Transcript QoF Talk 2013

The QOF 2013-14:
What’s new, What’s tricky,
What else can help?
Dr Simon Clay
MB ChB FRCGP DPD
Poplars Surgery, Erdington, Birmingham
This full presentation, a Word doc copy and a suite of
other QOF resources are available for purchase in one
package here: www.tinyurl.com/qofdisc
Two sections to talk:
1.
2.
Cover some areas from Q.O.F. 2013 which
are complex / confusing.
Some general areas of Q.O.F. management
that can help points acquisition.
Generic new rules that apply
across QOF 2013-14:
1.
2.
3.
Indicators previously having a 15/12 “time window”
now only have a 12/12 one. (44 different indicators)
(Hence almost no clinical entry ever “counts twice”
for us over 2 consecutive QOF yrs)
Most Expiring Exception codes now expire every 1st
April. (Hence no Expiring Exception code ever
exempts a patient from the relevant indicator over 2
consecutive QOF years. (bar CS002)
But variations across U.K. countries
All new changes highlighted in
Green.
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This PowerPoint only covers additional QOF
changes that go beyond the
“timeframe changes” noted in previous slide.
It also relates to the Business Rules as
released for England but is not necessarily
correct in all respects for other areas of U.K.
Diseases where there are not only
“time window” changes, but also
“point threshold” changes: (2)
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AF
Smoking
Disease areas where there
are significant changes: (13)
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CHD
HF
Hypertension
Stroke / TIA
Diabetes
COPD
Depression
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Mental Health
Cancer
CKD
Epilepsy
CVD-PP
Osteoporosis
New Disease areas / Rulesets:
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Rheumatoid Arthritis (new Disease area)
BP (new Ruleset)
The 2 “Point Threshold” diseases
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AF
Smoking
A.F.
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CHADS2 remains – (No CHA2DS2VASc yet)
AF2 (was AF5) (“DO CHADS2 on patients
every 12/12”) Was 15/12.
AF3 (was AF6) If CHADS2 is 1, Pt issued
Anti-platelet OR Anticoag’ in 6/12 before
Ref Date. Now 57-97% Was 50-90.
Smoking
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Smoking indicators 5-8 re-numbered
1-2 & 4-5.
Smok 3 added (was Info 5) (“Practice has
literature & Rx available for Smokers”)
Smok5 (Smokers with any of: HYP / CHD /
PAD / CVA / ASTHMA / COPD / CKD / MH / DM
offered support or Rx in L12M. Now 56-96%
(was 50-90)
Disease areas where there
are significant changes: (13)
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CHD
HF
Hypertension
Stroke / TIA
Diabetes
COPD
Depression
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Mental Health
Cancer
CKD
Epilepsy
CVD-PP
Osteoporosis
CHD6 Indicator:
(“M.I. patients need 4 drugs”)
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Previous requirement that patients on an ARB
only “counted” if they also had an exception
code to ACE’s has been quietly dropped.
Threshold increased Now 60-100% Was 45-80.
CHD10 is retired. (“All CHD Pts to be Rx’d with
Beta Blocker”)
Heart Failure:
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HF3 Pts with HF due to LVSD treated with ACE
or ARB.
Threshold now 60-100% Was 45-80.
HF & HF due to LVSD:
( = Left Ventricular Systolic Dysfunction)
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Important concept of HF vs. HF due to LVSD.
Why does it matter?
Because…
Only patients with LVSD are in denominator for
HF3 (“Put Pt on an ACE/ARB”) & HF4 (“Put Pt
on a B Blocker if they’re already on an
ACE/ARB”)
19 points available for HF3 (10) & HF4 (9)
LVSD cont’
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New QOF definition of HF due to Left Ventric’
Systolic Dysfunction.
Previously: Defined by Read code used for the
HF:
E.g. G581 LVF (as opposed to G58 Cardiac
Failure or G580 CCF)
Now No HF code is “HF due to LVSD” unless
accompanied by an additional official LVSD
code:
Valid codes to define LVSD:
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G5yy9 Left ventricular systolic dysfunction
585f. Echocardiogram shows left ventricular
systolic dysfunction
One of these codes needs to be added to all
new Pt’s with HF due to LVSD to add them to
denominator of HF3 & HF4 indicators.
One of these also needs to be added
retrospectively to all Pts with Read codes of
LVF, or they’ll STOP counting as HF due to
LVSD
Hypertension
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BP4 retired (Check Hypertensives’ BP annually)
HYP2 (was BP5) Patient’s BP to be ≤ 150/90.
Points dropped to 10. Was 55.
Threshold for HYP2 now 44-84% Was 40-80.
HYP3 (new) Patients aged <80 whose last BP
in 9/12 before Ref date is ≤ 140/90. Threshold
40-80% 50 points available!
Hypertension (cont’)
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HYP4 (New): Those Hypertensives aged 16-74
to have annual assessment of physical activity
using GPPAQ.
General Practice Physical Activity Questionnaire
5 pts available. 40-90%
GPPAQ
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(developed in 2006)
7 questions:
1. How much work their Job requires:
2. How many hours of Sport per week?
3. How many hours of Cycling per week?
Questions 4-7: How many hours of Walking,
Housework, Gardening is done. What is the
usual “Walking speed”?
Answers to 4-7 ignored in the calculation
(“not validated” (!)
http://www.patient.co.uk/doctor/General-Practice-PhysicalActivity-Questionnaire-(GPPAQ).htm
GPPAQ result options: *
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Patients are categorised as:
1. Inactive – sedentary job and no physical exercise or cycling
2. Moderately inactive – sedentary job and some but less than
one hour of physical exercise and/or cycling per week or
standing job and no physical exercise or cycling
3. Moderately active – sedentary job and one to 2.9 hours of
physical exercise and/or cycling per week or standing job and
some but less than one hour of physical exercise and/or cycling
per week or physical job and no physical exercise or cycling
4. * Active – sedentary job and three hours or more of physical
exercise and/or cycling per week or standing job and one to 2.9
hours of physical exercise and/or cycling per week or physical
job and some but less than one hour of physical exercise
and/or cycling per week or heavy manual job.
GPPAQ Read code options:
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Inactive: 138X.
Moderately Inactive: 138Y.
Moderately Active: 138a.
Active: 138b.
Hypertension (cont’)
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HP5 (New) Those patients (aged 16-74 only) who
score less than “Active” on GPPAQ have received
“Brief Intervention” in L12M.
6 pts available. 40-90%
Brief interventions examples: “opportunistic advice,
discussion, negotiation or encouragement”.
Read code 9Oq3. “Brief intervention for physical
activity completed”
Exception code: 8IAv. “Brief intervention for physical
activity declined”
Stroke / TIA:
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STIA5 (was STROKE8) “Patients whose last CVA
was Non-haemorrhagic or Hx of TIA should
have last Tot’ Cholest’ of ≤ 5.0mmol/L in L12M”.
(Was previously ALL patients with a CVA / TIA)
G61 Intracerebral Haemorrhage excluded.
Most G66 “Stroke & CVA unspecified” codes also
excluded
i.e. basically includes Cerebral Infarctions &
TIA’s
Stroke / TIA, (cont’)
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STIA6 (was STROKE10) Flu vacc uptake.
Thresholds increased to 55-95%. Was 45-85.
STIA7 (was STROKE12) Patients with Hx of TIA
or Non-haemorrhagic Stroke to be issued with
Asp’/Dipyrid’/Clopid’/Anticoag’ in L12M.
Thresholds increased to 57-97% Was 50-90.
Diabetes:
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DM2 (was DM30) Patient’s last BP (in L12M) is ≤
150/90. (53-93%) Was 45-71 !
DM003 (was DM31) Patient’s last BP (in L12M) is ≤
140/80. (38-78%) Was 40-65.
Diabetes:(DM5)
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DM5 (was DM13) Patient has had a Urine Alb/Creat
Ratio (ACR) done in L12M.
Note that ACR of ≥ 2.5 mg/mmol in men & ≥ 3.5
mg/mmol in women defines “Microalbuminuria”
(NICE)
Now, even Pts with previous “Proteinuria” diagnosed
(defined as ACR ≥ 30mg/mmol), need testing.
New Exception code: (Ver 26.0!)

9RX.. – “Declines to give urine specimen”.
Diabetes (cont’)
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DM6 (was DM15) Pts with Nephropathy
(= Proteinuria) or Microalbuminuria are Rx’d
with an ACE / ARB. 57-97% (was 45-80)
DM7 (was DM26) (Number of diabetics with
HbA1c of ≤ 59mmol/mol) 35-75% (40-50!)
DM8 (was DM27) (Number of diabetics with
HbA1c of ≤ 64mmol/mol) 43-83% (45-70)
DM9 (was DM28) (Number of diabetics with
HbA1c of ≤ 75mmol/mol) 52-92% (50-90)
Diabetes (cont’)
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DM10 (was DM18) Diabetics had Flu
vaccination: 55-95% (was 45-85)
DM13 NEW: Percentage of ALL the Practice’s
Diabetics receiving an annual dietary review
with a “suitably qualified professional”.
3 whole points!!! 40-90%
Read code options:
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66At. Diabetes Dietary R/V
66At0 Type I Diabetic Dietary review
66At1 Type II Diabetic Dietary review
Who’s a “suitably qualified professional”?
The NICE quality standard defines an appropriately
trained healthcare professional as one with specific
expertise and competencies in nutrition. This may
include, but is not limited to, a registered dietician who
delivers nutritional advice on an individual basis or as
part of a structured educational programme. The
Diabetes UK competency framework for dieticians sets
out level one competencies that are the minimum
standard for any staff involved in the healthcare of
people with diabetes. Therefore, if non-dieticians are
employed to deliver dietary advice, they should conform
to the level one competencies described in the Diabetes
UK framework as a minimum. http://tinyurl.com/cn2krhz
Diabetes (cont’)
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DM14 NEW: Newly diagnosed Diabetics to be referred
to a structured education programme within 9/12 of
diagnosis. 11 pts. 40-90%.
New valid codes:
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8Hj0.
8Hj3.
8Hj4.
8Hj5.
Referral
Referral
Referral
Referral
to
to
to
to
Diabetes structured education programme
DAFNE DM Educ programme
DESMOND Educ’ programme
XPERT Educ’ programme.
New Exception code(s):
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9OLM. “Diabetes Structured Educ’ programme declined
8IEa. – Referral to DAFNE diabetes structured educn prog
declined (Ver 26.0)
The 5 NICE Criteria for the
“New Diabetic” Educational Programme:
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Evidence-based and suit the needs of the individual. Specific
aims and learning objectives. Support the learner & family &
carers to develop knowledge and skills to self-manage diabetes.
Structured curriculum, theory-driven, evid’-based and resourceeffective, have supporting materials and be written down.
Delivered by trained educators with understanding of
educational theory appropriate to the age and needs of the
learners & trained and competent to deliver the principles and
content of the programme.
Quality assured & reviewed by trained, competent, independent
assessors who measure it against criteria that ensure
consistency.
Outcomes from the programme should be regularly audited.
Who is allowed to provide the
“New Diabetic” education?
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“Some practices may be able to deliver Structured
Education programmes in-house. These programmes
would need to meet the requirements outlined
above.”
(Blue book, p83)
Two New Erectile Dysfunction Indicators.
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DM15 NEW: Male Diabetics to be asked about any
problems with erections annually. 4 pts 40-90%
Pts need one of these 2 codes adding annually:
 1D1B. C/O Erectile Dysfunction
 1ABJ. Does not complain of Erectile Dysfunction.
Note that many E.D codes ignored (e.g. E2273
“Erectile Dysfunction”)
No maximum age limit on this indicator, so even if
he’s 99 & in a Nursing home…
No specific exception code to except from this
indicator alone. Only global DM Exception code
Further E.D. Indicator:
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DM016 NEW: “Diabetics with Erectile Dysfunction have
an annual record of Advice & assessment of contrib’
factors & Rx options”.
In fact, only those Diabetic men documented as
Complaining of E.D in the relevant QOF year & having
1D1B. “C/O E.D.” added, need “Advice & assessment.”
(so if it’s not actually bothering them, could you add
1ABJ. “Does not complain of E.D” & ignore it!
Read code: 66Av. : “Diabetic assessment of E.D.”
Ver 26.0! 66Au. – Diabetic erectile dysfunction review
6 pts. 40-90%
No specific Exception code to this indicator either.
Retired Diabetic Indicators:
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DM2 (Measure BMI annually) ??
DM10 (Neuropathy testing) ??
DM22 (eGFR or Serum Creatinine) ??
COPD
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COPD5 NEW: Pts MRC Dyspnoea score of ≥ 3 to have O2
saturation coded annually.
Read code 44YA0: “Oxygen saturation at periphery”
44YA1 “Peripheral blood oxygen saturation on room air at rest
(Ver 26.0)
44YA3 “Peripheral blood oxygen saturation supplmentl oxygen
at rest” (Ver 26.0)
Must also insert the result into a numeric field to “score” the
indicator
5 pts 40-90%
NICE clinical guideline CG101 recommends that patients with
oxygen saturations of 92% or lower when breathing air, be
referred for consideration for oxygen therapy.
COPD Cont:
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COPD8 Vaccinate COPD patients against Flu:
57-97% (45-85)
Depression
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DEP1 retired. (Depression Screening questions for
patients with CHD / Diabetes.)
DEP1 (was DEP6) New Depression patients aged 18+
to have “Bio-Psychosocial Assessment” at time of
diagnosis. (Assessment on same day as the diagnosis
recorded.) (instead of “within 28d after diagnosis”).
21 pts 50-90%
Valid Read code: 38G5. “Bio-Psychosocial Assessment”
Valid Exception codes:
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8IET. Bio-psychosocial assessment declined
9NSA. Unsuitable for bio-psychosocial assessment
“Bio-Psychosocial assessment” (BPA):
should assess the following:
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Current symptoms including duration and severity
Hx of depression
Family history of mental illness
Quality of interpersonal relationships with, for example,
partner, children and/or parents
Living conditions
Social support
Employment and/or financial worries
Current or previous alcohol and substance use
Suicidal ideation
Discussion of treatment options
Depression (cont’)
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DEP2 (was DEP7) R/V Newly diagnosed Depr’ Pts,
10 – 35 days after diagnosis.
8 pts 45-80%
R/V “could” (not must!) consist of:
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Symptom R/V
Social support R/V.
Other Rx options if req’.
Progress of external referrals
Enquiry about suicidal ideation
Valid Read codes:
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9H91. Depression medication review
9H92. Depression interim review
The Depression R/V (DEP2) &
some helpful bits from the Blue book:
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Face to face R/V “usual”, but telephone R/V by Dr or
Nurse Practitioner ok if:
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Pt starting Antidepressants or
Depression is mild with no suicidal ideation.
Dr phoning should know patient well
Dr should be confident of their ability to R/V by phone
Pt should have said they want telephone f/u or
Pt has failed to attend a face to face R/V
What if secondary care diagnose
the Depression?
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If CMHT diagnose & do the BPA or if you
“don’t know whether the BPA has been
completed”, it’s permissible to add global
Depression Exception code.
If ongoing care being provided by CMHT,
“patient should be Excepted from DEP2.”
(except you can’t except from that alone! So)…
9hC0. Depression: Pt. unsuitable.
Big practical problem here with DEP2,
(the R/V) (8 points to lose here)
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Lots of patients won’t come back, or not within the
10-35d time window. (That’s General Practice!)
By then, if we’ve added Depression & whether we did
the BPA or not, they’re still in the denominator for
DEP2, but we’ve lost the points & it’s too late to
chase them.
We can’t write to every depressed Pt 3x in a month
reminding them to come to their R/V!
Suggestion 1:
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Don’t code new Depressed Pts as “Depressed” until
they return for R/V. (Code it “Low mood?”) Do BPA.
If they return for R/V, retrospectively change Low
Mood to “Depression”. Ensure BPA code has same
date. Add the Dep R/V code as well. Ensure Episode
code of Dep’ is “New” Now Dep1 AND 2 are scored.
This will enhance points acquisition, as those that
don’t return won’t get coded as Depression & then pull
your DEP2 scores down.
It doesn’t solve problem of when they DO return, but
outwith the 10-35d window.
Suggestion 2:
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Add Depression code with Episode code of “New” on
those you think are depressed when first seeing them.
Add BPA code on same day & add whatever details
you feel you can.
Ensure you’ve got their correct mobile No. on the
clinical system.
Ask them to book a pre-booked appointment with you
in 2 weeks & get the receptionists to do it on way out.
Have a system in place to spot if they don’t come. You
now have 3 weeks to get a GP to do the phone R/V
within the 35 day window.)
Mental Health
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MH2 (was MH10) “Psychotic patients” have a CARE
PLAN documented in the record in L12M. Threshold
changed to 40-90% (was 30-55 !!!). 6 pts.
Note that previously, a “Care plan” documented once
ever after the Psychosis was added sufficed. Now code
needs to be re-added annually (& to 90% of Pts.)
MH (cont):
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Valid Read codes for MH2 (Care Plan done):
8CY.. Mental Health Care Programme Approach
 8CG6. Care Programme Approach review
====== Ver 26.0! =====================
 8CS7. Agreeing on mental health care plan
 8CG62 Discharge Care Programme Approach review
 8CG60 Initial Care Programme Approach review
 8CG61 On-going Care Programme Approach review
 8CMG1 Review of mental health care plan
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Note: Old Read codes for MH Care plan now NON-Valid!
 8CM2. Psychiatry care plan NOT VALID.
 8CR7. Mental health personal health plan NOT VALID.
Cancer
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CAN2 (was CANCER3) Patients with a Cancer added in
the last 15 months to have a Cancer R/V added within
3/12 of date of diagnosis.
R/V should cover both “individual health and support
needs“ & “coordination of care between sectors”
6 pts. 50-90%
Ca R/V should be face to face but CAN be done by
telephone.
CKD
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CKD2 RETIRED: (“Check BP of CKD patients
every 15/12”)
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CKD2 (was CKD3) Last BP documented as
≤ 140/85 mm Hg in L12M.
11 pts 41-81% (45-70)
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CKD4 additional Exception code:
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9RX.. – Declines to give urine specimen
Epilepsy
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EPIL6 RETIRED: (“Document the patient’s
Seizure frequency every 15/12”)
CVD-PP:
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CVD-PP1: Significant change:
Do a CVD Risk score on each new Hypertensive aged
30-75.
Then, for each whose Risk score is ≥ 20%, either
issue a Statin or Exception code.
10 pts, 40-90% (of those risk assessed!)
Several CVD Risk scores allowed (JBS CVD, QRisk2
etc)
What are the valid Risk scores?
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EITHER: a code showing JBS CVD Risk score of ˃ 20% (one of
the two code options below):
662m. JBS CVD risk of 20-30% in next 10 yrs.
662n. JBS CVD risk of > 30% in next 10 yrs.
OR: one of the 6 codes listed below, with a numeric of ≥ 20%.
38DR. Framingham 1991 CVD 10 year risk score
38DF. QRISK cardiovascular disease 10 year risk score
38DP. QRISK2 cardiovascular disease 10 year risk score
38B10 CVD risk assessment by third party
38G6. JBS CVD risk score
38G8. Dundee CVS risk score.
CVD-PP (cont’)
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Those who don’t have a Risk score added
aren’t considered. (Not in Denominator).
Pts also excluded if they have CHD, DM,
CVA/TIA, CKD, PAD, Fam’ Hypercholesterol’.
Main Osteoporosis change:
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Obligation to Exception code for each of the 4
different families of BSA drugs removed!
Now, any one Persisting code or any one
Expiring code added in L12M before Ref date
“counts” to exempt patients
Rheumatoid Arthritis
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New Disease area to QOF.
Consists of 4 separate Indicators:
RA1 Establish a Register of those patients aged
16+ with any Rheumatoid Arthritis. (1 point)
Examples of valid R.A codes:
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N040% (Rheumatoid Arthritis & sub-types,
including N040P : “ Sero-Negative R.A.” )
N041. Felty’s syndrome.
N042% Other Rheumatic Arthropathy with visceral or
systemic involvement
N047. “Sero-Positive R.A.”
Nyu11 [X]Other Seropositive Rheumatoid Arthritis
Nyu12 [X]Other Specified Rheumatoid Arthritis
Examples of Non-Valid Read codes for the
R.A. Disease area.
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N043. Juvenile Rheumatoid Arthritis - Still's
disease
N04y1 Sero - negative arthritis
(Basically anything that implies Children’s
disease & anything that doesn’t implicitly or
explicitly describe Rheumatoid disease.)
Rheumatoid Indicator 2
(Annual R/V)
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RA2 Patients should have a face to face R/V
annually.
Valid Read code: 66HB0:
(”Rheumatoid arthritis annual review”)
5 pts. (40-90%)
What should the RA2 Review consist of?
1.
2.
3.
4.
5.

Assess Disease activity (e.g. ESR, CRP).
Discuss DMARDS if relevant.
Any need to refer for surgery?
How much the disease is affecting their life
(e.g. Employment or Education)?
Any cross-referral to other members of the
MDT relevant?
“Visiting team would expect all these areas to
be demonstrably addressed, as a minimum!”
Rheumatoid Indicator 3: (CVD risk score)
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RA3 Patients from age 30-84(!) should have an
annual CVD risk calculation added.
Patients with pre-existing CHD, CVA, TIA or Familial
Hypercholesterolaemia are excluded.
Only valid Read code: 38DP.
(This is the “QRISK2 CVD 10 year risk score”)
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7 pts (40-90)
Valid Exception codes:
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8IEV. QRISK2 cardiovascular disease risk assessment
declined
9NSB. Unsuitable for QRISK2 CVD risk assessment.
(If latest QRISK2 used , goes up to age 84)
Rheumatoid Indicator 4
(Fracture Risk score)
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RA4 Patients aged 50-90 should have an Fracture risk
calculation added every 2 years. 5 pts (40-90%.)
Valid Codes:
 38GR. QFracture risk calculator)
 38DB. W.H.O. FRAX 10 year hip fracture
probability score
 38DC. W.H.O. FRAX 10 year osteoporotic fracture
probability score
http://www.shef.ac.uk/FRAX/tool.aspx?country=1
Additional Fracture Risk codes
(Ver 26.0)
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38DB0 – WHO FRAX 10 year hip fracture
probability score with BMD
38DB1 – WHO FRAX 10 year hip fracture
probability score with BMI
38DC0 – WHO FRAX 10 yr osteoporotic fracture
probablty scor with BMD
38DC1 – WHO FRAX 10 yr osteoporotic fracture
probablty scor with BMI
Summary of RA4:
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Add Fracture risk code to all RA Pts from age
50-90 every 2 yrs, unless:
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Osteop’ added 2 yrs ago or more OR
DEXA scan proving OP added 2 yrs ago or more OR
Valid BSA code added between 30/12 before Ref
date & 24/12 before Ref date.
BP (New Ruleset)
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Simply requires that we check BP of all patients
aged ≥ 40 every 5 years. 15 pts, 50-90%
Replaces Records 11 & 17. (These required
check of BP on Pts aged ≥ 45 every 5 yrs in 65
& 80% of Pts respectively.
SO, significant extra workload: lower age
threshold (now 40), higher max coverage
threshold requirement, same points available.
A few Q.O.F. “Tricks”
Lithium & “Therapeutic range”
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MH10 : Lithium documented in therapeutic
range (0.4-1.0 mmol/L) from Dec each QOF
year). Read code 44W8.
Some patients very happy & stable but levels
are < 0.4 mmol/L
Dilemma!
Solution: 44W80 “Lithium level therapeutic”
(Any value attached to this code satisfies QOF)
“Depression Resolved” code:
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212S. “Depression Resolved”
If added after latest Depression code, removes
the patient from entire Depression register.
(incl’ Dep1 & Dep2 therefore)
Useful if BPA was not done.
Also poss’ useful if Dep R/V was not done in
correct Time window.
Exception codes: Use them whenever
they’re clinically justified:
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It never harms the practice financially to add
an Exception code if justified, because of the
way the Rules are written.
There are 2 types: Persisting & Expiring.
Use the former if you can!
E.g.
Statin not tolerated: 8I76 (Expiring)… or…
Adverse reaction to Statin U60CA (Persisting)
Exception codes (cont’)
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Always add some free text to explain rationale
for using an Exception code:
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Helpful to defend use if inspected.
Can aid re-adding code next year if Expiring code.
E.g. 33720: Unable to perform spirometry +
“(Dementia precludes doing test)” helps you to
re-add next year to exempt from COPD4 (FEV1)
The “Maximum tolerated treatment”
Exception codes:
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4 codes available to indicate that the patient can’t
tolerate more aggressive Rx in particular diseases:
8BL0 : Maximum tolerated Rx for Hypertension:
(Hyp, CHD, STIA, DM, CKD, PAD)
8BL1: Maximum tolerated Lipid lowering Rx.
(CHD, STIA, DM, PAD)
8BL2: Maximum tolerated Rx for Diabetes:
(DM indicators 7,8,9 – HbA1c)
8BL3: Maximum tolerated Rx for Epilepsy: (Epilepsy)
Still should measure BP, T.C, HbA1c.
Don’t forget to add some free text to say WHY!
These are “Expiring” codes. Re-add annually if valid.
What’s on the QOF Resource disc?
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Spread sheet docs:
Spread sheet summary of
every indicator
Spread sheet list of every
Exception code
Full set of the Rulesets for
each disease.
GMS official blurb
documents.
List of other useful QOF
Resources
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Word documents on:
Cancer
CVD-PP
Depression.
Episode codes
Heart Failure
Lithium
Osteoporosis
Rheumatoid Arthritis
Smoking & the QOF
Urine tests & the QOF
Various others
Many thanks for your attention.
Questions?
Web Address to get details of the contents of QOF
Resource Disc & how to buy one:
www.tinyurl.com/qofdisc
Dr Simon Clay
Poplars Surgery, Erdington.
If you want to be on the Email list to be informed of
next year’s disc, Email me on:
[email protected]