Q&A

The three care pathways cannot be the same for QP6-8 and QP9-11

QP11, more guidance related to this area can be found on page169 in the Quality and Outcomes Framework guidance for GMS contract 2011/12.

It is important these patients receive a review by the practice as they are new in the area and the review is about their wellbeing, patient’s individual health, support needs and the coordination between the sectors. It is not appropriate to move the diagnosis date either so I would suggest you ensure they have a review but for the purpose of the QOF if they do prevent you from achieving at the end of the QOF year then you exception report them with an explanation as to why. You may even wish to add the date the review has taken place in the free text to evidence you have cared for the patient as expected. 

There is no age criteria for the Asthma register, if they have a diagnosis in their record and they have been prescribed inhalers they will appear in ‘work to do’. It is not appropriate to exclude children 8 years and under from the review indicator. If the child is not able to give an answer to the three RCP questions, these should be directed at the guardian attending with the child.

Children will not appear in Asthma 002 ‘confirmation of diagnosis’ until the year of their 8th birthday.

If the patient cannot get to either the hospital or surgery and you are unable to carry out a spirometry test, the patient would need excepting. The problem here is that there are very limited lower exception codes. If one of the following is not appropriate then you would have to use the ‘Patient unsuitable’ Code.

You are required to  Read code both the Asthma review and the three RCP questions in the same consultation, I would suggest a quality search identifying patients who have been reviewed without the three RCP questions. This search can be reversed looking at patients with the 3 RCP questions without a review code. If a complete review has taken place and it is only the review Read code missing, you can backdate the Review read code along with the three questions using the original answers to the date of the review. If a review has been coded without the 3 RCP questions then the patient would require another consultation.

No, both reviews can be completed at the same time. Approximately 15% of your COPD register will also have an Asthma diagnosis. I would suggest you combine both templates to ensure the reviews are completed where appropriate.

A new cancer diagnosis requires a ‘new’ or ‘first’ episode attached to the Read Code. If the diagnosis is entered onto the clinical record by template the entry should have an episode type default as ‘New’ or ‘First’ but if the entry is made via the browser/consultation mode you would need to select the episode type.

Thanks for your enquiry.  In the indicators mentioned in order to succeed in QOF 2012/13 (providing the patient meets the other indicator criteria) they would need a valid Read Code (in the appropriate timeframe) from the REFERSSSA_COD (Support and refer Stop Smoking Service/Advisor) cluster OR a valid Read Code from the PHARM_COD (Pharmacotherapy) cluster.  Therefore in your example it would be a logical ‘OR’ rather than an ‘AND’ to link your two statements i.e:

8CAL.     Smoking cessation advice

8IEM.    Smoking cessation drug therapy declined or  8B3Y.Over the counter nicotine replacement therapy or an issue of nicotine replacement therapy

Total population 15 and over.

If a lifelong non-smoker they will only need it recorded the once unless under 25 years then its 12 monthly until the year of their 25 birthday. Once recorded as a non-smoker after their 25^th birthday then it will not require again unless their status changes.

If an ex-smoker, a smoking status is recorded every 24 months unless you record it three consecutive years then it will not be required again unless their status changes.

Smokers require their smoking status every 24 months

Chronic Disease Registers

Patients who are on the disease registers If a lifelong non-smoker they will only need it recorded the once unless under 25 years then its 12 monthly until the year of their 25 birthday. Once recorded as a non-smoker after their birthday then it will not require again

If an ex-smoker, a smoking status is recorded every 12 months unless you record it three consecutive years then it is not required again unless their status changes.

Smokers require their smoking status every 12 months

There is no documentation in the guidance to suggest the advice has to be face to face but to fulfil the set criteria in the book you would need to discuss the options with the patient. This could be done over the telephone and documented as a telephone consultation with evidence of what was discussed.

Many practices are struggling with the new smoking indicators, Smoking 6 and Smoking 8.

Smoking 6:

The percentage of patients with any or any combination of the following conditions: CHD, PAD, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma, schizophrenia, bipolar affective disorder or other psychoses who smoke whose notes contain a record of an offer of support and treatment within the preceding 15 months

Smoking 8:

The percentage of patients aged 15 years and over who are recorded as current smokers who have a record of an offer of support and treatment within the preceding 27 months.

To fulfil both indicators:

To be included in the dominator the patient would need to be listed as a ‘current smoker’ (A latest entry of one of the smoking QOF Codes).

To achieve the criteria for this indicator (numerator) for those patients in the denominator you have to have a record of being offered support and treatment in the preceding 15 months.

The smoking codes are as follows:

Version 2 – Advice and Support                                                                                      CTV 3

8CAL.      Smoking cessation advice                                                  Ua1Nz     Smoking cessation advice

8HTK.      Referral to stop-smoking clinic                                         XaFw9    Referral to stop-smoking clinic

8HkQ.     Referral to NHS stop smoking service                             XaQT5    Referral to NHS stop smoking service

8H7i.       Referral to smoking cessation advisor                             XaItC       Referral to smoking cessation advisor

8IEK.       Smoking cessation programme declined                        XaIye      Seen by smoking cessation advisor

9N2k.      Seen by smoking cessation advisor                                  XaW0h   Practice based smoking cessation programme start

13p50    Practice based smoking cessation programme start                    date

date                                                                                        XaX5W   Consent given for follow-up by smoking cessation

8IAj.        Smoking cessation advice declined                                                  team

8IEM.      Smoking cessation drug therapy declined                     XaX5X     Declined consent for follow-up by smoking

9Ndf.      Consent given for follow-up by smoking cessation                      cessation team

team                                                                                       XaRFh     Smoking cessation advice declined

9Ndg.      Declined consent for follow-up by smoking                   XaREz      Smoking cessation programme declined

cessation team

Version 2 – Pharmacotherapy  “ advice and support”continued

745H%.  Smoking cessation therapy                                                XaMwY%  Smoking cessation therapy

8B3f.       Nicotine replacement therapy provided free XaIQn     Nicotine replacement therapy provided free

8B2B.      Nicotine replacement therapy                                          XaEKU     Nicotine replacement therapy

8B3Y.      Over the counter nicotine replacement therapy          XaFst       Over the counter nicotine replacement therapy

8IEM.      Smoking cessation drug therapy declined                      XaMlI%   Smoking cessation drug therapy

du3..%    NICOTINE                                                                               XaXpT     Issue of nicotine replacement therapy voucher

du6..%    BUPROPION                                                                          XaZ01     Smoking cessation drug therapy declined

du7..%    NICOTINE 2                                                                           du3..%    NICOTINE

du8..%    VARENICLINE                                                                       du6..%    BUPROPION

du8..%   VARENICLINE