Top Tips 2024


Ardens CQC Searches
The LMC wanted to make practices aware of a suite of searches that the CQC use when they are planning to review a practice. These can be located within the Ardens searches on EMIS. They are called “CQC Inspection Searches”. They include Safety Alerts, DMARDS, Medication Review, Medicines Monitoring, Missed Diagnosis. This will help practices to review their current position clinically and areas to work on and these can used as part of the audit process within practice.

Frailty Core Contract
The LMC have been made aware from the ICB that the prevalence of Frailty is low in Somerset. Nationally the prevalence is a 8% and in some practices in Somerset it is 1%. Frailty has been part of the GP Core Contract since 2017, the requirements have changed and the LMC have put together a helpful document for practices to use to ensure the correct SNOMED codes and requirements are met.

Top Tips 2022/23


Shingles Vaccine Technical Guidance
Please find the link to the Shingles vaccine technical guidance here. This guidance outlines the technical requirements for the programme and provides information on eligible cohort, clinical codes required to record shingles vaccination events and how payments will be supported through General Practice Extraction Service.


Friends and Family Data
Please remember to submit your Friends and Family Test data onto CQRS by the 12th of each month. Here is a link to the guidance for practices.


CQRS Reminder

CQRS currently has a reminder for practices to complete the four manual Yes/No indicators for the QI indictors, QIPDD009, 10, 11 and 12.  Guidance on the end of year process can be found at Quality Outcomes Framework (QOF) - CSU Collaborative & CQRS. Please complete by 31.3.23. 

11.11.22 - updated 16.3.23

If your practice ImmForm data is not uploaded you will need to enter it manually, there are a suite of searches within Ardens. Ardens - 3.15 – Vaccinations- Flu 2022-23 (Ardens V24.1), 8. Seasonal Flu ImmForm upload and there are four searches there to input the data.

Enhanced Access - Appointment Mapping for GPAD –Instructions to help support you with mapping your Extended Access appointments to ensure they are captured on the (GP Appointment Data) GPAD dashboard.

Frailty  -  updated June 2022

This document will link you to the frailty requirements. 


Population Manager QOF v46 (Release 1.3)


If a previously eligible patient for a shingles vaccine who has now turned 80, but they had declined the vaccination please ensure you record a decline code or record two invitations before their birthday.


Vaccinations & Immunisations – QOF
There are a number of Allergy, Contraindication and Adverse reaction codes that can be used to exclude patients for the denominators for VI001 – 003, see here.

Top Tips 2021


COVID-19 Immunosuppressed patients
NHS Digital has put together a very helpful GP COVID-19 vaccine dashboard which visualises vaccine uptake across patient groups and provides patient contact information to arrange a 1st dose or get a pending or overdue 2nd dose booked in.  The access the dashboard you will need smartcard activity code is B0360 once you have this; scroll down the page to the Access to the dashboard (step 2) on this link .   

On the 4 October it was updated to include 3rd Primary Dose patient lists for each practice.  This report has been produced to provide GP practices with a list of their immunocompromised patients, from 12 upwards, who are eligible for a 3rd primary dose as advised in the following JCVI guidance.  Please click the link to the GP COVID-19 vaccine dashboard, there are user guides to support practices. 

Please go to section 7.  “3rd Primary Dose – Patient List” – this is the section where you can download your patient list for immunosuppressed. 

CQRS Local
CQRS Local replaces the need to return the Enhanced Service return claim form each quarter. Once you have registered you will be able to see the Enhanced services you have signed up to. The LMC has put a page together to support the CQRS Local implementation.

SNOMED code extraction issue on CQRS
In Somerset the majority of the 6in1 and MenACWY for teenagers are given by the school nurses. A list of patients is sent to the practice to record onto the patient record, these should be coded with “given by other healthcare provider” the SNOMED codes are;

The automated extraction will only exclude the above codes if they are added to the patient record. All other SNOMED codes will be pulled through on the extraction and any free text will not be included so you will need to send in an amendment form to remove any patients who have been vaccinated outside the surgery.


Covid-19 Booster codes – Booster codes have been released by NHS Digital in the MKB178 release on EMIS. The description for the SNOMED code is Immunisation course to maintain protection against SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2).

Coming soon in the MKB179 release will be the SNOMED codes for Immunosuppressed patients to record the new third, fourth and fifth dose codes.

Covid vaccine name changes – a number of vaccines have undergone name changes on NHS directory (dm+d) database in the attached document you will see a list provided by EMIS Now with the previous term and the new term to help you.

For more information please click here.

Seasonal Flu SNOMED codes for CQRS and DES – Please find a list of SNOMED codes for the DES and CQRS this year. 


Flu and Immform: We brought to your attention that there have been some big issues regarding practices and the automated data extraction from EMIS to Immform.  We have now found that EMIS have created a suite of searches for the Uptake reports, so you are able to manually upload your data.  Please follow this path to find the searches in the EMIS Library.
EMIS Library - SNOMED searches – Cytology I Immunisations – Seasonal Vaccinations – Influenza Vaccinations UPTAKE 2020/21 – Seasonal Influenza UPTAKE Reports 2020/21, you will see all the data you need to input your manual entry into Immform.  Remember – Run the searches on the relative run date for the month you are entering e.g. February run date will be 28.2.21. 

Learning Disabilities Data (LDD) on CQRS: Please be aware that Learning Disabilities Health Checks 21/22 on CQRS are now collected monthly and no longer requires  a manually entry of your register.  Declarations for April are currently awaiting declaration on CQRS.   

Hep B: Please be aware that Hepatitis B 21/22 is now an automated service on CQRS. 


Extension to the shingles immunisation programme (England): Individuals become eligible for routine vaccination against shingles when they reach age 70, and all those aged up to and including 79, are now eligible to receive the vaccine until they reach age 80.  
Individuals who are eligible for the shingles vaccination programme who turned 80 years during the pandemic and missed the opportunity to be vaccinated can now be vaccinated until 31 July. There are no contractual changes to this programme, the offer of vaccination is opportunistic or if requested for the catch-up cohort. GPs will continue to be reimbursed via the standard item of service fee, which should be claimed manually. NOTE: The automated extraction on CQRS may not pick these patients up so you will need to send an amendment form for processing.  This cohort will not be included in the Shingles PGD so practices should use a Patient Specific Direction (PSD) for this group of patients. 


Flu and Immform: It has been brought to our attention there have been some big issues regarding practices and the automated data extraction from EMIS to Immform.  We have completed some lengthy investigations and we have some tips to have smooth the process. 

Top Tips 2020


Population Stratification: A number of practices have contacted us regarding the Population Stratification and how to do this. Ardens have produced a suite of searches to help assist with BAME, poorly controlled Long Term Conditions, and missing patient reviews. The email that was sent to practice managers on 23 November from Craig Sutton at the CCG. This email included some searches and guides which will also assist with the identifying patients you need to review. The patients who are included in the deprivation neighbourhood can be identified by running a search in EMIS to identify your total population.Then import into an Excel spreadsheet and by using the V-look up facility on Excel you can compare the Somerset postcodes in deprivation areas with your total population list . The two commissioned services for weight management are included in the guide and all referrals you make will be processed through your normal procedure.

Seasonal Influenza Business Ruleset: We have received a number of queries regarding which snomed codes to use for the seasonal flu season this year, the link below will take you to the business ruleset once you click on it will allow you to download a copy to save.
This can be located on the NHS Digital Enhanced Services website please see here.


Flu and Immform: It has been brought to our attention there have been some big issues regarding practices and the automated data extraction from EMIS to Immform. We have completed some lengthy investigations and we have some tips to have smooth the process.



Shingles: Recommendation from PHE in Phase two letter was to opportunistically offer to anyone who has turned 80 Since the 1 February a vaccination if not already been vaccinated. These patients can still benefit from the vaccination. This can be offered until 31 December 2020. NOTE: The automated extraction on CQRS may not pick these patients up so you will need to send an amendment form for processing.


QOF Influenza Invitation Snomed codes for the flu season this year:


HF006 – The percentage of patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction, who are currently treated with a beta-blocker licensed for heart failure.
Contractors are advised that patients already prescribed an unlicensed beta-blocker prior to diagnosis of HF due to LVSD do not have their drug therapy changed to meet the criteria of this indicator. Those patients already prescribed an unlicensed beta-blocker will be excluded from the indicator denominator. Please refer to this page.

DM006 - The percentage of patients with diabetes, on the register, with a diagnosis of nephropathy (clinical proteinuria) or micro-albuminuria who are currently treated with an ACE-I (or ARBs)
Target 97% This indicator is part of the eight prescribing Indicators this year please refer to page 9 of the above guidance.


Influenza - Practices must include within at least one written communication (including letters and SMS text messages) offering vaccination to eligible patients, a request that the patient advises the practice of their ethnicity status if they have not previously provided this information to the practice and where provided by the patient or their carer, the practice must record the ethnicity information in the patient record. See page 15 paragraph b in the guidance here



Things to consider:

Age Group – Patients aged 25 – 49 are eligible for screening every 42 months

Age Group – Patients aged 50 – 64 are eligible for screening every 66 months

Information from Phase Two letter dated 9 July 2020 - Asked to maintain accurate disease registers, prescribing indicators and the delivery of cervical screening indicators, where we expect the rate of delivery to be as close as possible to normal performance. We acknowledge that practices will have to make extra efforts to encourage patients to attend.


QOF Indicators 2020/21 - Diabetes 22 & 23

Diabetes – DM 22: The percentage of patients with diabetes aged 40 years and over, with no history of cardiovascular disease and without moderate or severe frailty, who are currently treated with a statin (excluding patients with type 2 diabetes and a CVD risk score of less than 10% record in the last three years).
Practices will need to QRISK all the patients in the denominator of DM22 and 23. You can do this via batch data manager so you don’t need to do this each on each individual patient. If you are unsure of how to do this please contact us via the LMC. You will need to wait for this to run overnight and update in Population Manager.
Then go into DM22 and review all the excluded patients with no history of CVD and without moderate or severe frailty who would be suitable for a statin. If the patient is not suitable or contraindicated you will need to add e of these codes to the record, Statin contraindicated 315363002 or Statin not indicated 134391005 or Statin declined 134396000.

DM23: The percentage of patients with diabetes and a history of cardiovascular disease (excluding haemorrhagic stroke) who are currently treated with a statin NICE 2018 menu ID: NM163.
Then go into DM23 and review all the excluded patients with a history of CVD and a score of 10% or more who would be suitable for a statin. If the patient is not suitable or contraindicated you will need to add e of these codes to the record, Statin contraindicated 315363002 or Statin not indicated 134391005 or Statin declined 134396000.



This document will link you to the frailty requirements.  Updated August 2021

QOF Indicators for 2020/21

CHD (CHD005): The percentage of patients with Coronary Heart Disease with a record in the preceding 12 months that Aspirin, an alternative antiplatelet, or an anticoagulant is being taken NICE 2015 menu ID:NM88. Target 96%.

Practices will need to review those patients who are excluded from the indicator, you will need to review medication to ensure they are either on Aspirin or antiplatelet or anticoagulation these need to be reviewed by GP and then if patient has declined then all 3 codes need to be added Aspirin declined 985721000000109 and anticoagulation declined 413559006 and clopidogrel declined 407583007. If the patient is unsuitable for medication please use Except form CHD QoF patient unsuitable 717111000000104

Shingles: Recommendation from PHE in Phase two letter was to opportunistically offer to anyone who has turned 80 Since the 1 February a vaccination if not already been vaccinated. These patients can still benefit from the vaccination. This can be offered until 31 December 2020. NOTE: The automated extraction on CQRS may not pick these patients up so you will need to send an amendment form for processing.


QOF - Prescribing Indicators for 2020/21

There are eight indicators which support optimising pharmacological management of patients with specific conditions and the prescribing of specified medications. These indicators will remain conditional upon performance.

Atrial Fibrillation (AF007): In those patients with atrial fibrillation with a record of a CHA2DS2-VASc score of 2 or more, the percentage of patients who are currently treated with anti-coagulation drug therapy NICE 2014 menu ID: NM82. Practices will need to score the patients in the AF006 denominator populations folder on EMIS as this populates any patients with a score of 2 into AF007.

You will then need to wait overnight for EMIS to run Population Manager and then review the excluded patients in AF007as these will need to be reviewed for drug therapy. These patients will need to be reviewed by GP and then either anticoagulation contraindicated 413558003 or anticoagulation not indicated 413560001 anticoagulation not tolerated 413561002 or anticoagulation declined 413559006.


New QOF Indicators – Asthma: WEB are still working with NHS Digital on the SNOMED coding for the new QOF indicators, currently EMIS is working on version 44. However for those using the Ardens Templates , these are being updated with the new business rule set codes. Asthma register is now from age 6 NOT 8 years old.
Practices will be expected to use a minimum of two diagnostic tests to confirm an asthma diagnosis. These tests should be performed up to 3 months before any date of diagnosis and up to 6 months after this date. The business ruleset 45 which is available on NHS digital and is still subject to testing states the diagnostic tests are spirometry testing for asthma, FeNO test performed or Peak expiratory flow rate.
Asthma Review has been amended to incorporate aspects of care positively associated with better patient outcomes and self-management. They will be looking for the latest Asthma Control Questionnaires, number of exacerbations in the last 12 months and Asthma management plans in the last 12 months.
Practice will be required to record smoking exposure in children and young people under the age of 19 years old. Most recent record of exposure to second hand smoke up to 31 March it is expected you could use “Passive smoker”.
Practices could be working on these indicators now by making contact with the patients via telephone or video consultations, questionnaires can be sent prior to the consultation.

MMR – All Ages now need to be claimed through CQRS: Following the publication of the Interim report of the Vaccination and Immunisation Review in October 2019 NHSE/I has agreed changes to the payment of MMR vaccines from 1 April 2020. In summary in 2020 they require an automated payment service for the following patient groups receiving MMR vaccination: Children 0-5 years Children 6-15 years Adults 16 years and over. A management count is also required to monitor adherence with a targeted catch-up campaign in those aged 10/11 years.
Participation in an MMR catch-up programme for patients aged 10 and 11 years will form part of the core requirements of vaccination and immunisation services from 1 April 2020. Practices will be required to audit the records of this cohort and when a patient is identified as unvaccinated or partially vaccinated, they are required to contact the patient on three separate occasions to try to get the patient to be vaccinated.


Residential Institute Codes (RI): A new process for RI codes was introduced last year, it has been simplified and there are only two codes which can be found here. Please note you do not need to recode your existing patients.
Here's link to the  PCSE patient registration process. They have produced a simple and easy to use Guide to Patient Registrations. This will keep you up to date with the current process.


Pension Forms and PCSE: A lot of practices have reported problems in uploading the forms to the PCSE website as the files are too large, if you follow these simple instructions it will resolve this issue.


MJOG: If anyone who is using MJOG, and they have gone to snomed they must let MJOG know as there is some reconfiguration that is required for the coding to work correctly.