🧬 Simple Contract Cholesterol 2025/26

💷 How much is this worth to me?

This template supports compliance with key QOF indicators related to lipid management:

• CHOL003 – Appropriate lipid-lowering therapy prescribed in CHD, PAD, STIA, and CKD

• CHOL004 – Achievement of cholesterol targets (LDL or non-HDL) in CHD, PAD, and STIA

Accurate use of this template ensures:

• Prescribing aligns with indicator requirements

• Valid exception coding is applied where needed

• QOF income is protected even if targets are not met, through appropriate PCA documentation

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📊 High-level overview of the specification requirements

CHOL003: Lipid-Lowering Therapy

Patients with CHD, PAD, STIA, or CKD must be prescribed:

• A statin (typically Atorvastatin 20mg or stronger)

• Or, if statin not suitable: an alternative lipid-lowering medication (e.g. ezetimibe, Inclisiran)

Valid exceptions include:

• Statin not tolerated (recorded once ever)

• Patient on maximal tolerated therapy

• Other PCA reasons (must be renewed annually)

CHOL004: Cholesterol Targets

Applies only to CHD, PAD, and STIA:

• LDL must be ≤2.0 mmol/L, or

• If LDL not recorded, non-HDL must be ≤2.6 mmol/L

If these targets are not met, a valid PCA must explain why.

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📌 What do you need to know?

This template covers all relevant scenarios:

💊 CHOL003: Prescribing or PCA for Statin Use

• Tick if a statin is prescribed

• If not:

  • Record “statin not tolerated” (only needed once ever)

  • Record annual PCA if on maximal tolerated therapy or alternative required

• If using alternative therapy, select from:

  • Ezetimibe

  • Inclisiran

  • Bempedoic acid

  • PCSK9 inhibitors

🎯 CHOL004: Lipid Targets

• If patient is not at target, you must:

  • Intensify treatment where possible

  • Or apply a PCA:

    • Maximal tolerated therapy

    • Lipid therapy not indicated

    • Patient declined test

⚙️ PCA Management

• Annual PCAs: must be updated each year (e.g. on-going refusal, intolerance)

• Once-only PCAs: used for permanent conditions like statin intolerance

• PCA coding ensures QOF protection even without biochemical target achievement

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💡 Hints and Tips

• For patients not on a statin, make sure both:
  ➤ A PCA is recorded
  ➤ An alternative lipid-lowering drug is prescribed
  …or QOF may be missed.

• Inclisiran and PCSK9 inhibitors are valid alternative therapies and should be recorded as prescribed.

• Where blood results are not at target, don’t leave blank — either escalate treatment or use the CHOL004 PCA.

• Ensure cholesterol readings are current — LDL preferred, but non-HDL acceptable if LDL not available.

• Always revisit exceptions annually unless they are marked as “once only”.