QOF

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Learning disabilities health check scheme

GPES will normally extract data on a quarterly basis to establish the number of patients, aged 18 or over within the financial year, who are recorded as receiving a LD health check.

The following code will need to be used to record a learning disability health check and to enable CQRS to calculate payment based on the GPES extraction:

69DB. Learning disability health examination

Action Plan Codes

9HB4. Learning disabilities health action plan completed
9HB2. Learning disabilities health action plan reviewed
9HB0. Learning disabilities health action plan declined

Learning disability (LD) register Aged 14 years and over (The same Read codes as for QOF)

E3... Mental retardation
E30.. Mild mental retardation, IQ in range 50-70
E31.. Other specified mental retardation
E310. Moderate mental retardation, IQ in range 35-49
E311. Severe mental retardation, IQ in range 20-34
E312. Profound mental retardation with IQ less than 20
E31z. Other specified mental retardation NOS
E3y.. Other specified mental retardation
E3z.. Mental retardation NOS
Eu7.. [X]Mental retardation
Eu70.% [X]Mild mental retardation
Eu71.% [X]Moderate mental retardation
Eu72.% [X]Severe mental retardation
Eu73.% [X]Profound mental retardation
Eu7y.% [X]Other mental retardation
Eu7z.% [X]Unspecified mental retardation
 
918e. On learning disability register
 
Eu81z [X]Developmental disorder of scholastic skills, unspecified
 
Eu814 [X]Moderate learning disability
Eu815 [X]Severe learning disability
Eu816 [X]Mild learning disability
Eu817 [X]Profound learning disability
Eu818 [X]Specific learning disability

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Guidance

Access the full guidance here: page 31 onwards

Background and purpose

The government is committed to reducing the incidence of co-morbidities and premature deaths for people with learning disabilities (LD) and supports the recommendations from the Confidential Inquiry into premature deaths for people with learning disabilities (CIPOLD).

This enhanced service (ES) is designed to encourage practices to identify all patients aged 14 and over with learning disabilities, to maintain a learning disabilities 'health check' register and offer them an annual health check, which will include producing a health action plan. From the prevalence figures available, it is estimated that approximately 240,000 patients fall into this category across the country.

Requirements

The ES is for one year from 1 April 2014.

The requirements for taking part in the ES are as follows:

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Payment and validation

Area teams will seek to invite practices to participate in this ES before 30 April 2014. Practices wishing to participate will be required to sign up by no later than 30 June 2014.

Payment under this ES will be on a quarterly basis comprising 116.00 for each patient aged 14 and over in the financial year on the practice s agreed learning disabilities register who receives a compliant health check in that quarter. Only one payment may be made as regards to any patient, in a given practice, in any one financial year.

CQRS will calculate the quarterly payment, based on the quarterly achievement data either via manually entered data or data extracted from GPES.

Payment should be made by the last day of the month following the month in which the practice and area team approve the payment. Where CQRS has not been provided with data (i.e. the practice has not enabled the extraction or the extraction is not supported by their system supplier) the data will need to be entered onto CQRS manually.

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Prepared By Jean Keenan