BMA and RCGP work prioritisation Dec 2021

BMA and RCGP work prioritisation Dec 2021

The current version of BMA and RCGP work prioritisation December 2021 is v1

Introduction and installation

Primary Care IT has released a suite of searches to support practices in prioritising care of patients during the contract year 21/22, in light of the change in contract regulations highlighted in letter C1475 about temporary GP contract changes and the guidance produced by the BMA and RCGP.

For QOF related searches to help you achieve the remaining scored indicators and a summary of the changes, see our previous article QOF and IIF 2021/22 update December 2021

Whilst the BMA/RCGP guidance covers a number of areas of care that should be prioritised, we have scoped these and developed searches for the areas that can be covered by searches.  These include:
  1. Child/Maternal health
  2. Cytology
  3. LTC (long term condition) higher risk
    1. Asthma
    2. COPD
    3. Diabetes
    4. Frail
    5. Housebound
    6. Hypertension
  4. Mental health

Child/Maternal health

Coding of baby checks and post natal checks can be variable at practice level.  If you are using the OneTemplate to code these activities, the searches will correctly identify patients who have not had 6 week checks or post natal visits.  Our clinical team felt a child hip examination was a reasonable surrogate marker for a 6/8 week check to have been conducted so we have also included this in the search (this was because on early test sites the numbers shown as having not had a baby check were extremely high and a large number of children had actually had the check when manually reviewed)
CMH01 Baby checks - this search identifies patients who have not had a 6/8 week check using the codes for the check and the hip examination codes as a surrogate marker for the check.  The associated report gives you the current age of the patient and their date of birth.  When running these searches on early test sites many children had actually had the check performed, but the documentation of it was poor - so it may be worth reviewing the records and highlighting to practice members the importance of coding these reviews appropriately. 
It's worth noting whilst this data is not currently pulled these checks are a contractual requirement so it might be worth making sure you have robust ways of recording this information at this stage, in case this changes in future.

CMH02 Post natal checks - this search identifies patients who have given birth in the last 2 years and haven't had a post natal check, or post natal care coded.  As per the previous search, in early testing sites many of these patients had actually received this care, but it just hadn't been coded appropriately.

Again, the report will help you identify when the delivery occurred so the records can be checked


Cytology

The CS005 and CS006 searches provides the achievement for this area of QOF,

*CS005 is a report that shows patients aged 25-49 who have had a third recall letter coded more than 4 weeks ago, and *CS006 is a report showing patients aged 50-64 who have had a third recall letter coded more than 4 weeks ago.  You may wish to use these reports to identify patients who have had a recall letter more than 4 weeks ago and could have the code "Excepted from cervical screening quality indicators - no response to three invitations" CID 11099110000000100 added.  This will remove these patients from the eligible population and also increase your percentage performance for the indicator.  If you need to know how to bulk add codes to a search, please see our separate support article on this topic.

The interval of 4 weeks has been used to reflect an appropriate interval for no response after sending the 3rd letter to being exception reported. Unless the searches are run with a relative date of 31/03/2022, be aware that more patients will appear in these reports even if they have been cleared down, due to patients whose last valid smear was close to 40 months/66 months ago.
Practices who do not code their third letter will see more patients on the list, and may wish to refer to any saved non-responder lists to see when a third invitation should have been sent.
Exception reporting on your clinical system does not affect a patient's recall schedule for the national screening programme.

LTC higher risk

This area is broken up into a number of clinical areas:

Asthma

We have created searches to mirror the 3 areas highlighted in the BMA/RCGP guidance, these are:
  1. Asthma with admission in the last 12 months
  2. Asthma with previous ICU admission
  3. 2 or more severe exacerbations in the last 12 months (needing oral steroids)
For each of the searches we have created:
  1. reports for those patients with the criteria
  2. a further search highlighting those with the criteria who haven't had a review this year (marked with a *)
  3. and a further report based on those who haven't had a review this year (also marked with a *)
We have then created a further search which groups together all patients in each of the 3 categories who have not had a review this year, called **OVERALL HIGH RISK ASTHMATICS WITH NO REVIEW and built a report under this called **Last review Report - which shows when the patients last review was coded.
Depending on the numbers of patients found in each of the searches, practices may wish to go into the individual searches, or just look at the summary search and use this.


COPD

We have created searches for this area in with the same approach as for asthma.  The areas highlighted are:
  1. COPD with admission in the last 12 months
  2. 2 or more exacerbations in the last 12 months requiring oral steroids or antibiotics
  3. COPD patients on LTOT
For each of the searches we have created:
  1. reports for those patients with the criteria
  2. a further search highlighting those with the criteria who haven't had a review this year (marked with a *)
  3. and a further report based on those who haven't had a review this year (also marked with a *)
We have then created a further search which groups together all patients in each of the 3 categories who have not had a review this year, called **OVERALL HIGH RISK COPD WITH NO REVIEW and built a report under this called **Last review Report - which shows when the patients last review was coded.
Depending on the numbers of patients found in each of the searches, practices may wish to go into the individual searches, or just look at the summary search and use this.

Diabetes

The searches for diabetes are:
  1. Type 2 diabetes with HbA1c >75
  2. Recent DKA
  3. Disengaged diabetics
For type 2 diabetics with Hba1c >75 as well as the search there is a report to show the last HbA1c value and date.  For disengaged diabetics we have built a search which will identify patients who have been more than 14 months since their last HbA1c.  There is also an associated report which shows the date and value of the last HbA1c

Frail

Frail01 search will show you those patients with moderate or severe frailty.  There is an associated report which shows you when each of the patients was last seen.

Housebound

HB01 Housebound patient register will show you those patients coded as housebound.  There is then an associated report which will show you when the patients were last seen.  There are 2 further searches and reports which show you those patients not reviewed in the last 6 or 12 months respectively, so you can prioritise those who were seen last a long time ago.

Hypertension

We have built 2 searches for this area: 
  1. Those patients who have a BP above NICE target more than a month ago
  2. Those patients who have a BP more than 10mmHg above the NICE target more than a month ago
Depending on the numbers shown, you may wish to prioritise those with a BP more than 10mmHg above target first and then move on to all patients afterwards.  Each search has an associated report which shows you the last BP level and value.

Mental health

The guidance says to focus on:
  1. mental health monitoring for patients with long term mental health conditions/severe mental illness
  2. Significant mental health with concerns regarding suicide or deliberate self harm-risk or currently unstable mental health
We have built searches:
  1. MH01 - which shows you patients with mental health problems and no care plan documented this QOF year
  2. MH02 - which shows you all patients with concerns about suicide recorded in their records over the last year
  3. MH03 - which shows all patients who have no suicide codes, but codes suggestive of a concern regarding self harm.

First published 23rd December 2021
Updated 



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