The PCIT PCN DES searches look like this:
Cancer
This contains a number of areas that will ensure optimal performance for the early cancer diagnosis element of the PCN DES:
Cancer Screening Programmes
These searches are organised as follows:
In each of the types of screening programme the eligible cohorts and your performance data are found in the corresponding folder (eg: Bowel Screening, Breast Screening, Cervical Screening). Each screening programme folder contains a "Targeting Searches" subfolder where there are searches that help you to identify patients that you should target to help performance in the relevant screening programme. For example for bowel screening:
These cover:
Bowel screening
Find those not screened successfully | Eligible patients without a coded screening result in the last 2 years |
Find incomplete or spoiled samples | Those whose most recent coded screening outcome was of an incomplete or spoiled result. Such patients would require a retest |
Find those who have not responded to invites | This will show patients who have been coded as non-responders to invitations |
Find potential coding errors | Coding for results or non responders uses legacy coding not recognised in the BCSP code clusters |
Breast screening
| Find those not screened successfully | Eligible patients without a coded screening result in the last 3 years. Does not include patients who have been coded as opted out. |
| Find those who have not responded to invites | This will show patients who have been coded as non-responders to invitations |
Cervical screening
| Smear due <49 (recall 3 years) | Eligible patients age 25-49 whose last smear was more than 3 years 4 months ago. This is technically overdue from a recall perspective, but not yet overdue for QOF (CS005). 3y4m allows for at least the first recall invitation to have been sent and potentially actioned. Search does not replace official screening recall lists, but may be used to identify individuals for follow up. |
| Smear due <65 (recall 5 years) | Eligible patients age 50-65 whose last smear was more than 5 years 4 months ago. This is technically overdue from a recall perspective, but not yet overdue for QOF (CS006). 5y4m allows for at least the first recall invitation to have been sent and potentially actioned. Search does not replace official screening recall lists, but may be used to identify individuals for follow up. |
| Subtotal hysterectomy | Women who have had a coded subtotal hysterectomy should still be recalled for cervical screening. Consider review of records and/or advice if a patient in this search questions recall. |
| Never had a smear result | Women of eligible age who have never had a coded smear result. Look for disclaimers on the Care History. |
Latest smear was inadequate | The most recent coded result was of an inadequate smear. Usually a repeat test is performed at least 3 months after the inadequate result. |
The audit folder has been designed to support an annual audit of smear activity. An aggregate report counts the number of smears performed by each clinician, while a list report compiles the procedure and coded result for each patient. Finally, an inadequate smear report will help to quickly identify the patients who had inadequate smear samples and whether they had a repeat test.
The audit folder is designed to look at the last calendar year, therefore to get a picture of the current calendar year, the folder must be run with a relative run date of the next 1st January.
Using these targeting searches - particularly the top level search for patients not screened - are not appropriate for bulk sending out invitations. There may be individual reasons why a patient has not been screened, but coding may be missing which has not removed a patient from a search.
Within the cervical screening folder, there is also a "Cervical screening Audit" set of searches. This will aid you with performing an annual cervical screening audit for your smear takers:
As noted by the name, the searches will always look at the previous complete calendar year, very easy if it is being run in January. To review the current calendar year to date, it would be necessary to set a relative run date of at least the next 1st January to see the desired information.
Suspected cancer referrals - Audit
This folder will help you to audit your previous suspected cancer referrals and see how many of them have been diagnosed with cancer subsequently. It also allows you to see cancer diagnoses that have not been preceded by a 2 week wait referral.
Suspected cancer referrals - FIT testing
This folder of searches is designed to work in conjunction with the PCIT suspected cancer diagnosis templates for colorectal cancer as well as HP290. These tools ensure that practices have a clear way of following up on FIT test requests prior to any suspected cancer diagnosis referral being made.
Suspected cancer referrals - Follow ups
This folder allows you to audit suspected cancer referrals made during the current contract year to check whether they have been reviewed in the suspected cancer clinic. This requires some coding compliance, utilising the following codes:
Seen in fast track suspected cancer clinic | 382761000000101 |
Fast track appointment cancelled by doctor | 2002091000006100 |
Fast track appointment cancelled by hospital | 2001691000006101 |
Fast track appointment cancelled by patient | 2001681000006104 |
Choose and book referral rejected by service provider | 511471000000105 |
Reason for referral delay | 397604009 |
Did not attend fast track suspected cancer clinic | 774581000000102 |
These codes would be used by any member of staff, primarily secretaries and coders, and then they can be cleared from the searches when a clinician has reviewed the patient and is satisfied the case can be closed. The code to use is Care complete [915811000006103]
Suspected cancer referrals - Referrals
This folder allows you to count all suspected cancer referrals in the current contract year by referral type. An aggregate report is provided to view the number of each referral type by month.
Cardiovascular Risk
This contains a number of areas that will ensure optimal performance for the cardiovascular disease specification of the PCN DES:
AF
These reports are copied from 007 Prevalence Improvement. They have been designed to identify patients not currently diagnosed with AF who have particular codes on their record which may warrant further investigations to confirm or exclude AF as a diagnosis.
In some cases, the patient may be flagged due to the presence or absence of codes, for example patients on warfarin who have not had their valve replacement coded. Patients with resolved AF may be picked up by PI-AF04.
Cholesterol
The following reports allow you to look at patients who have had tests that would allow an opportunistic CVD risk assessment, as well as patients who have an already high risk assessment who aren't on a statin:
There is no way to remove patients with QRISK >10% from the statin report.
Heart Failure
Another set of reports copied from 007 Prevalence Improvement.
PI-HF01 identifies patients with hypertension and a coded ECG showing left ventricular failure, plus patients with AF who are on digoxin, none of whom are coded with Heart Failure.
Hypercholesterolaemia
One report allows you to look at patients who are at risk of familiar hypercholesterolaemia:
Hypertension
The following PCIT reports allow practices to identify patients who are likely to have hypertension:
These reports will show the 3 most recent blood pressures plus any medication courses used to manage blood pressure.
Care Homes
Simply a list of all patients coded as living in a care home, based on the PCN DES rule for recording patients in care homes. For each patient the report details their address, whether the Residential Institute code has been added, and what the most recent frailty code is.
Health Inequalities
This contains reporting and work to do folders:
Reporting
Work to do
The reports based on Core20Plus5 look for combinations of patients with the following characteristics:
Core 20 | Patients with a Townsend Score >2.5. Townsend Score is related to the Index of Multiple Deprivation. A score >2.5 indicates that the patient is in the 1st quintile (living in the 20% most deprived areas/postcodes in the country). Practices in affluent areas may have very low numbers of patients in the quintile, while other Practices may pick up a significant portion of their registered population. |
Cancer diagnosis | Patients with a coded diagnosis of cancer in the last 12 months |
COPD | Patients living with COPD |
Pregnant | Pregnant women who also appear in the Core 20 cohort plus any pregnant woman from a BAME community (regardless of their IMD/Townsend Score) |
Hypertension | Patients with raised blood pressure without a diagnosis of hypertension |
SMI | Patients with a Severe Mental Illness |
The number of patients in the Core 20 search will determine how many patients are picked up in the combination searches for patients with 1 or more additional characteristics.
Learning Disability patients who haven't had an annual health check is the "work to do" search for IIF HI-03.
Heart Failure
There is a drive to categorise patient's heart failure beyond a simple 'Heart failure' diagnosis. Searches group patients on the register into those who have and have not had this aspect of the diagnosis coded. A report also draws out those categorisation codes which may be sorted in Excel to review how up to date the categorisation is.
| Heart failure with normal ejection fraction | 446221000 |
| Heart failure with mid range ejection fraction | 788950000 |
Heart failure with reduced ejection fraction | 70327007 |
Heart failure with reduced ejection fraction due to cardiomyopathy | 703275009 |
Heart failure with reduced ejection fraction due to coronary artery disease | 703273002 |
Heart failure with reduced ejection fraction due to heart valve disease | 703276005 |
Heart failure with reduced ejection fraction due to myocarditis | 703274008 |
Some patients with heart failure have an uncoded LVSD finding. This has an impact on QOF as there are indicators specifically for patients with HF + LVSD, in addition to the prevalence of the condition. Whilst we have not provided a report here to check all patients with a current diagnosis of heart failure, a report will show any patients with LVSD coded in the absence of a heart failure diagnosis as these patients would not even be on the Heart Failure register.
Proactive Care
Aggregate reports counting the number of coded Provision of proactive Care episodes during the year, and those whose proactive care ended.
| Provision of proactive care | 934231000000106 |
| Proactive care ended | 934691000000105 |
SMR (Structured Medication Reviews)
This contains a number of areas that will ensure optimal performance for the Structured Medication Reviews specification of the PCN DES:
You can see your performance for Structured Medication Reviews. You can also see patients who are at highest risk and therefore should be prioritised for SMR.
Target groups
This folder shows you different groups of patients you may wish to target for SMRs:
The first 4 groups (A-D) were transferred from the IIF part of the PCN DES at the end of the 2022-23 contract year, so the naming has been retained. SMR01E has been built according to PCIT's best interpretation of polypharmacy. This deliberately excludes appliances and nutritional supplements which are not strictly medications and would inflate the total number of active 'lines' on the medication screen, particularly if they exist more than once on a record..
Work to do
Social Prescribing
Aggregate reports counting the number of social prescribing referrals made during the contract year broken down by month, and counting the number of patients who declined social prescriber intervention (who did not also have a referral made) during the contract year.
| Referral to social prescribing service | 871731000000106 |
| Social prescribing declined | 871711000000103 |
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