🩸 Simple Contract Diabetes 2025/26

💷 How much is this worth to me?

This template supports achievement of multiple QOF diabetes indicators, including:

• DM020/DM021 – HbA1c control

• DM034/DM035 – Statin prescribing

• DM036 – Blood pressure control

It also supports additional local enhanced services (LES) and ensures correct frailty stratification, which affects KPI thresholds. Accurate use maximises income while ensuring care is tailored to patient needs.

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📊 High-level overview of the specification requirements

Indicator thresholds differ based on frailty status:

Patients with no frailty:

• HbA1c target: ≤58 mmol/mol

• BP target (if aged <80): ≤140/90 (or ≤135/85 if home/ambulatory)

• Statin required if over 40 without CVD (unless 10-year QRISK <10%)

Patients with moderate or severe frailty:

• HbA1c target: ≤75 mmol/mol

• No BP or statin indicators apply unless the patient has CVD (in which case statin still applies)

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📌 What do you need to know?

This template covers all key components:

🧓 Frailty Assessment

• Based on the Rockwood Clinical Frailty Scale

• Required to determine which QOF targets apply

• Options: Not frail, Moderately frail, Severely frail

🩺 Blood Pressure (DM036)

• Enter clinic, home, or ambulatory readings

• Tick if patient is exempt due to clinical judgement or maximal tolerated treatment

🧪 HbA1c Control (DM020/DM021)

• Automatically interprets HbA1c target based on frailty

• Tick exception if:

  • On maximal tolerated treatment

  • Patient refuses blood tests

💊 Statin Prescribing (DM034/DM035)

• Required for:

  • All with CVD

  • Those aged 40+ without CVD/frailty, unless QRISK <10%

• If statin not appropriate:

  • Tick if declined

  • Tick if clinically unsuitable

  • Record alternative lipid-lowering therapy (e.g. ezetimibe, inclisiran)

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💡 Hints and Tips

• Frailty status drives indicator thresholds — always complete this first.

• Use home/ambulatory BP if clinic reading fails to meet target.

• If HbA1c is not at target, always explain why using the PCA section.

• Patients with CVD must be on a statin regardless of frailty — unless exception coded.

• Remember: PCAs such as "statin not tolerated" may be one-time entries, while others must be renewed annually.