CQRS: RSV for pregnant women
The current version of CQRS: RSV for pregnant women is v2.0. This search folder is available in 001 CQRS v5.4 and above
Introduction:
RSV vaccinations are claimed via CQRS in the same way as many other vaccinations but often get missed due to coding. Practices should check their data prior to extraction and maximise their income potential. For more information on identifying eligible patients, refer to this article.
To give users more time, PCIT has set the anchor date for all CQRS searches to the 25th of each month. This means that, although CQRS refreshes approximately 10 days after the end of the monthly reporting period, users have until the 25th to extract and reconcile data from PCIT SystmOne searches before it automatically rolls over to the next month
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 |
RSVP001 | Monthly count of the number of registered patients from 28 weeks of pregnancy who have a record of receiving a dose of RSV carried out by the GP practice within the reporting period (i.e. last month) | 10 years | Day before 55th birthday |
Business rules were released for RSVP001 for 1st September 2025. Primary Care IT has built a set of searches along the same lines as all other CQRS searches with a particular emphasis on checking coding and where the vaccination was given.
A key feature of the searches is that they look for the 'GMS' attribute which means they should only pick up activity done within the Practice; coded vaccinations received electronically from a third party system should not have this attribute and this should mean they are excluded, reducing the burden of reviewing each record to verify where a vaccination was given (e.g: elsewhere by the maternity services team).
Actions:
Primary Care IT recommends that all patient records returned by the manual claim search RSVP001 are reviewed to confirm that the vaccination was given on or after 28 weeks of pregnancy.
There are several reasons why a patient may not be included in an indicator, and these all need to be considered.
- A RSV vaccination has been given in the previous 6 months. The recommendation is for pregnant patients to be vaccinated once for each pregnancy, so double vaccinations or double coding across consecutive months will not be counted in the main RSVP001 claim search.
- Patient was too old or too young. PCIT has defined an expected age range of 10 years to 55 years, but patients between 55 and 64 years old may be picked up if they have been vaccinated.
The main claim search will only identify patients registered as female on their registration page. Practices should review individual records to confirm pregnancy.
Missed Activity
Having run the Payment search, move to the Missed Activity searches which are designed to help capture a missing data. Do check that the reports return as zero. All of the claiming searches have been built around codes rather than medication issues, and these searches will identify any patients who had a medication issue in the last month but no corresponding clinical code on the same day. There are two specific searches for this category
1) Missed Activity - RSV given (Pregnancy Code Not Entered Same Day) - This report captures patient who have had a RSV vaccination code in the last month but have not had a pregnancy code recorded on the same day. These patients must be rectified if they are to be claimed for.
2) Missed Activity - RSV Vac given, without Pregnancy Code on Record - which is designed to capture patients aged 10–55 years who have received the RSV vaccination but have never had a pregnancy code recorded in their medical records
Always review the Missed Activity searches that return with patients. These are opportunities to fix coding and increase the monthly claim
Valid codes
Administration of RSV (respiratory syncytial virus) vaccine [1303503001]
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 are other factors which erroneously brought the patient into the 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.
Missed activity data offers some opportunities for learning. Hopefully most entries highlighted by the Missed Activity reports are due to coding which can easily be fixed. Whilst it isn't possible to 'fix' where a vaccination has been given to an ineligible patient, there is an opportunity for reflection and learning to ensure the same scenario is not repeated.
Version History
v2.0.0 - updated to reflect new business rules requiring pregnancy coding.
v1.0.0 - new release
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