Please note only the payment indicators have been produced.

Why might a patient be missed from a CQRS report?

There are a number of different reasons why the broader search criteria might pick up a patient who has been missed:

1. The patient received the vaccination when they were too young or too old. Each vaccination has a specified age range where patients may receive them. There are often minimum and maximum ages which cannot be ignored, even by a single day.
   
2. The vaccination was given outside of the specified window. Often a second or third vaccination can only be given after a minimum period of time (eg: 28 days after the first vaccination) and there is no allowance for anything given at 27 days.
   
3. The code used wasn't part of the Business Rules codelist. The codes for each search are prescriptive; while for many searches there isn't much choice, use of long-standing alternative codes may mean a vaccination is missed from the search. If you are using your own templates to record vaccinations the codes may not reflect the current criteria. The use of EMIS codes, even where the code term is identical, is not counted by CQRS, but will be found by the broader searches.
   
4. The patient was deducted before the end of the payment period (usually the end of the month). Some Practices appeal the omission of these patients as they argue the completed activity was undertaken when the patient was registered.  

For (1) and (2) it won't be possible to rectify the data to achieve payment, but these examples can be used within the Practice to learn about the missed income and make changes to ensure it doesn't happen in the future.

Every effort has been made to ensure that the 'reporting' searches are as accurate as possible by using the code clusters specified by the business rules. The Missed Activity reports have many additional codes to capture as much related information as possible. Where business rules have specified codes and drug issues, codes have been used which may mean that patients without coding are flagged as Missed Activity in the PCIT searches.

When using the CQRS searches, remember:

1. The searches are designed to look at the previous calendar month, which is fine when reviewing the results prior to extraction but users may need to re-run the folder using a relative run date if reviewing after the CQRS extraction. The relative run date can theoretically be any date in the month following the achievement period, but we strongly recommend using a relative run date of the 1st of the following month (eg: for the Achievement period of the month of April, set run date as 1st May).
   
2. Patients must have been registered as patients before the end of the reporting month. This means that patients who left or died can be included.
   
3. Left or deceased patients may be flagged as hidden in the patient list. Users must have RBAC B8029 (Manage detailed health records) on their login/smartcard in order to view the name or use Check Patient. 
   
4. Newly registered patients whose data was transferred via GP2GP may be included in the results. Due to the complex nature of the business rules, incorporating the rule in relation to when a code was added presents a significant layer of difficulty.
   
5. Some business rules may specify codes and medication; the PCIT searches only consider codes as the structure of the searches cannot realistically take into account a mix of codes and medication.