Since the arrival of a new set of rules about childhood immunisations and the shingles vaccination, many practice managers have been left wondering, what is it exactly that we should be doing to make sure we don’t miss anyone?

Many PMs will have a local health team who arrange vaccinations and call everyone in, but now that practice QOF achievement is more dependent on achievement, and with a potential clawback of 50% of the IoS fees for related activity, what do you actually need to be looking for?

There are some core standards that practices must adhere to and we talk about them here

But apart from those core standards, if we want to ensure we’re meeting the targets, what are we looking for to make sure we’ve achieved the maximum vaccination of the cohort?

In the list below, the searches are looking for patients who were registered on the achievement date. Generally, for monthly services, this will be patients who were registered during the month. This includes patients who are currently registered, and those who were registered but have since de-registered after the achievement date.

Reports are looking at a one-month period prior to the achievement date unless otherwise specified.

6-in-1 programme

DTP = Diphtheria, Tetanus, Polio

6IN1001

Monthly count of patients who are at least 6 weeks old but who aren’t yet 10 years old who had a DTaP/IPV/Hib/HepB vaccination administered in the reporting period by the GP practice and where this was their first dose of a DTP-containing vaccine.

6IN1002

Monthly count of patients who are aged at least 9 weeks but not yet 10 years of age who received a DTaP/IPV/Hib/HepB vaccination where this was their second dose of a DTP-containing vaccine. This vaccine should be administered within a one-month period leading up to the end of the reporting period and must have been at least 21 days after their last dose of a DTP-containing vaccine.

6IN1003

Monthly count of patients who are aged at least 13 weeks but not yet 10 years of age who received a DTaP/IPV/Hib/HepB vaccination where this was their third dose of a DTP-containing vaccine. This vaccine should be administered within a one-month period leading up to the end of the reporting period and must have been either at least 28 days after their preceding dose or at least 21 days after their last dose of a DTP-containing vaccine, and at least 28 days after their first dose of a DTP-containing vaccine.

6IN1004

Monthly count of patients who are aged at least 3 years and 4 months old but not yet 10 years of age who received a DTaP/IPV/Hib/HepB vaccination where this was their fourth dose (booster dose) of a DTP-containing vaccine. This vaccine should be administered within a one-month period leading up to the end of the reporting period and at least one year after their third dose of a DTP-containing vaccine.

6IN1005

Monthly count of the number of patients aged 10 and over who received a Td/IPV vaccination administered by the GP practice in the one month up to and including the period end and where this was their first dose of a DTP-containing vaccine.

6IN1006

Monthly count of the number of patients who are aged 10 and over who received a Td/IPV vaccination within the reporting period and this was their second dose of a vaccine containing DTP. The second dose needs to have been administered at least 21 days after the preceding dose.

6IN1007

Monthly count of the number of patients who are aged 10 years and over who had a Td/IPV vaccination administered by the practice and where this was their third dose of a DTP-containing vaccine. Vaccine needs to have been administered within the month leading up to the period end date, and must have been either at least 28 days after their preceding dose or at least 21 days after their last dose of a DTP-containing vaccine, and at least 28 days after their first dose of a DTP-containing vaccine.

6IN008

Monthly count of the number of patients aged 10 or over who received a Td/IPV vaccination within the reporting period and where this was their fourth (or booster dose) of the vaccine.  The vaccination must have been administered within one month of the period end date and must have been at least one year since their last dose of a DTP-containing vaccination.

6IN1009

Monthly count of the number of patients aged 10 and over who received a Td/IPV vaccination and where this was their fifth dose (second booster) of a DTP-containing vaccine. The booster dose must have been administered within a month before the period end and at least five years after the fourth dose of a DTP-containing vaccine.

This is the list of reports that CQRS are looking for. You might want to consider writing reports that include all patients registered in the month you’re looking at and then follow the text to include or exclude patients accordingly. Your clinical system may have the CQRS reports available to view, which may save you time. You might want to consider writing reports to look at patients who do not meet these criteria. You might also want to add alerts to patient notes or vaccination templates to warn you if the criteria are not likely to be met – i.e., booster doses administered at 365 days or less, or second boosters administered at five years or less. You might also want to consider adding alerts for patients where second or third doses are administered before 21 or 28 days accordingly. If doses are not correctly identified, they will not be picked up by the CQRS searches, so you need to ensure that your teams are coding doses appropriately.

MMR programme

MMRC001

Monthly count of the number of patients aged 10 or 11 (at least 10 and less than 12 years) on 1st September in the previous financial year who are identified as not having received a previous dose or completed course of MMR vaccine up to and including the achievement date – i.e., those who did not receive either a first dose or a second dose of an MMR vaccine.

MMRV003

Monthly count of patients who are aged less than 1 who received an MMR vaccine administered by the GP practice within a one-month period before the period end date.

MMRV004

Monthly count of patients who are aged 1 to 5 years and who have not previously been fully vaccinated against MMR who received a first MMR vaccination administered by the practice within the reporting period.

MMRV005

Monthly count of patients who are aged 1 to 5 years and who have not previously been fully vaccinated against MMR who received a second MMR vaccination administered by the practice within the reporting period. The patient must have been under 6 years of age when the vaccination was administered and this must have been at least 28 days after their first vaccination.

MMRV006

Monthly count of patients who are aged 6 to 16 years (inclusive) at the achievement date and have not previously been fully vaccinated against MMR who received a first MMR vaccination administered by the practice within the reporting period. Vaccination must have been administered while the patient was between 6 and 16 years of age and in the one-month period leading up to the period end date.

MMRV007

Monthly count of patients who are aged 6 to 16 years (inclusive) at the achievement date and have not previously been fully vaccinated against MMR who received a first MMR vaccination administered by the practice within the reporting period. Vaccination must have been administered while the patient was between 6 and 16 years of age and in the one-month period leading up to the period end date. Second vaccination must have been administered at least 28 days after their first MMR vaccination.

MMRV001

Monthly count of patients aged 16 and over who have not been previously vaccinated against MMR or who have unknown or incomplete vaccination statuses who received a first vaccination administered by the practice within one month prior to the end of the reporting period. The patient must have been at least 16 years of age when the vaccination was administered.

MMRV002

Monthly count of the number of patients aged 16 and over who have not previously been fully vaccinated who received a second dose administered by the practice in the one month before the period end. The patient must have been aged at least 16 years of age when the vaccination was administered and it must have been administered more than 28 days after their first vaccination.

There are management information counts, MMRMI004 and MMRMI005, which will not be used for payment information.

Shingles

SHROU02

Monthly count of those aged 70 to 79 (inclusive) at the point of vaccination who have a record of receiving a dose of Zostavax in the period.

SHROU03

Monthly count of patients who are registered as immunocompromised, aged 70 to 79 (inclusive) at the date of vaccination, who received a dose of Shingrix in the period.

SHROU04

Monthly count of the number of immunocompromised patients aged 70 to 80 at the point of vaccination who received a second dose of Shingrix in the period. The first dose must have been administered between 70 and 79, and the second dose between two and six months after the first dose. The second dose must have been administered when the patient was at least 70 and before they reached 81 years old.

There are management counts, SHROUMI07, SHROUMI08 and SHROUMI09, which are not used for calculating payment information via CQRS.

QOF

What is QOF looking for in relation to these cohorts? Note that in all cases, patients who have a contraindication for the vaccination are removed from the denominator of patients. Vaccination contraindications MUST be applied before the patient attains the age referred to in the indicator.

VI001 is looking for babies who turned 8 months in the preceding 12 months (i.e., during the QOF year) and whether they have had three doses of a DTP-containing vaccine before reaching 8 months of age.

VI002 is looking for patients who turned 18 months in the preceding 12 months (i.e., during the QOF year) and who have received their first dose of MMR between 12 and 18 months of age.

VI003 is looking at the number of patients who turned 5 in the preceding 12 months (i.e., during the QOF year) who have had a booster dose of the DTaP/IPV whilst being under 5 years of age. The booster dose must be coded explicitly as such, or this will not be counted. They must also have received 2 doses of MMR between the ages of 1 and 5 (i.e., aged 1 to 4 at the time of vaccination). Vaccination contraindications for either will remove the patient from the denominator.

VI004 is looking for patients who have been given one dose of Shingles vaccination between the ages of 70 and 79 for a single dose vaccine and two doses between the age of 70 and 81 for a two-dose Shingles vaccination. Patients with a contraindication or who decline to receive the vaccination will not be included. Patients who turned 80 and have received their first, but not second, vaccination of a two-dose vaccine, can be eligible for achievement in the following year if the second dose is completed before the patient turns 81.

Short-term and long-term goals?

In the short term, the counts performed by CQRS won’t help you directly to achieve your QOF targets. But looking to get ahead of the CQRS reporting might. If you can write reports to anticipate which patients will and won’t be picked up by CQRS, you should be able to focus on your achievement longer term. Patients in the MMR group, for example, who are vaccinated for MMR at under 12 months, would not be helpful to your QOF achievement. CQRS is aimed at calculating the payment for your current achievement; therefore, it does not look at long-term performance. If that is the case, how can you help your practice to achieve your QOF targets related to vaccination and immunisation?

Look at your patients turning 8 months, 18 months and 5 years of age. Do this ahead of time, so you have time to see if you can get patients in for vaccination. For those who have been vaccinated, ensure that the doses are recorded correctly. For the unvaccinated, invite and chase up. This is one of the core standards. Consider adding alerts to patient notes in order for GPs and clinical staff to have opportunistic discussions about this. Look also at the patients in your 70 to 79 age group. Have any had one vaccination and then not had the second? Add alerts to offer the vaccination opportunistically.

The focus on long-term health through vaccination is increasing and by focusing on this now, achievement through QOF longer term will be possible for most.