CQRS: Pneumococcal (PPV) vaccination programme searches
The current version of CQRS: Pneumococcal (PPV) vaccination programme is v5
The Pneumococcal (PPV) vaccination programme 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) |
PNEU001 | Monthly count of patients aged 65 years or over as at 31 March 2022 who have received a pneumococcal vaccination (PPV) by the GP practice, within the reporting period. | Born on or before 31st March 1960* | No upper age |
PNEU004 | Monthly count of patients aged 2 years to 64 years and identified as at risk, with at least one clinical code or “requires a pneumococcal vaccination” in the patient’s record, who have received a pneumococcal vaccination (PPV) by the GP practice within the reporting period. | Born on or after 1st April 1960* | Born on or before 31st March 2023* |
* These dates apply to the contract year 2024-25. Move years on for each subsequent contract year.
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: [PNEU004] ). 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 accommodating if the same vaccine code has been used twice, as long as the code relates to a first dose. There are a number of similarly named legacy EMIS codes which do not count. We recommend using a template to minimise the chances of this occurring.
- Patient was too young. The PPV business rules are unusual in CQRS as an indicator specifying a date of birth. A pneumococcal vaccine can be given to a patient when they are aged 64, but if they are healthy and were born after April 1960 they will not count for PNEU004.
- The patient's does not have a qualifying condition. Sometimes a clinician may consider the patient to be at risk but the code does not include the patient in the [PNEU004] denominator. A code of 'Requires a pneumococcal vaccination' can be added with a date on or before the dose to indicate a clinical decision has been made.
PNEU004 is a combination of previous PNEU002 and PNEU003 indicators. [PNEU004] identifies at risk patients under the age of 64 as well as patients who have been coded with 'Requires a pneumococcal vaccination'. Unlike the solution for PNEU003, some patients will NOT appear in PNEU004X despite apparently having a long term condition placing them at risk. Some common reasons for this are:- Diabetic patients who are diet controlled (ie: no medication). They can be made eligible by adding the code 'Requires a pneumococcal vaccination' before the end of the reporting month.
- Patients on immunosuppressive agents or biologics with no other qualifying conditions if they have not had medication 'issued' on EMIS in the past 12 months. While likely that the hospital is prescribing the medication, Practices can still add it to the patients medication screen and mark as hospital issue. Alternatively add the code 'Requires pneumococcal vaccination' before the end of the reporting month.
- The same applies to patients receiving chemotherapy or radiotherapy - coding within the past 12 months is key to include them in [PNEU004].
- Patients on immunosuppressive agents, biologics, chemotherapy, or radiotherapy, who have already received a pneumococcal vaccination in the previous 12 months will not be eligible for any indicator.
- Some conditions look for the latest entry of a code. If this is actually resolved, the patient is not considered to have the qualifying condition for [PNEU004]. This can apply to diabetes, immunosuppression,
Valid codes
12866006 - Administration of pneumococcal vaccine
170337005 - Pneumococcal vaccination given
247951000000102 - Requires a pneumococcal vaccination
Missed Activity
Having run the top folder, check that the report PNEU000X - 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.
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
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.
For some indicators there are additional columns denoting first dose or qualifying conditions for eligibility. First dose is always shown on the left hand side of the report; qualifying conditions are shown on right hand side of the report.
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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