001B CQRS: Advice and Guidance searches

The current version of CQRS: Advice and Guidance is v1.1

Introduction

Unlike most other indicators on CQRS which are extracted automatically from your system approximately 10 days after the end of the monthly reporting period, this Advice and Guidance service is a manual claim. Practices should check their data prior to extraction and maximise their income potential. For reviewing data in historic months, the relative run date may be any date in the month following the achievement period (eg: for the achievement period of April, any date in May can be selected).
For more information on identifying eligible patients, refer to this article.

This article assumes the reader has access to CQRS, and can interpret the descriptions of payment indicators; only payment indicator codes are used below.

Indicator	Description	Lower age limit	Upper age limit (inclusive)
AG001	Monthly count of the number of pre-referral advice and guidance requests by general practice.	None	None

To date (June 2025), there are no business rules to properly reflect the CQRS count, which is probably due to the complex nature of validating unique advice and guidance requests, and why this particular service requires Practices to submit a manual submission. Primary Care IT has built a set of searches along the same lines as all other CQRS searches which a particular emphasis on checking coding. A denominator (dependency) search designed by PCIT includes patients who may not qualify a claim under the indicator. This is similarly named, but with square brackets (eg: [AG001] ). 

Approach

In the absence of published business rules, PCIT has developed searches and reports based on current thinking of how to track A&G requests. A single code has been identified which can be used by members of the team to document A&G requests. Other codes are available to select but this is the only code available nationally across multiple clinical systems.

Unlike other CQRS claim indicators, we strongly recommend reviewing the AG001 report rather than picking up the number of patients. The report will show every Choose and book advice and guidance request code from the previous month which may reveal more than 1 unique A&G request. Remember that duplicate coding of the same request should be disregarded.

For the Missed Activity searches, other codes suggestive of a conversation with secondary care will be picked up. It may be necessary to interrogate individual records if no descriptive text was added alongside the code. See below for more information.

The claim and Missed Activity searches will only pick up potential Advice and Guidance requests which have been coded. If a clinician speaks to a hospital colleague on the telephone for the purposes of an A&G request but does not use a code, there is no trail to identify that the conversation occurred. 

Valid Codes

Term	SNOMED
Choose and book advice and guidance request	820641000000100

Missed Activity Codes

These codes are used by the Missed Activity search, but we do not recommend using these routinely 

Term	SNOMED
Choose and book advice and guidance request	1771171000006104	EMIS code. Inactive - only selectable on template
Discussed with consultant	394693004
Discussed with doctor	394696007
Discussed with psychiatrist	773705000
Consultant advice service used	1934671000006104	EMIS code.
Telephone contact by consultant	314849005
Advice and guidance request sent	2008431000006105	EMIS code
Advice and guidance response received	2010121000006102	EMIS code

Advice and Guidance Received Codes

These codes are not used in the searches but are provided in the reports to show where responses had been returned, thereby closing the request. 

Term	SNOMED
Advice and guidance response received	2010121000006102	EMIS code
NHS e-Referral service advice and guidance received	2386511000000107

Missed Activity

Reports to help review potential data can be found in the Missed Activity folder, named with the indicator code followed by an X. If the searches have run, highlight the report and press View Results from the ribbon or right click for the quick menu.

The missed activity reports for CQRS have been designed in a standard fashion for ease of understanding.

      CHECK - data in the CHECK column means that the codes used are correct, but the patient was either too old or young, or the Action Plan code is too early.

      REVIEW - data in the REVIEW column means that activity has been found but with a different code that may indicate claimable activity.

There may be a few scenarios where data appears in both CHECK and REVIEW columns due to the way missed activity reports have been configured; prioritise CHECK before considering wither INVALID contains claimable activity.

The codes selected by Primary Care IT for the Missed Activity report may be used for purposes other than A&G requests. The associated text column may help to immediately disregard some of these entries (eg: Discussed with doctor - coded by a nurse who sought the opinion of a GP on site).

AG000X - Advice and Guidance received but not sent is a search which looks for a response code but there has not been a request code in the preceding 3 months. These patients could have a "request sent" code added to increase the claimable activity for the month.

AG001Xa - Potential Advice and Guidance referrals for review is a search which looks for a wide range of codes that may indicate a referral that meets the criteria for the Advice and Guidance ES.  It is important to consider these referrals against the criteria as these could be potential missed income.

AG001Xb - EMIS Advice and Guidance Code used is a search for practices who wish to ensure all referrals have the SNOMED code for advice and guidance recorded.  This is especially important for practices who have been advised by their ICB that only referrals with the SNOMED code will be counted if evidence is required.

Always check the 0% searches to ensure that single patients from the denominator are not missed!

The Full Hierarchy button on the ribbon can make checking the parent searches of 0% searches easier.

Review the CQRS article for points to consider when using these searches.

While the main searches have been built to closely mirror the business rules, there is a creative element to the denominator searches. Where the main search isn't 100%, don't discount that there are other factors which erroneously brought the patient into the denominator 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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