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LES Requirements

a. The Practice will code each patient on its NPT register with the code:

9kD.. Near Patient Testing – enhanced service administration

This is the code required for the current EMIS NPT screen, so many Practices will already have their NPT patients coded in this way.
Practices should review codes for existing patients to ensure that the correct code has been used.

b. The Practice will pick 10 NPT NES patients at random each month for the retrospective care bundle review and code them with the following code:

9kN6. DMARD monitored in primary care – enhanced service administration

c. The records of each of these 10 patients will then be reviewed for the previous period in which there was a DMARDS prescription issued in respect of the five care bundle elements. This should be carried out before the end of the month, commencing April 2015.

For example: At the end of November 2015 the Practice picks 10 patients from its NPT register of 48. Over the month of December the Practice applies the data collection process for these patients for the last month in which they received a prescription.

At the end of the following month ie December, the Practice randomly picks another 10 patients from the NPT register of 48 and completes the data collection process by the end of January. It is quite possible over the year long period (12 care bundle reviews) that the same patient(s) processes are audited more than once.

d. Coding care bundle compliance
As each patient is reviewed for the five elements, the following READ codes will be entered if the patient has passed the element. A CS template will be provided so that these 5 elements can be coded easily and consistently across all Practices.

Appropriate tests:

414.. Sample sent to lab. for test

The code will be entered on the patient’s clinical record, with the date of the care bundle review, should the appropriate sample have been sent to the lab. At the appropriate time, as outlined in the NPT specification.

The Practice is looking to check that the appropriate test was carried out in the appropriate time period. The entering of the READ code, dated at the date of the Care Bundle review is the Practice stating that on review the test was carried out at the appropriate time (as required by the NPT NES guidelines).

e. Appropriate actions (I): Were the blood tests reviewed prior to the last prescription?

41H.. Review of patient laboratory test report

The code will be entered on the patient’s clinical record, with the date the care bundle review was carried out.

The Practice is looking to check that the blood test results were reviewed prior to the last prescription. By entering the READ code, dated at the date of the review, the Practice is stating that through the review it was established that the blood test results had been checked and found to be okay prior to the issue of the last prescription.

f. Appropriate actions (II): Appropriate actions have been taken and recorded in the clinical notes regarding any abnormal results

9j Risk management

The code will be entered on the patient’s clinical record, with the date the care bundle review was carried out, should the appropriate actions have been taken and recorded regarding abnormal results as outlined in the NPT specification. The code should also be entered if the results were normal and no action was required.

g. Vaccine:
If the vaccine has been given, this element will already be entered on the patient’s clinical record (using a QOF code) and so should not be entered again

6572 Pneumococcal vaccination
65720 Pneumococcal vaccination given
657K. Booster pneumococcal vaccination
657L. First pneumococcal conjugated vaccination (GMS)
657M. Second pneumococcal conjugated vaccination (GMS)
657N. Third pneumococcal conjugated vaccination (GMS)
657P. Pneumococcal vaccination given by other healthcare provider
7L197 Subcutaneous injection of Pneumovax II

If the Pneumococcal vaccination was contraindicated or declined, and has been coded as such, this will appear on the CS template for the Practice’s information.

812E. Pneumococcal vaccination contraindicated
813Q. Pneumococcal vaccination declined

h. Side effects:

8BIZ. Drug side effects checked

The code will be entered on the patient’s clinical record, with the date the care bundle review was carried out, should a check have been made for drug side effects.

i. Full compliance:
The appropriate code for each element passed (appropriate tests, appropriate actions [I & II], vaccine and side effects) will be entered on the CS care bundle-DMARD template for each patient. The vaccine code will pre-populate the CS template if the code has already been entered on the Practice clinical system using one of the QOF codes above.

Having carried out the care bundle review on the patient’s records, the READ codes (items d-h) are extracted to the Audit and Analysis Tool. The Tool applies a business rule that states that if all 5 of these code elements have been achieved within the appropriate time period (the month during which the review took place) then there is full compliance and that box in the A&A tool is populated.

Please note: payment is not made for achieving full compliance, but for carrying out the Care Bundle data collection and improvement methodology process.