001P CQRS: RSV for pregnant patients
The current version of CQRS: RSV for pregnant patients is v2.0. This search folder is available in 001 CQRS v6.4 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 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.
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 |
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 which a particular emphasis on checking coding and where the vaccination was given. A denominator (dependency) search designed by PCIT includes patients who may not qualify a claim under the indicator. These are similarly named, but with square brackets (eg: [RSVP001] ).
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 (eg: elsewhere by the maternity services team).
Actions:
Primary Care IT recommends that all patient records returned by the claim search RSVP001 are reviewed to confirm that the vaccination was given on or after 28 weeks of pregnancy.
When reviewing the figures, Practices are looking for the searches in the top folder 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 vaccination was recorded without the GMS attribute. The business rules require that vaccinations given under GMS should be recorded correctly. Failure to select GMS may lead to the vaccination not being recognised for payment.
- The wrong code was added. Administration of RSV (respiratory syncytial virus) vaccine and the identically named legacy EMIS code does not count. We recommend using an up-to-date template to minimise the chances of this occurring.
- 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.
Valid codes
Administration of RSV (respiratory syncytial virus) vaccine [1303503001]
Missed Activity
RSVP00X
Having run the top folder, move to the Missed Activity folder and check that the report RSVP00X - medication issued but no codes is empty; all of the claiming searches have been built around codes rather than medication issues, and this search/report will identify any patients who had a medication issue last month but with 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.
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.
RSVP001X
This report captures patients who most likely cannot be claimed for:
- Patients who have had a previous RSV vaccination in the last 6 months, which means a vaccination given last month can not be claimed for
- Patients who were too old or young at time of vaccination last month
RSVP001A
This report captures:
- Patients who have had a RSV vaccination code in the last month but did have not had a pregnancy code recorded on the same day. These patients must be rectified if they are to be claimed for.
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.
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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