QOF and disease register support for GP practices and PCNs
QOF and disease register support for GP practices and PCNs
What is QOF and disease register support?
A managed service that keeps your QOF registers accurate and your recall moving across the whole year. Our clinical pharmacists and pharmacy technicians run the searches, check the registers, work the recall lists and code every outcome inside your own clinical system, under our clinical governance.
We work in EMIS, SystmOne, Vision and Medicus. On EMIS and SystmOne we use Ardens searches; on Medicus we use its built-in search and reporting.
What the service covers
- Register checks: finding patients whose medicines or records suggest a possible missing diagnosis. An appropriately qualified clinician confirms the diagnosis and coding before the register changes.
- Register accuracy: reviewing patients recorded on a register without supporting evidence, and clearing duplicate or legacy codes that confuse the QOF business rules.
- Recall searches: lists built and worked every month, staged so patients who need only a blood test or a blood pressure reading are handled separately from those who need a full medication review.
- Medication reviews for long-term condition registers, through our long-term condition clinics.
- Exact coding: the reading, the review, the medicines change and the patient’s decision, with personalised care adjustment codes used only where they genuinely apply.
How the service runs across the year
Across the year, not only in March
We run register checks and recall as a steady monthly cycle, so achievement builds through the year and the final quarter is for closing the last gaps. The same team runs your searches each month and learns which groups of patients are hardest to reach.
Who does the work
Clinical reviews are carried out by GPhC-registered pharmacists, 85% of whom are independent prescribers. Pharmacy technicians run searches and coding checks, so pharmacist time goes on patients. Prescribing follows protocols agreed with the practice: our independent prescribers sign prescriptions within their competence, and anything outside it goes to the patient’s GP.
QOF support across a PCN
A PCN can commission the same register and recall cycle across every member practice, with one standard and reporting for each practice and for the network. See PCN pharmacist services.
What it has delivered
A practice of around 6,000 patients handed over its medicines-related QOF work in August. One governed pathway supported around 26 indicators, with registers worked across the year. We have supported 375+ GP practices and 88+ PCNs in 23 ICB areas. Read the full case studies.
Further reading: how clinical pharmacists support QOF and the newer indicators and where pharmacist input has the biggest impact on QOF outcomes.
Accurate registers
Possible missing diagnoses found for a clinician to confirm, and unsupported entries reviewed.
Recall that keeps moving
Searches built and worked every month, staged by what each patient needs.
Exact coding
Readings, reviews, medicines changes and patient decisions coded as the work is done.
Across the whole year
A steady monthly cycle, so the final quarter is for closing the last gaps.
In your clinical system
Delivered in EMIS, SystmOne, Vision or Medicus, with Ardens where you use it.
PCN-wide when you need it
One standard across member practices, reported for each practice and the network.
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Frequently Asked Questions
Which QOF areas can a pharmacist support?
Mainly the medicines-related indicators across long-term condition registers, such as hypertension, diabetes medicines, CVD prevention and lipids, asthma, COPD, CKD and anticoagulation in atrial fibrillation. We agree the indicators with you at the start.
Do you change our registers?
Register changes are made once an appropriately qualified clinician has confirmed the diagnosis and coding. A medicine alone does not confirm a diagnosis or justify adding a patient to a register.
How is the work recorded?
Every review, reading, medicines change and patient decision is coded in your clinical system as it is done, using codes the QOF business rules recognise.
Can you support QOF across a PCN?
Yes. We run one register and recall cycle across every member practice and report for each practice and for the network.
How do we start?
Tell us which registers or indicators matter most to you this year. We agree the searches, the protocol and the reporting with you, then begin the monthly cycle.
