Last review date 03/02/2023
LTC Reviews
Exception Reporting
(Please also see 'Understanding QOF Exceptions' )
There are various situations where a patient can be exempt from QOF, these are now called personalised care adjustments.
- The investigative service or secondary care service is unavailable (where relevant to the indicator)
- This care adjustment will apply only to the following indicators:
HF002, AST002, COPD002, COPD008 and DM014
- This care adjustment will apply only to the following indicators:
- Intervention described in the indicator is clinically unsuitable
- The patient has chosen not to receive the intervention described in the indicator
- There is a requirement for a personal contact or a discussion recorded in the patient record which ideally notes the reasons for the intervention being declined. This contact may be face-to-face, video conferencing or telephone contact between a health professional and the patient
- The patient has not responded to invitations for the intervention described in the indicator (a minimum of two invitations for the intervention in the preceding 12 months, except for the cervical screening indicators where women should receive a total of three invitations for screening)
- Patients should be sent a minimum of two invitations for QOF care on two unique occasions in the QOF year i.e. 1 April to 31 March a minimum of seven days apart. The exceptions to this are indicators CS005 and CS006 where the patient should be sent a minimum of three invitations at three unique occasions
CAUTION: When using the Ardens LTC reports there is a code in the 4 OQF Invite section on our reports that allow you to code each of the individual QOF Invites. Please see our Sending LTC Invitations Support Article for more details.
- Patients should be sent a minimum of two invitations for QOF care on two unique occasions in the QOF year i.e. 1 April to 31 March a minimum of seven days apart. The exceptions to this are indicators CS005 and CS006 where the patient should be sent a minimum of three invitations at three unique occasions
- The patient has registered with the practice or has been newly diagnosed with the condition of interest in the preceding 3 months and has not received the defined clinical measurements e.g. blood pressure measurement
- Where a patient newly registers with a practice or is newly diagnosed with a clinical condition in the last three months of the QOF year (1 January – 31 March) this criterion applies automatically, unless the practice has recorded the defined clinical measurements within the timeframe for the indicator. Any achievement automatically over-rides any Personalised Care Adjustments
- The patient has registered with the practice or has been newly diagnosed with the condition of interest in the preceding 9 months and has not achieved the defined clinical standards e.g. blood pressure control within target levels
- Where a patient newly registers with a practice or is newly diagnosed with a clinical condition in the last nine months of the QOF year (1 July – 31 March) this criterion applies automatically, unless the practice has achieved the defined clinical standards within the timeframe for the indicator. Any achievement automatically over-rides any Personalised Care Adjustments
It is advised that a comment is always recorded to justify the reason for any exemptions.
More information relating to this and the GMS contract can be found here.
Please Note: If you are exception reporting a patient, remember to also add the 'declined invitation to attend care planning appointment XabVB read code to prevent them being sent further LTC invitations. This read code is in the red box on the 'Invitations' and 'Booking' tab on the LTC template.
QOF Alert Action
When you open the patient's record, just click on the QOF Alert Action on the home screen to add the appropriate exemption codes. Please make sure you have set up the QOF Alert Actions so they open the appropriate Ardens QOF template.
On the patient home screen you should see any outstanding QOF alerts, like this example below.
Alternatively, in the bottom right of the main LTC templates click on the QOF symbol
to open this template.
Clicking on the action link should open the relevant QOF template and you can select the relevant individual indicator exceptions or the bottom option is a high level register exception code. You will see the same exception coding setup for all other QOF disease register templates.
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