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Performance Matters - Clinical Coding of Chronic Disease Reviews for QOF

Recent CQC visits to practices, and post-payment visits (PPVs) by CCG and NHSE have highlighted that there are wide differences from practice to practice in how chronic disease reviews are coded for QOF. It is important that practices carry out comprehensive chronic disease reviews for patients, and that these are recorded appropriately in the medical records. The specific requirements for what a chronic disease review should include can be found on the NHSE website.

Many of these reviews are more detailed than many clinicians expect. For instance the dementia review on page 60 of the NHSE guidance states

In particular the review should address the following key issues:

  • an appropriate physical, mental health and social review for the patient,
  • a record of the patients’ wishes for the future,
  • communication and co-ordination arrangements with secondary care (if applicable),
  • identification of the patients’ carer(s); and
  1. obtain appropriate permissions to authorise the practice to speak directly to the nominated carer(s) and provide details of support services available to the patient and their family, if applicable, the carer’s needs for information commensurate with the stage of the illness and his or her and the patient’s health and social care needs,
  2. as appropriate, the carer should be included in the care plan or advanced care plan discussions,
  3. if applicable, the impact of caring on the care-giver,
  4. offer the carer a health check to address any physical and mental health impacts, including signposting to any other relevant services to support their health and wellbeing.

CQC, CCG, and NHSE are likely to inspect medical records to ensure that there is evidence that all aspects of the chronic disease review have been covered when the code has been added that a review has been done.

This also applies to medication reviews, such that there needs to be evidence in the records that a review by an appropriately trained person has been completed. Practices should have a Medication Review Policy which outlines the process for completing a medication review. This can allow for different clinicians to complete the reviews, depending upon the complexity of the medication regime, and the training and skills of the clinician. The LMC can share examples of medication review policies if you do not already have one.

Using templates can aid the recording of appropriate reviews. There are a number of templates available in SystmOne and EMIS for this purpose.

If it is identified that a review has been carried out, but that the appropriate code has not been entered, it is legitimate for the code to be added later. If this is done however, it is best practice to annotate the back dated entry to explain why this has been entered at a later date.