QOF

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Patients will be included for this indicator if they have:

(They will be rejected if they are solely on Lithium treatment)

Codes for Mental health care plan in the preceding 12 months (Recorded after mental health diagnosis)

8CY.. Mental Health Care Programme Approach (v25)
8CG6. Care Programme Approach review (v25)
8CS7. - Agreeing on mental health care plan (v26)
8CG62 - Discharge Care Programme Approach review (v26)
8CG60 - Initial Care Programme Approach review (v26)
8CG61 - Ongoing Care Programme Approach review (v26)
8CMG1 - Review of mental health care plan (v26)

Patients are not included if they have a remission code after their latest diagnosis:

Remission Codes
E1005 Schizophrenia in remission
E1015 Hebephrenic schizophrenia in remission
E1025 Catatonic schizophrenia in remission
E1035 Paranoid schizophrenia in remission
E1055 Latent schizophrenia in remission
E1075 Schizo-affective schizophrenia in remission
E1106 Single manic episode in full remission
E1116 Recurrent manic episodes, in full remission
E1146 Bipolar affective disorder, currently manic, in full remission
E1156 Bipolar affective disorder, currently depressed, in full remission
Eu317 [X]Bipolar affective disorder, currently in remission
E1166 Mixed bipolar affective disorder, in full remission
E1176 Unspecified bipolar affective disorder, in full remission
Eu329 [X]Single major depressive episode, severe, with psychosis, psychosis in remission
Eu32A [X]Recurrent major depressive episodes, severe, with psychosis, psychosis in remission
Eu26. [X]Nonorganic psychosis in remission
Eu223 [X]Paranoid state in remission

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Psychosis, schizophrenia and bipolar affective disease codes (the earliest code)

E10..% Schizophrenic disorders
E110.% Manic disorder, single episode
E111.% Recurrent manic episodes
E1124 Single major depressive episode, severe, with psychosis
E1134 Recurrent major depressive episode, severe, with psychosis
E114% Bipolar affective disorder, currently manic
E115% Bipolar affective disorder, currently depressed
E116% Mixed bipolar affective disorder
E117% Unspecified bipolar affective disorder
E11y.% Other and unspecified manic-depressive psychoses (excluding E11y2 Atypical depressive disorder)
E11z. Other and unspecified affective psychoses
E11z0 Unspecified affective psychoses NOS
E11zz Other affective psychosis NOS
E12..% Paranoid states (v9)
E13..% Other nonorganic psychoses (excluding E135.. Agitated depression)

E2122 Schizotypal personality
Eu2..% [X]Schizophrenia, schizotypal and delusional disorders
 
Eu30. [X]Manic episode
Eu300 [X]Hypomania
Eu301 [X]Mania without psychotic symptoms
Eu302 [X]Mania with psychotic symptoms
Eu30y [X]Other manic episodes
Eu30z [X]Manic episode, unspecified
Eu31. [X]Bipolar affective disorder
Eu310 [X]Bipolar affective disorder, current episode hypomanic
Eu311 [X]Bipolar affective disorder, current episode manic without psychotic symptoms
Eu312 [X]Bipolar affective disorder, current episode manic with psychotic symptoms
Eu313 [X]Bipolar affective disorder, current episode mild or moderate depression
Eu314 [X]Bipolar affective disorder, current episode severe depression without psychotic symptoms
Eu315 [X]Bipolar affective disorder, current episode severe depression with psychotic symptoms
Eu316 [X]Bipolar affective disorder, current episode mixed
Eu317 [X]Bipolar affective disorder, currently in remission
Eu318 [X]Bipolar affective disorder type I (v21)
Eu319 [X]Bipolar affective disorder type II (v21)

Eu31y [X]Other bipolar affective disorders
Eu31z [X]Bipolar affective disorder, unspecified
Eu323 [X]Severe depressive episode with psychotic symptoms
Eu328 [X]Major depression, severe with psychotic symptoms (v16)
Eu329 [X]Single major depressive episode, severe, with psychosis, psychosis in remission (v18)
Eu32A [X]Recurrent major depressive episodes, severe, with psychosis, psychosis in remission (v18)
Eu333 [X]Recurrent depressive disorder, current episode severe with psychotic symptoms (v9)
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Mental Health exception reporting codes (Added in the last 12 months)

9h9.. Exception reporting: mental health quality indicators
9h91. Excepted from mental health quality indicators: Patient unsuitable
9h92. Excepted from mental health quality indicators: Informed dissent

Code for Lithium prescription

d6...%

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Mental health 002.1 Rationale

This indicator reflects good professional practice and supported by NICE clinical guidelines.Core interventions in the treatment and management of schizophrenia in adults in primary and secondary care. 2009

Patients on the mental health register should have a documented primary care consultation that acknowledges, especially in the event of a relapse, a plan for care. This consultation may include the views of their relatives or carers where appropriate.

Up to half of people who have a serious mental illness are seen only in a primary care setting. For these patients, it is important that the primary care team takes responsibility for discussing and documenting a care plan in their primary care record.

When constructing the primary care record research supports the inclusion of the following information:

1. Patient’s current health status and social care needs including how needs are to be met, by whom, and the patient’s expectations.

2. How socially supported the individual is: e.g. friendships/family contacts/voluntary sector organisation involvement. People with mental health problems have fewer social networks than average, with many of their contacts related to health services rather than sports, family, faith, employment, education or arts and culture. One survey found that 40 per cent of people with ongoing mental health problems had no social contacts outside mental health services.

3. Co-ordination arrangements with secondary care and/or mental health services and a summary of what services are actually being received.

4. Occupational status. In England, only 24 per cent of people with mental health problems are currently in work, the lowest employment rate of any group of people (ONS Labour Force Survey, Autumn 2003). People with mental health problems also earn only two thirds of the national average hourly rate (ONS, 2002). Studies show a clear interest in work and employment activities amongst users of mental health services with up to 90 per cent wishing to go into or back to work.

5. “Early warning signs” from the patient’s perspective that may indicate a possible relapse. Many patients may already be aware of their early warning signs (or relapse signature) but it is important for the primary care team to also be aware of noticeable changes in thoughts, perceptions, feelings and behaviours leading up to their most recent episode of illness as well as any events the person thinks may have acted as triggers.

9. The patient’s preferred course of action (discussed when well) in the event of a clinical relapse, including who to contact and wishes around medication.

It is recommended that a care plan is accurate, easily understood, reviewed annually and discussed with the patient, their family and/or carers. If a patient is treated under the care programme approach (CPA), then they should have a documented care plan discussed with their community key worker available. This is acceptable for the purposes of the QOF provided the practice has evidence of a review having taken place with the community key worker and the patient treated under the CPA.

Where a patient has relapsed after being recorded as being in remission their care plan should be updated subsequent to the relapse. Care plans dated prior to the date of the relapse will not be acceptable for QOF purposes.

Mental health 002.2 Reporting and verification

See indicator wording for requirement criteria.

Verification - the NHS England may require contractors to randomly select a number of care plans to ensure that they are being maintained annually..

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Prepared By Jean Keenan