IIF 2023/24

Primary Care IT has again produced a comprehensive set of searches to support the Investment and Impact Fund 2023/2024 requirements.

These are based on and built according to the business rules originally published by NHS Digital on 4th April 2023 and referencing the Network Contract Directed Enhanced Service guidance. 

The current version of 025A IIF 2023/24 is v4.2

The Investment and Impact Fund payment indicators were heavily slimmed down for the 2023/24 contract year, with almost all previous indicators being transferred to management indicators informing much of the wider Network Contract DES (PCN DES) requirements.

IIF searches

The searches have been added to customer sites by Primary Care IT, and if your region has EMIS Enterprise (Search and Report) they can be found within the Primary Care IT folder. They look like this:

Within the 025A folder is an audit report "IIF Practice and 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 PCN member Practices (if there is no capability to run it at Enterprise level).

When running the searches, consider the date. If you want to include 'today', the relative run date must be set to 'tomorrow'. For end of month reporting, use the first day of the following month (ie: 1st January reports up until 31st December).

IIF Reporting searches

There are only 5 payment indicators for IIF, so searches and reports are compiled within a single folder.

ACC-08: appointments booked within 14 days of appointment

This indicator is very hard to achieve if a whole-Practice approach is not embraced from the beginning and throughout the entire contract year.

All slot types should have been reviewed and mapped to the appropriate National Appointment Category.

All staff should be educated in how to identify and use slots mapped to any of the counting National Appointment Categories.

The report counts the number of booked appointments, separated by how far ahead they were booked ( <14 days and >14 days). This is divided by month with a total at the end, enabling the Practice to perform its own calculations on percentage performance throughout the year.

Personalised Care Adjustments for booking appointments are available at the point of booking for certain National Appointment Categories, but these are still being used experimentally and do not count towards the indicator.

A separate set of reports are available for the Appointment Reporting module which assesses the data in various ways. These might be helpful to understand how slots are being used, and whether slots are being offered using the incorrect mapping. Submit a ticket to the support desk to request installation (they cannot be shared via the Enterprise units).

CAN-02: FIT tests reported prior to 2WW referral

Unlike other indicators, we are using two aggregate reports to count the denominator and numerator for CAN-02. The reason for this is that the number of referrals and number of QFITs are needed to calculate the achievement since a patient might have more than 1 referral during the contract year.

1. IIF-CAN02b All Lower GI 2WW referrals is the denominator
   
2. IIF-CAN02a Lower GI 2WW referrals with FIT result is the numerator
   

The achievement aggregate reports break down the number of patients referred each month - this differs slightly to the GPES report which counts clinical codes. This means that Practices who double code (or triple code) Fast track referrals potentially inflates the denominator to the detriment of the overall achievement. Think carefully about reviewing each patient to check that each referral episode has been singularly coded.

This code achieves the indicator:

1. Quantitative faecal immunochemical test [1049361000000101]

These codes can remove the patient from the indicator:

1. Provision of faecal immunochemical test kit declined [149441000000102]
2. On examination - per rectum - rectal mass [163326007]
   
3. Ulcer of anus [20928004]
4. Stercoral ulcer of anus [91105001]

HI-03: Learning Disability Health Check & Plan

Patients on the Learning Disability register should be offered a health check and health action plan every year. As an expansion over last year's HI-01, this indicator includes the requirement to record ethnic origin. Ethnic origin is a one-off exercise, so continuation of HI-03 next year would mean only the health check and health action plan are required. 

The health action plan must be coded on or after the date of the earliest health check of the contract year.

It is possible for patients or their carers to decline the health check review, which will reduce the size of the denominator (thereby boosting the percentage achievement).

These codes are needed achieve the indicator:

1. Ethnic origin code (majority of codes available in clinical system are valid)
   AND
2. Learning disabilities health action plan reviewed [413163007] or Completion of learning disabilities health action plan [712491005] 
   AND
3. Learning disabilities annual health assessment [199751000000100] or Learning disabilities health assessment [413126003] or Examination of learning disabled patient [442127005]

These codes can remove the patient from the indicator:

1. Learning disabilities annual health assessment declined [514021000000103]
2. Learning disabilities health action plan declined [413162002]
   

VI-02 / VI-03: Flu vaccinations

VI-02 measures the number of at risk patients aged 18-64 eligible for a flu vaccination who were vaccinated during the flu season; VI-03 measures the number of children in 2 'academic' year groups (those who were aged 2 or 3 on 31st August 2023).

It is important to understand that the eligible cohort for VI-02 is not the same as the eligible cohort for the seasonal influenza enhanced service. There are some differences in terms of eligible long term conditions, and pregnant women are not included. It is not possible to add patients to the cohort through the use of Requires flu vaccination.  

There are 4 important elements to think about in order to achieve these indicators:

1. Vaccinate as many patients as possible
   
2. Ensure all patients vaccinated elsewhere are coded correctly
   
3. Invite all eligible patients and record using an appropriate code
   
4. Code all declines 
   

The above approach will ensure that the numerator kept as large as possible, and the denominator is as small as possible (by way of excluding patients who have declined and those who have not responded to 2 invitations).
Two coded invitations at least 7 days apart will automatically remove a patient from the indicator (boosting the overall indicator achievement), but they would be reinstated if they subsequently received a vaccination. There is no need to code declined after two non-responses.

Any of these codes achieve the indicator:

1. Administration of first inactivated seasonal influenza vaccination [985151000000100]
2. Administration of first intranasal seasonal influenza vaccination [884861000000100]
3. First inactivated seasonal influenza vaccination given by pharmacist [1037351000000105] 
4. First inactivated seasonal influenza vaccination given by midwife [1066181000000105]
5. Seasonal influenza vaccination given in school [1239861000000100]
6. First intramuscular seasonal influenza vaccination given by other healthcare provider [945831000000105]
7. Seasonal influenza vaccination given by other healthcare provider [955651000000100]
8. Seasonal influenza vaccination given by midwife [1066171000000108]
9. Seasonal influenza vaccination given by pharmacist [955691000000108]
10. Seasonal influenza vaccination given while hospital inpatient [955701000000108]
11. First intranasal seasonal influenza vaccination given by other healthcare provider [955661000000102]
12. First intranasal seasonal influenza vaccination given by pharmacist [1037311000000106]

These codes can remove the patient from the indicator:

1. Seasonal influenza vaccination declined [822931000000100]
2. First intranasal seasonal influenza vaccination declined [885971000000103]
   
3. Second intranasal seasonal influenza vaccination declined [886011000000103] 

1. Influenza vaccination invitation letter sent [315641001]
   
2. Influenza vaccination invitation first letter sent [200481000000107] 
   
3. Influenza vaccination invitation second letter sent [200491000000109]
   
4. Influenza vaccination verbal invitation [761311000000109]
   
5. Influenza vaccination first verbal invitation [860151000000103]
   
6. Influenza vaccination second verbal invitation [860171000000107]
   
7. Invitation by telephone for influenza vaccination [737041000]
   
8. Influenza vaccination first telephone invitation [1095821000000105]
   
9. Influenza vaccination second telephone invitation [1095831000000107]
   
10. Influenza vaccination invitation email [844941000000103]
    
11. Influenza vaccination invitation first email [844961000000102]
    
12. Influenza vaccination invitation second email [844981000000106]
    
13. Influenza vaccination invitation SMS text message sent [1484821000000104]
    
14. Influenza vaccination invitation SMS first text message sent [1484831000000102]
    
15. Influenza vaccination invitation SMS second text message sent [1484841000000106]
    
16. Influenza vaccination invitation SMS third text message sent [1484851000000109]
    

Two invitation codes at least 7 days apart need to be on the record between 1st September and 31st March.

IIF Data Quality

A selection of data quality searches are provided to help maximise achievement. It is essential that these searches and reports are run frequently to keep on top of the IIF indicators.

IIF-ACC08d identifies all patient appointments booked more than 14 days in advance using slots mapped to any of the eligible National Appointment Categories. View the report to see appointment dates, times, slot types, and session holder. Nothing can be done to rectify these appointments, but they may be useful as education to all staff to understand how to avoid booking too far in advance. Think about using different slot types to book routine appointments which are mapped to National Appointment Categories not considered by ACC-08.

IIF-ACC08q offers the ability to see all appointments booked more than 14 days ahead of 'today' which will count against the overall achievement for ACC-08. Take the opportunity prior to the appointment to review the slot type and change if appropriate.

This search needs to be run at least weekly to make the most of it.

IIF-CAN02q is a simple search to list all patients with an EMIS code of 2 week rule referral - colorectal [831271000006106] which doesn't count.

IIF-CAN02x lists all patients who have been referred but there was no QFIT (Quantitative Faecal Immunochemical Test) result coded in the 21 up to (and including) the date of the referral. Think about comparing the date of the referral to the date of the QFIT. If there is a day or two between the two, could an extra code be justified if the patient completed the kit on the same day as the referral? The column for Any coded QFITs contains a True or False - dates with True came from a lab report so cannot be edited, while dates with False are coding attempts by staff at the Practice to place a QFIT within the 21 day window of referral.

IIF-HI03d is a report to show any patient on the Learning Disability register who has 1 or 2 elements of the indicator coded. View the report and fill in the gaps. Hopefully most gaps relate to a missing health check or action plan.

Remember that the health action plan must be coded on or after the earliest health check of the year.

IIF-VI02q / IIF-VI03q are reports that must be watched carefully. The searches and reports should be reduced to zero prior to the end of the contract year. Any patient appearing in the report has not been included in the indicator, but a code as been added to record a vaccination (or decline) which isn't valid. These should be simple recoding exercises. Some codes will come in automatically from PharmOutcomes, but any codes added by staff members are an education opportunity - ensure that they are using the correct template or are aware of valid codes to use.

Any coding fixed from these reports will definitely help towards the overall achievement.

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