CQRS: Meningitis B searches
The current version of CQRS: MenB vaccination programme is v4
The MenB service indicators are extracted automatically from your system approximately 10 days after the end of the monthly reporting period. Practices have a short opportunity to 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).
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) |
MENBI01 | Monthly count of the number of patients who received a first dose of MenB vaccine from the age of 2 months and before attaining 24 months of age, administered by the GP practice within the reporting period. | 56 days (8 weeks) | Day before 2nd birthday |
MENBI03 | Monthly count of the number of patients who received a second dose of MenB vaccine from the age of 4 months and before attaining 24 months of age, administered by the GP practice within the reporting period. | 112 days (16 weeks) Previous dose must have been at least 28 days prior | Day before 2nd birthday |
MENBI09 | Monthly count of the number of patients who received a booster dose of MenB vaccine from the age of 12 months and before attaining 24 months of age, administered by the GP practice within the reporting period where the first dose of MenB vaccine was received prior to the patient attaining 12 months of age. | 364 days (52 weeks) Previous dose must have been at least 28 days prior | Day before 2nd birthday |
MENBI10 | Monthly count of the number of patients who received a booster dose of MenB vaccine from the age of 12 months and before attaining 24 months of age, administered by the GP practice within the reporting period where the first dose of MenB vaccine was received on or after the patient attaining 12 months of age. | 364 days (52 weeks) Previous dose must have been at least 28 days prior | Day before 2nd birthday |
The main searches closely mirror the business rules to properly reflect the CQRS count, but each search is also based on a denominator (dependency) search designed by PCIT to include patients who may not be picked up by the extraction. These are similarly named, but with square brackets (eg: [MENBI01] ). When reviewing the figures prior to CQRS extraction, Practices are looking for the searches to show 100%. When the search is not 100%, Practices can refer to the corresponding report in the Missed Activity folder. It is also possible to use the Check Patient feature to try to understand why a patient has been picked up in the denominator search but not for CQRS. There are several reasons why a patient may not be included in an indicator, and these all need to be considered.
- The wrong code was added. The business rules are very strict and require 'Administration of first dose of meningitis B vaccine' code, then 'Administration of second dose of meningitis B vaccine' code. Using the same code twice will not count. We recommend using a template to minimise the chances of this occurring. Fortunately 'First/second meningitis B vaccination given by other healthcare provider' does count when the rules check previous doses.
- Patient was too old or too young. The MenB vaccination is only licensed for use in young children. It should not be given before the child is 56 days old, or on or after their 2nd birthday.
- The code was added too early. The second and third doses of MenB vaccination (MENBI03 & MENBI09) must not be given until at least 28 days after the previous dose. Payment won't be given if subsequent doses were administered at 27 days.
- The patient's historical record is incomplete. Where codes are missing patients won't be picked up, so adding 'Administration of second dose of meningitis B vaccine' when the first code isn't present will not count the patient in MENBI03, MENBI09.
Valid codes
Codes for these indicators are very specific in that you must use the code corresponding to the number of doses given. Subsequent doses do rely on the previous dose codes being correct.
MENBI01
720539004 - Administration of first dose of meningitis B vaccine
MENBI03
720540002 - Administration of second dose of meningitis B vaccine
MENBI09 & MENBI10
720544006 - Administration of booster dose of meningitis B vaccine
Missed Activity
Having run the top folder, check that the report MENBI00X - medication issued but no codes is empty; all of the claiming searches have been built primarily around codes rather than medication issues, and this search/report will identify any patients who had a medication issue last month but there was no corresponding clinical code in the same period. The reason for this is to support good practice of coding vaccinations; not only does this make future reporting easier, it ensures whenever the patient requests their vaccination history that everything is included from the vaccination filter in Care History.
Having run the top folder, check that the search MENBI00X - medication issued but no codes shows 0; all of the claiming searches have been built primarily around codes rather than medication issues, and this search will identify any patients who had a medication issue last month but there was no clinical code.
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 a subsequent dose was given too early or too late. It may be necessary to refer to the ES business rules to confirm appropriate age ranges and intervals between doses.
INVALID - data in the INVALID column means that activity has been found but with a different code that may indicate claimable activity. This column only focuses on the code and not on the age or the interval, meaning the report may need to be re-run or work out the time criteria yourself offline.
There may be a few scenarios where data appears in both CHECK and INVALID columns due to the way missed activity reports have been configured; prioritise CHECK before considering wither INVALID contains claimable activity.
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.
The business rules and code cluster lists for enhanced services can be found on the NHS Digital website.
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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