Version 33.0 of the Business Rules has been published. In addition to the usual changes where new codes have been added to clusters, some codes have also been removed from some QOF register clusters. This does not usually happen in-year but there were clinical reasons for doing so. The changes affected heart failure, the asthma register and CKD register. Note that these changes are effective from 1 October 2015.
The updated Business Rules are available here: www.hscic.gov.uk/qofbrv33 and NHS Employers have also published some FAQs following these changes.
Heart failure (HF)
Q. Why has the code for ‘left ventricular cardiac dysfunction’ (Read v2 G5yyD/CTV3 Xaacj) been removed from the ‘heart failure due to left ventricular systolic dysfunction (LVSD)’ component of the heart failure register?
A. The HF003 and HF004 indicators are aimed at patients with a diagnosis of heart failure due to left ventricular systolic dysfunction (LVSD). As the Read code for left ventricular cardiac dysfunction does not solely relate to LVSD and following advice from NICE, it was agreed that it would not be appropriate for patients with heart failure due to cardiac dysfunction to be included in these indicators. As such, from 1 October 2015 this code will not be in the register cluster and patients with just this code will therefore no longer be included.
Practices may wish to review the records of these patients and (if clinically appropriate i.e. if their left ventricular dysfunction is systolic) update this code to G5yy9 ‘Left ventricular systolic dysfunction’ (for EMIS, Vision or Microtest) or XaIIq ‘Left ventricular systolic dysfunction’ (for SystmOne).
Q. Some of the asthma-related prescribing Read codes have been removed from the asthma register, why?
A. Part of the register criteria for asthma is based on appropriate prescribing of therapies. The Business Rules included some drug therapies only licensed for patients with a diagnosis of COPD and they are not licensed as a treatment for asthma. As such, the following Read v2 and CTV3 codes have been removed from the asthma treatment component of the asthma register:
c1e..% hierarchy containing:
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c1d..% hierarchy containing:
If you have patients with asthma whose sole asthma medication is one of the inhalers listed above then they will no longer appear on your QOF asthma register.
Patients receiving additional, appropriate asthma treatment such as short-acting bronchodilators or steroid inhalers will remain on the register. Practices may wish to review the records of any patients affected by this change to review their asthma treatment however, a change in prescribing should only be done where clinically appropriate.
Chronic kidney disease (CKD)
Q. Why has the CKD register changed?
A. In April 2015 the CKD register was updated to take account of a change in the diagnostic criteria. In addition to the existing codes the register is now for patients with new classifications G3a to G5 CKD. The CKD clusters have been reviewed by the HSCIC and have found that some of the codes related to categories G1 and G2. As such, the clusters have been updated to include only those diagnoses of stage G3a and above in line with the register wording.
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