The following support article offers further support on the use of the Service Requirements searches within the 5.32 Contract - Network DES (23-24) search folder (for general information on the use of Network Contract DES searches, please see the following support article). 


To access the service requirement searches, navigate to Population Reporting > Ardens Searches > 5.32 Contracts - Network DES (23-24) > b. Service Requirements (no specific targets) search folder:



Each service requirement is broken down by sub folder and depending on the searches we can provide, will vary by work done (achievement), work to do (outstanding work) and data quality (incorrect / missing requirement). 


Access

Due to the data extraction for this particular service requirement, we are unable to provide a full suite of searches. We are, however, continuing to look at ways we maybe able to support further PCNs /  practices in the future and will keep practices updated.


This folder contains work done searches and will highlights the following:

  • Access I Community Pharmacists Consultation Service - Referrals - shows number of patients (all) coded with a 'Referral to CPCS (Community Pharmacist Consultation Service) ' referral in the last 12 months.
  • Access I Community Pharmacists Consultation Service - Referrals declined - shows number of patients (all) coded with 'Referral to CPCS (Community Pharmacist Consultation Service) declined' in the last 12 months.
  • Access I Online consultation in last calendar month - shows number of patients with an online consultation encounter in the last month. Please note - this search may not be 100% accurate due to how the data is being extracted from outside the clinical system. 


Cancer

The 1. Work done folder will highlight the following:

  • The number of fast track (2WW) cancer referrals recorded in the last 12 months. This search is further broken down by those referrals that have been marked with 'Cancer safety netting' between 0-3 days of the referral being recorded.
  • The number of lower GI fast track (2WW) referral recorded in the last 12 months.  This search is further broken down by those referrals that have a FIT result within 21 days before or 14 days after the referral.

The 2. Work to do folder will identify:

  • Patients with a lower GI 2WW referral in the last 14 days, but they do not have a FIT test result recorded within 21 days before or 14 days after the referral. Practices should check if this is an incorrect coding issue or missing coding requirements.  
  • Patients with a 2WW referral in the last 2 weeks but there has been no cancer safety netting recorded. Practices are to decide if the cancer safety code should be added and are able to access the Ardens Fast Track Safety Netting template to add the code.



The 3. Data Quality folder will identify patients with a cancer safety netting code but this has been recorded before the 2WW referral. Practices must decide if the cancer safety netting code should be added on the day of the referral.


Care Homes

The 1. Work Done folder will indicate the number of patients aged 18 years and over coded as living in a care home. A further breakdown is available to identify care home patients with dementia or acute confusion, and specific care home activity completed (i.e. personalised care plan, ward round).


The 2. Work to Do folder will highlight care home patients that require the following activity as this has not been recorded in the last 12 months:

  • delirium assessment as the patient has been recorded with acute confusion
  • falls risk assessment 
  • personalised care and support plan 
  • psychosocial assessment 
  • ward round 
  • preferred place of death 


Practices may wish to use the Ardens Care Homes Template to aid recording this activity.


The 3. Data Quality folder will identify patients with a care home code that is not recognised by Network Contract DES, practices should access the patient record and update accordingly (the Ardens Care Home Template will include the correct codes to use). It will also identify care home patients with a temporary care home code recorded more than 12 months ago and there is no recent care home code since, practices should access the patient record and update accordingly. Please note - patients with a temporary care home code recorded more than 12 months will not be picked up in work done.


CVD

The 1. Work Done folder will highlight required work complete around AF, CVD and Hypertension.


The 2. Work to Do folder will identify outstanding work and is broken down as follows:

  • AF Screening I ?For ECG referral/done as irregular pulse in L12M +age.... - practices are to consider an ECG for these patients as they have had a irregular pulse recorded in the last 12 months. A ECG referral must be present in the last 12 months for the patient to be included in the work done folder. 
  • CVD-PP I **For QRISK2/3 and age 50-74y - these patients require a QRISK score recorded in their record.
  • CVD-PP I ?For QRisk2/3 and age 75-84y - as none in the last 5y... - consider adding a QRISK score for these patients as this has not been recorded in the last 5 years and the patient is not receiving Lipid-lowering therapy or has a recorded CVD condition. 
  • CVD-PP I ?Start LLT as latest QRisk2/3 10-20% +age 25-84y - consider starting the patients on Lipid-lowering therapy if appropriate.
  • CVD-PP I ?Start LLT as latest QRisk2/3 >= 20 % + age 25-84y - consider starting the patients on Lipid-lowering therapy if appropriate.
  • CVD -PP I Review LLT as previous expiring exception > 12m ago (dec/ci) - review the patients Lipid-lowering therapy as the contraindication / decline code previously added has now expired. Practices to decide if it's appropriate to reapply the codes.
  • CVD-SP I ?Review as non-HDL chol >2.5 or LDL chol >1.8 in L12m...- consider reviewing the CHD/PAD/STIA patients as their latest cholesterol is high.
  • FH Screening I Age <29y + Tot chol >7.5 or >30y = Tot chol >9 - consider a familial hypercholesterolaemia assessment, referral or diagnosis for the following patients. 
  • HTN Screening I Last BP >= 140/90 in 1/4/20-31/3/24 - the patients latest BP reading is high and a normal BP has not been recorded since. Consider confirming or excluding a Hypertension diagnosis. 


Inequalities 

The 1. Work Done folder will report on required work activity complete for ethnicity, Autism and SMI patients. 


The 2. Work to Do folder will identify outstanding work and is broken down as follows:

  • Inequalities I ?Confirm/excl HTN as BP >= 140/90 1/4/20-31/3/24 + eth - consider confirming or excluding a Hypertension diagnosis as the patient's latest BP is high and they are an ethnic minority.
  • Inequalities I ?For BP as not done in L5Y + age >=45 + ethnic minority - consider a BP reading as this has not been done in the last 5 years and the patient is an ethnic minority.
  • Inequalities I  ?Record ethnicity - an ethnicity code is required for these patients. 
  • Inequalities I  COVID - ?For 2nd vaccine dose as age >=16y - consider a second COVID vaccine dose for patients over 16 years.
  • Inequalities I  COVID - ?For 2nd vaccine dose as age >=16y + ethnic mi... - consider a second COVID vaccine dose for these patients as over 16 years and they are an ethnic minority. 
  • Inequalities I  SF - ?For vaccine as age 18-64y + risk + ethnic minority - consider a flu vaccine for these patients as they are at risk and are an ethnic minority. 
  • Inequalities I  SMI - ?For all core PHC items as not done in L12M - all core SMI requirements have not been completed for these patients in the last 12 months.
  • Inequalities I  SMI - ?For all core PHC items as not done in L12M+ eth.... - all core SMI requirements have not been completed for these patients in the last 12 months and they are an ethnic minority.


Medication 

The 1. Work Done folder will report on required work activity complete for drug monitoring and reviews.


The 2. Work to Do folder will highlight the following:

  • Drug alerts - consider starting gastroprotection / stopping NSAID / stopping beta-blockers for patients that fall under the required searches.
  • Drug monitoring - complete recommended investigations.
  • Drug review - consider a structured medication review.


Personalised Care

The 1. Work Done folder will highlight patients on the Asthma register with more than 3 ICS and more than 6 SABA inhalers issues in the last 12 months. This is for information only and practices must decide how these patients are managed.


Vaccinations

The 1. Work Done folder will highlight patients that have been given a flu vaccine.


The 2. Work to Do folder will identify particular cohorts that have not had a flu vaccine. Please note - that PCNs / Practices are working towards achievement within IIF for patients aged 18-64 years + at risk and patients aged 2-3 years.


If you require any further assistance on the process above, please contact Ardens support on: support-emis@ardens.org.uk