QOF

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Age must be 17 or over with a diagnostic code for diabetes mellitus that has not been resolved.

Foot risk Clasification codes (Only one code required, recorded in the previous 12 months)

2G5E. O/E - Right diabetic foot at low risk
2G5F. O/E - Right diabetic foot at moderate risk
2G5G. O/E - Right diabetic foot at high risk
2G5H. O/E - Right diabetic foot - ulcerated
2G5I. O/E - Left diabetic foot at low risk
2G5J. O/E - Left diabetic foot at moderate risk
2G5K. O/E - Left diabetic foot at high risk
2G5L. O/E - Left diabetic foot - ulcerated
2G5d. O/E - Left diabetic foot at increased risk

2G5e. O/E - Right diabetic foot at increased risk

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Excluded if both Feet have been Amputated.

2G42. O/E - Amputated right leg
2G44. O/E - Amputated right above knee
2G46. O/E - Amputated right below knee
AND
2G43. O/E - Amputated left leg
2G45. O/E - Amputated left above knee
2G47. O/E - Amputated left below knee

Foot examination exception codes (Added in the last 12 months)

8I6G. Diabetic foot examination not indicated
8I3W. Diabetic foot examination declined
8IAo. Foot pulse check declined
8IB6. Patient unsuitable for foot pulse check
8IAn. Neuropathy assessment declined
8IB5. Patient unsuitable for neuropathy assessment

Diabetes exception reporting codes (Added in the last 12 months)

9h4.. Exception reporting: diabetes quality indicators
9h41. Excepted from diabetes quality indicators: Patient unsuitable
9h42. Excepted from diabetes quality indicators: Informed dissent

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The percentage of patients with diabetes with a record of a foot examination and risk classification: 1) low risk (normal sensation, palpable pulses), 2) increased risk (neuropathy or absent pulses), 3) high risk (neuropathy or absent pulses plus deformity or skin changes in previous ulcer) or 4) ulcerated foot within the preceding 12 months

DM 012.1 Rationale

Patients with diabetes are at high risk of foot complications. Evaluation of skin, soft tissue, musculoskeletal, vascular and neurological condition on an annual basis is important for the detection of feet at raised risk of ulceration.

The foot inspection and assessment should include:

NICE clinical guideline 10 (2004). Type 2 diabetes: prevention and management of foot problems.
The NICE guideline on Type 2 diabetes: the prevention and management of foot problems advises that foot risk is classified as:

The practitioner carrying out the inspection and assessment is advised to:

For the purpose of QOF the Read codes for 'moderate risk' are used to record the concept of 'increased risk'.

In NHS Scotland, foot risk is calculated by using the SCI-DC electronic foot risk screening tool which is based on the SIGN clinical guideline 116 foot risk algorithm and as such is recognised as best practice and encouraged for use in Scotland.

DM 012.2 Reporting and verification

See indicator wording for requirement criteria.

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Prepared By Jean Keenan