LTC Reviews



Sending Invitations

Booking Appointments

Sending Reminders

Pre-assessment Questionnaires

Initial Review & Tests

Follow-Up Review

Interim Reviews

Exception Reporting

LTC Reporting

LTC Review - FAQ

This page will takes you through the steps you might wish to consider setting up before you start using the LTC process. The first thing you may wish to decide is whether you choose to invite patients at your practice that just have QOF conditions, or have both QOF and Best Practice conditions. 

The Conditions that are covered in each of these reports are detailed below:



HTN + Pulse:    HTN, AF
Cardiovascular:CHD, CHF, PAD, CVA/TIA
Diabetes:DM1, DM2, Pre-Diabetes, Gestational Diabetes
Renal:CKD 1-5
Mental Health:SMI
Respiratory:Asthma (if bronchodilator issued in last year), COPD
Other:Rheumatoid Arthritis, Epilepsy (if antiepileptics issued in last year)


Cardiovascular:CVD-Primary Prevention High Risk, Familial Hypercholesterolaemia
Endocrine:Hypothyroidism, hyperthyroidism, primary hyperparathyroidism 
Gastrointestinal:Coeliac Disease, Severe Frailty, Post-Bariatric Surgery
Haematology:Monoclonal Gamopathy of Unknown Significance (MGUS
Liver:Non-alcoholic fatty liver disease (NAFLD + NASH)
Gout + on ULT

Please note:  At the end of May 2024, we will be updating our LTC and Best Practice reports to include patents that also have PCOS and Bronchiectasis.  The Initial Review and Follow Up tabs on the LTC template have already been updated with these changes.

If you choose the QOF and Best Practice invitation reports, all of the above conditions are included in the invitation reports.  QOF Only will just cover the QOF Conditions.

We have selected 4 steps that you might wish to consider to set up either QOF and Best Practice or QOF only Reviews.

Step 1 talks you through how to remove all the Patient Status Alerts so that they don't appear on the LTC Booking tab on the LTC Template.

Step 2 goes through creating Slot Types for the different appointment options that you may decide to set up moving forward

Step 3 explains the Free Slot Preset option in SystmOne and how this can be used to help design the appointment searches for your reception and admin team

Step 4 guides you through the different Read Code searches you might wish to run to see if any of the codes used by the Ardens LTC Review process are being used by your Practice already. 

Set Up Step 1 - Removing the LTC Legacy Patient Status Alerts.

As these are no longer used, the Legacy Patient Status Alerts that appear on the LTC Booking screen will need to be disabled to avoid confusion.

Go to Setup > Data Output > Patient Status Alerts > Ardens LTC One Stop Clinic, Ardens LTC Two Stop Clinic, Ardens LTC  Three Stop Clinic  folder and disable all the alerts that appear in the each of those stop folders.  

This can be done by un-ticking the tick that appears in the Enabled column as below:

Setup Step 2: Consider Creating Slot Types

If you wish to create LTC specific Slot Types at your Practice for your LTC Processes, go to Setup > Appointments > Slot Types > New Slot Type. 

These Slot Types can be designed to help receptionists to book appointments for patients AND for patients booking appointments online (if you wish).

If you do create any new Slot Types remember to add them to the applicable Rota Templates.  

Important! If you are not offering online appointments, please copy the invitation letter and then delete the line directing the patients to book their appointment online. Then use this letter when sending invitations out.

Then go to Setup > Users & Policy > Organisation Preferences > Online Services. Select Appointment Booking & ensure appropriate boxes are ticked & slot types added.

Setup Step 3:  Consider creating Free Slot Search Pre-sets

These are designed to make it easier for your Reception and Admin staff to find the next available appointments to book. 

Go to Setup > Appointments > Free Slot Search Configuration to create your Practices free slot searches. Click New to create the appropriate free slot by either using the staff filter, Rota Type filter or Slot Type filter.  Minimum durations and search date parameters can be set under the Date & Time section. 

For more information, please see the below video guide.

Setup Step 4: Read Code Checks

Xaagy  – Chronic disease management annual review completed
6617. – Chronic disease initial assessment
XabVB – Declined invitation to attend care planning appointment


The system is reliant on the first read code being added after the annual review to ensure that second or third invites are not sent out. It is then reliant on the second read code being added to remove the patient from the follow-up report. The third read code can be used if a patient declines the invitation and stops further invitations.

To ensure these read codes are not being used for anything else, please run the ‘Xaagy & 6617. & XabVB Check’ report before you send your first batch of invitations.

To find this report, go to Clinical Reporting > Ardens > Invitations | LTC Reviews > Setup > Xaagy & 6617. & XabVB Check. This will find any patients who have had these two read codes recorded in their notes in the last year. Then review these patient’s notes to see who and why the read code was added, so to prevent it being added again in the future. You will only need to do this as a one-off as part of the initial set-up.

Epilepsy + on Antiepileptics + no other QOF Conditions report

The Epilepsy + on Antiepileptics + no other QOF Conditions report can be found under the 03 Prebooking assessment folder:

This report can be used to contact patients that fall under the report in order to decide whether they require an Epilepsy review for this year.  

It is possible to send Questionnaires in bulk to patients on SystmOne through the Communication Annexe functionality.  We have created an Epilepsy review questionnaire asking for details on the patients limitations and seizures along with lifestyle questions.  Please see our LTC Pre-Assessment Questionnaires article  for more information on sending Questionnaires to patients. 

If the patient doesn't require an Epilepsy review, the 'Chronic Disease default from follow-up' code - (6619.) can be added to the patients record, which will stop any invitations being sent to the patient.

Dementia and Learning Disability Invitation Reports

Please Note - If you wish to use our reports for Dementia and LD patients, please follow the invitation steps on the Dementia and LD patient lists first, followed by the main invite reports for all other LTC patients.

It is possible to send separate invites for patients that have dementia and no LD or LD all patients based on month of birth by using the reports under 04 Booking | 1st Invite Dementia and LD | 2024 25 Folder as below:

The reports are split between all patients born in the selected month that has Dementia and Not LD and a 2nd report looking for patients that have LD.  Please note that these reports will not include any patients that are housebound, Care Home or EOL.  The report also states in brackets that you add in the LTC Invite code (XabEf) and consider adding the QOF Invite code (Y1f8f) code.  

If the first LTC Invite code (XabEf) is added, the patient will follow that same 2nd and 3rd invitation process as other conditions, but each of these reports are separated in the 2nd and 3rd invitation folder so separate communications can be sent.

Please Note: Patients under the age of 16 are not included in any of the QOF only and QOF and Best Practice reports.  However, these can be found in the 04 Booking | Age under 16 reports if required.  For more detail please refer to our LTC Reporting Page.

NEXT: Sending Invitations