IIF 2022/23

IIF 2022/23

Primary Care IT has produced comprehensive searches for the Impact and Investment Fund 2022/2023.
These are based on and built according to the business rules originally published by NHS Digital on 6th April 2022 and referencing the Network Contract Directed Enhanced Service, Investment and Impact Fund 2022/23: Updated guidance published by NHSE in March 2022
The current version of IIF 2022/23 is v3.9

Version Update

If you have made copies of a previous version, please ensure these are replaced to ensure figures being reported are aligned to monthly CQRS reports. A full summary of updates can be seen at the bottom of this article.
In version 3.6 PCIT has also adjusted the way CVD-01 is calculated to bring it in line with the system suppliers. Previously the denominator excluded patients whose first raised BP was this year and within the last 6 months (subset INYBP-6M) UNLESS they had been followed up. We took this approach to facilitate work to do. The business rules and system suppliers take a different approach and only exclude patients whose first raised BP was after 01/10/22 unless they had been followed up within the 6 months. The consequence of this change is that Practices will see their achievement for CVD-01 drop by around 5-10% mid-way through the year. However achievement for both approaches will be the same at the end of the year. 
The CVD-01 work to do folder still references the old method to ensure all recently identified patients are visible in order to target them for follow up within 6 months. The Population Excluded list of IIF-CVD01 will NOT show patients whose first raised BP was after 1st October. Whilst these patients are technically exempt from the denominator, following up some of these will help to boost the overall achievement.

In v3.6, the logic of RESP-01 denominator was mistakenly altered in a way which dropped the percentage achievement for many Practices, but this change was in fact implemented by the NHS Digital changes released in December 2022. As a result, v3.8 of the searches are again aligned with the business rules.

IIF searches

The searches can be downloaded from the PCIT hub, or if your region has EMIS Search and Report you will find them within the Primary Care IT folder.  They look like this:

Within the top level folder is an audit report "IIF Practice & PCN Extract" which summarises the achievement figures for each indicator. The data can be dumped into a spreadsheet and joined with the output from other constituent PCN member Practices. 

Video guide of IIF search folders




We recommend running the searches using a relative run date of the first of any given month so they are aligned to monthly reporting metrics.

Scheduling searches to run

Many of the searches are complicated and take quite a long time to run. We find that the most successful approach to running the searches is to configure the folder to run on a schedule.
Right click on the main IIF folder and select Schedule. Configure the schedule as below to run overnight, which should mean the results can be viewed tomorrow morning. This can be seen in the left hand image below. Relative run dates can be configured using the Baseline Fixed date option (see left image for 1st September, looking at April to August data).
We strongly discourage Practices from setting searches to run every night as it may cause performance issues. Instead, we suggest setting a schedule of bi-weekly runs as seen in the right hand image below. Remember to set a realistic end date of just after the end of this financial year!

                        

Which IIF searches should I use to target patients?

We have produced a support article (click here to open) to help Practices navigate the folders of searches. Sometimes it isn't always a case of looking at the Population Excluded tab, and sometimes a bit of data quality work and housekeeping can help resize cohorts before the actual work for the indicator is done.

IIF Reporting searches

The initial reporting searches are laid out in the same structure as the IIF documentation:


These searches will give you your current performance for IIF.
Reporting searches look back at the previous full day. Click here for an expanded explanation of how the reporting searches are built and how to run them. 

I Prevention and Tackling Health Inequalities

This folder holds the searches for the "Prevention and Tackling Health Inequalities" area of IIF:

When running the IIF-SMR03 search between April and July, use a relative run date of at least 1st September to show the denominator population. 1st September is a good date as it will pick up any eligible patients who had a DOAC prescription in April or May. During the first 4 months of the contract year, it may be easier to look at IIF-SMR03p in the Work to do folder.
Even where the work has been done (weight, eGFR, CrCl and dose status) in the first three months the reporting search will show as 0 due to the way the business rules are built.  We have clarified the logic with NHS Digital and this is an expected behaviour.
IIF-CVD02 can be run without setting a relative run date. Practices may notice a small difference in the population size between this search and running CVD02 with a relative run date. This is due to patients not being recognised as fully registered (eg: where the registration status prior to 01/04/2022 was Application Form FP1 submitted).

II Providing High Quality Care

This folder holds the searches for the "Providing High Quality Care" area of IIF:

IIF-SMR03 contains a rule which causes the search to return 0 between 1st April and 30th July 2022. Either use a relative run date on or after 1st September 2022 to see a representative figure, or look at IIF-SMR03p and IIF-SMR03x in the Work to do for pharmacist folder.

III A Sustainable NHS

This folder holds the searches for the "Sustainable NHS" area of IIF:


What can I do with reports for the Environmental Sustainability (ES) indicators?
The data source for the ES indicators is NHS Business Services Authority which provides accurate data about all prescriptions issued by a GP Practice. The reports created in the IIF searches have been designed to be a guide in the absence of a regular achievement update. However due to the limitations of clinical systems these reports do require a degree of manipulation in Excel to determine current achievement. 

ES-01
ES-01b is the denominator, while ES-01a is the numerator. The indicator has a downward trend meaning the upper threshold for maximum achievement is a lower percentage than the lower threshold.
  1. Use ES-01b to calculate the total number of devices issued since 1st April. Notice that some drugs have more than 1 row, distinguished by different numbers in the Quantity column.
  2. Convert the quantities into devices (eg: 120 doses = 1 device, 240 doses = 2 devices), and multiply this by the total column to work out how many devices of each drug have been issued.
  3. Repeat the process for ES-01a.
  4. Divide the total number in ES-01a by the total number calculated in ES-01b to establish the current achievement. The lower threshold to start scoring points is 44%, while the upper threshold is 35%.
  5. If the current achievement percentage is greater than 35%, look at the drugs in ES-01a to target possible switches. It may be necessary to build your own searches of these drugs to identify individual patients.
  6. Remember, this indicator is about reducing the number of MDI prescriptions and changing them to DPI. This exercise may well require some patient education on inhaler technique, so the switches may need to be done gradually.
  7. The thresholds will be harder to achieve next year, so don't ignore it this year to stand any chance of earning points next year!
ES-02
ES-02b is the dataset from which an average CO2 calculation can be derived, while ES-02a displays all those on lower CO2 value inhalers. The indicator has a downward trend meaning the upper threshold for maximum achievement is a lower percentage than the lower threshold.
  1. Use ES-02b to calculate the number of each device issued since 1st April, similar to ES-01 above. Convert rows for multiple devices per prescription into a total number of device issues per drug. Make a note of the overall total number of devices.
  2. Multiply each drug total by the CO2 value specified in the guidance document, then add them together.
  3. Divide the total CO2 emissions value (in 2) by the total number of devices (in 1) to determine the current average CO2 emissions.
  4. If the current achievement percentage is greater than 18kg CO2 per device, think about switching patients to devices with lower CO2 emissions. The 'worst' devices are generic Salbutamol CFC-free 100 microgram inhaler and Ventolin Evohaler 100 microgram.
  5. The accumulating average means the longer you leave in the year to switch devices, the harder it is to meet the achievement threshold. The thresholds will be harder to achieve next year, so don't ignore the indicator this year.

IIF Data Quality

This folder contains a number of searches that look at potential data quality issues which may affect IIF performance. Each search and report has some information in the description explaining why the patient is included and what to do. 


IIF Initial assessment

During our lessons on IIF, you will have seen there are a number of areas we suggest you review early in the year - as depending on your baseline, you may or may not have a lot of work to do to achieve these targets.  If you do have a lot of work to do, you will need to start this early in the year to achieve these targets (e.g. patients having previously had 6 or more SABAs will need early review to ensure they don't do the same again this year). 

The populations in these searches remain fairly static, but offer an overview what sort of progress has been made over time.
Do not use these searches for identifying patients to chase targets, use the Work to do folders instead.

CVD-01 Case Finding

This folder contains searches to help you identify potential hypertensive patients and breaks them down into risk areas so you can look at your highest risk patients first.
  1. Group 1 represents patients those with the highest BP values, greater than 180mmHg systolic or 120mmHg diastolic
  2. Group 2 represents patients whose latest BP is greater than 160mmHg systolic or 100mmHg diastolic (excluding any patients already displayed in group 1)
  3. Group 3a represents patients whose latest BP is greater than 140mmHg systolic or 90mmHg diastolic (excluding any patients already displayed in group 1 or group 2) AND who are in a BAME group or have a long term condition (CHD, stroke/TIA, PAD, CKD, diabetes, BMI >35.
  4. Group 3b represents all remaining patients whose latest BP is greater than 140mmHg systolic or 90mmHg diastolic.
This folder is useful for Practices planning to set up a recall clinic for raised blood pressures. However for ongoing work we now recommend using the folder "IIF Work to do for CVD-01".

CVD-03 QRISK >20% on a statin

This folder allows you to see the number of patients aged 25-84 who have a QRISK of more than 20% and are not on a statin. For ongoing work we now recommend using the data quality search IIF-CVD03p
The denominator for CVD-03 will be determined by the number of patients who have a previously calculated (elevated) QRISK, and we are aware that the percentage of the overall population varies depending on what a Practice has done historically, including using batch coding.

RESP-02 6 or more SABA

This search shows you patients who have 6 or more issues of a SABA.  These can be used to target patients for review:

SMR01B Severe Frailty

This search will give an idea of the number of patients currently on the frailty register in order to plan for invitations to structured medication reviews.

IIF Work to do for CVD-01

We produced a dedicated set of searches in v3.4 to help Practices target their CVD-01 denominator population. Due to a rule in the reporting denominator, patients who had a first raised BP reading in the past 6 months are not included unless they have been followed up. The searches in this folder ignore the exclusion rule to display all patients eligible for follow up, broken down by those who need a repeat BP check (those with previously raised BP April '20 - March '22), and those who may have had a repeat BP check but still need some coding actioned to demonstrate complete follow up.


The final search "High BP 2022-23 LOST TO FOLLOW UP" was added in v3.5. This search becomes relevant from October of the financial year when the follow up window begins to close for patients who had their first raised BP recorded just over 6 months ago. Ideally this search should report close to 0 patients.

IIF Work to do

This set of searches give you actionable work lists for your pharmacists to work through. The description of each search has instructions of what can be done, and it is recommended to have our IIF Quick guide to coding to hand.


v3.7: All searches have been updated to reflect activity completed today. If you have been working through a particular indicator, there is now no need to use a relative run date on searches in this folder. Once run, the searches and reports will only show who needs work doing to achieve an indicator. However corresponding Reporting indicators will still need to be run using a relative run date (set to tomorrow) to observe the improvement.


RESP-01 Regular ICS

This search displays asthma patients who have few or no issues of corticosteroid AND a low number of SABA inhalers. This has been set to identify patients who are likely to be mild asthmatics by virtue of being prescribed an overall low number of inhalers in the past 12 months. These patients can be reviewed to see if you need to code them as "Mild asthma" as well as adding the code "Inhaled corticosteroid not indicated".
The report will help to further break down patients by complexity; the number of both ICS and SABA prescriptions are shown, as well as what types of inhaler the patient is on. Some patients may already be coded as Mild Asthma.
It may help to export the results of the report to Excel for sorting or filtering.

ACC-08

B1998 (26th September 2022) - this indicator has been dropped for the remainder of the 2022-23 IIF programme, but will be reinstated in April 2023. Primary Care IT believes that there is potentially a lot of work to be done in Practices to ensure they can realistically achieve this indicator. We recommend Practices still keep an eye on this indicator to be aware of current performance. 
In v3.4 we added some searches to reflect the ACC-08 indicator (looking at 'first' appointments being booked within 2 weeks of the appointment). The National Appointment Category mapping undertaken for IIF in 2021 laid the groundwork for this indicator. The achievement thresholds are very high and set to become even higher in 2023-24.
While official achievement data is extracted via GPAD, we have produced a reporting search as a guide to track monthly and overall performance.
In Data Quality there is also a search to help track patients booked into slots more than 14 days ahead which will help the Practice to understand what is being booked, and perhaps serve as a learning exercise to staff booking appointments.

Population Reporting is only capable of looking at data connected to patients, so we have also produced a small set of Slot Reports in Appointment Reporting designed to help Practice management identify patterns in booking behaviour, and slots which might need to be remapped.

As a result of reviewing these reports, Practices may feel it necessary to introduce a naming standard to their appointment slots, or even create some new slots.


Changelog

v3.9
  1. Updated data quality searches IIF-VI01q, IIF-VI02q, IIF-VI03q to include invalid declined codes as well as vaccinations
  2. Fixed ASTCOPDICSTRTATRISK list in [IIF-RESP01, IIF-RESP01, IIF-RESP01a, IIF-RESP02a (report) with additional 8 drugs previously missed (including generic Clenil 100 and generic Seretide 50)
  3. Fixed ASTTRT list in [IIF-RESP01], [IIF-RESP02], MAXSABA2, MAXSABA3 with additional 6 drugs previously missed (including generic Seffalair)
  4. Fixed CHANGMED1 - linked features were missing complete BP_COD list
  5. Renamed IIF-CAN01q report to IIF-CAN01x (parent was already CAN01x)
v3.8
  1. Amended [IIF-SMR01B] according to NHSD rule update
  2. Amended [IIF-SMR03] and [IIF-SMR03p] according to NHSD rule update
  3. Amended [IIF-RESP01] according to NHSD rule update (actually updated in v3.6)
  4. Amended [IIF-CAN01], IIF-CAN01p, IIF-CAN01x according to NHSD rule update
  5. Amended [IIF-CVD04] and IIF-CVD04 according to NHSD rule update
  6. Created IIF-CVD04p in Work to do folder
  7. Created IIF-CVD04c (patients passing numerator rules, but missing qualifying cholesterol code) and IIF-CVD04e (patients with plain FH diagnosis who might be candidates for re-coding) in Data Quality folder
  8. Amended IIF-CVD04d (rewritten to exclude patients found in CVD-04, then include anybody with a history of secondary hypercholesterolaemia code)
  9. Amended [IIF-CVD05] according to NHSD rule update
  10. Retired IIF-HI01q due to outdated code logic
  11. Created sub search "(no recent cancer diagnosis)" for SMR01C to improve search performance. Applied search results to sub searches x5 instead of feature
  12. Updated codes clusters used in HI-01, SMR-01A. SMR-01C, SMR-03, VI-01, VI-02, VI-03, CVD-03, CVD-05, RESP-01, RESP-02, ES-01
v3.7
  1. Added new IIF-CVD04a initial assessment report
  2. Added IIF-EHCH04 report to II Providing High Quality Care
  3. Corrected IIF-VI03q where 3x intranasal codes were missing from rule 1 exclusion
  4. Renamed folder "IIF Work to do for pharmacist" to "IIF Work to do"
  5. Enhanced IIF-CVD02q, adding columns for HF/DM/CKD/microalbuminuria diagnosis, and latest BP
  6. Added MAXSABA2 and MAXSABA3 in new [RESP01] subsets folder
  7. Amended [IIF-RESP01] and IIF-RESP01a to replace SABA issues MAXSABA2 and MAXSABA3
  8. Moved IIF-RESP01a from Initial Assessment into Work to do folder
  9. Amended reports in Reporting folders to include Organisation code and organisation names as rows to support enterprise level reporting (if enabled)
  10. Amended [IIF-SMR03p], IIF-SMR03p, IIF-SMR03x, IIF-CVD03p date parameters to facilitate live updating of work to do searches (no need to use relative run date)
v3.6
  1. Changed CVD-01 subsets to match system supplier BP panel code logic
  2. Amended [IIF-EHCH02] and IIF-EHCH02 according to NHSD rule update
  3. Amended IIF-EHCH02q due to NHSD change in rules (care home status after PCSP no longer relevant)
  4. Amended [IIF-CVD05] and IIF-CVD05 according to NHSD rule update
  5. Amended [IIF-SMR03] and IIF-SMR03 according to NHSD rule update
  6. Retired IIF-SMR03q due to NHSD change in rules (eGFR after creatinine clearance no longer relevant)
Why have the figures for my CVD-01 searches changed?
Primary Care IT has always built the IIF searches from scratch. Once the EMIS GPES search criteria were visible in July we noticed that CVD-01 had been interpreted in a different way to ours, but similar to SystmOne. PCIT searches looked at separate (but associated) systolic and diastolic BP values, which was a direct interpretation of the business rules and complicated to implement. The clinical system providers took a different view and looked for SNOMED codes which have both a systolic and diastolic component. In SNOMED, these are called panel codes. Those who have looked into the rules might know that there are 97 codes in the cluster BP_COD, but by restricting it to panel codes limits your choice to 4 codes. These are: o/e blood pressure reading; Standing blood pressure reading; Sitting blood pressure reading; Lying blood pressure reading. The consequence is that a number of other means of coding a blood pressure are not valid, especially if used as the first follow up BP code.

v3.5
  1. Added exclusion rule for [IIF-CAN01] now code is released
  2. Added data quality search IIF-CAN01q) identifying invalid 2 week rule codes for referral
  3. Enhanced IIF-RESP01a) initial assessment search - now identifies patients with >3 ICS issues with >4 SABA issues in the past 12 months
  4. Updated all CVD01 subsets - added value is GTEQ 1 in linked features to only pick up codes with associated values.
  5. Updated IIF-CVD05d to include any patients with CHADS2 score on or after 01/04/2015.
  6. Updated IIF-CVD05q to change CHADS2 rules to before 12 months before the search date (there will be some crossover with IIF-CVD05d)
  7. Amended reports IIF-CAN01a & IIF-CAN01b to look at Patients instead of clinical codes.
  8. Fixed exclusion rule for [IIF-EHCH02] due to incompatible date criteria.
  9. Fixed date criteria, changing from 21/22 to 22/23 in IIF-HI01d
  10. Fixed logic for IIF-SMR02B rule 1 from Exclude to Include.
  11. Fixed date for [IIF-CVD05] and [IIF-CVD06} where latest CHADS2 should be before 01/04/2015.
  12. Fixed rule 3 [IIF-SMR03] where earliest prescription should be after 01/04/2022.

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