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Section 2: clinical indicators
Summary of all Clinical Indicators
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Secondary Prevention in Coronary Heart Disease (CHD)
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Indicator
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Points
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Payment Stages
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Records
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CHD 1. The practice can produce a register of patients with coronary
heart disease
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6
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Diagnosis and initial management
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CHD 2. The percentage of patients with newly diagnosed angina
(diagnosed after 1 April 2003) who are referred for exercise testing and/or
specialist assessment
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7
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25-90%
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Ongoing Management
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CHD 3. The percentage of patients with coronary heart disease whose
notes record smoking status in the past 15 months, except those who
have never smoked where smoking status need be recorded only once
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7
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25-90%
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CHD 4. The percentage of patients with coronary heart disease who
smoke, whose notes contain a record that smoking cessation advice or
referral to a specialist service, where available, has been offered within
the last 15 months
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4
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25-70%
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CHD 5. The percentage of patients with coronary heart disease whose
notes have a record of blood pressure in the previous 15 months
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7
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25-90%
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CHD 6. The percentage of patients with coronary heart disease in
whom the last blood pressure reading (measured in the last 15 months) is
150/90 or less
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19
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25-70%
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CHD 7. The percentage of patients with coronary heart disease whose
notes have a record of total cholesterol in the previous 15 months
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7
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25-90%
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CHD 8.The percentage of patients with coronary heart disease whose
last measured total cholesterol (measured in last 15 months) is 5 mmol/l or
less
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16
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15-60%
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CHD 9. The percentage of patients with coronary heart disease with a
record in the last 15 months that aspirin, an alternative anti-platelet
therapy, or an anti-coagulant is being taken (unless a contraindication or
side-effects are recorded)
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7
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25-90%
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CHD 10. The percentage of patients with coronary heart disease who
are currently treated with a beta blocker (unless a contraindication or
side-effects are recorded)
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7
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25-50%
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CHD 11. The percentage of patients with a history of myocardial
infarction (diagnosed after 1 April 2003) who are currently treated with an ACE inhibitor
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7
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25-70%
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CHD 12. The percentage of patients with coronary heart disease who
have a record of influenza immunisation in the preceding 1 September to 31
March
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7
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25-85%
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Sub Set - Left Ventricular Dysfunction
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Records
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LVD 1. The practice can produce a register of patients with CHD and
left ventricular dysfunction
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4
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Diagnosis and initial management
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LVD 2. The percentage of patients with a diagnosis of CHD and left
ventricular dysfunction (diagnosed after 1 April 2003) which has been
confirmed by an echocardiogram
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6
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25-90%
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Ongoing Management
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LVD 3. The percentage of patients with a diagnosis of CHD and left
ventricular dysfunction who are currently treated with ACE inhibitors (or
A2 antagonists)
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10
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25-70%
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Stroke and Transient Ischaemic Attacks
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Indicator
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Points
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Payment Stages
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Records
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STROKE 1. The practice can produce a register of patients with
Stroke or TIA
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4
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STROKE 2. The percentage of new patients with presumptive stroke
(presenting after 1 April 2003) who have been referred for confirmation of
the diagnosis by CT or MRI scan
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2
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25-80%
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Ongoing Management
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STROKE 3. The percentage of patients with TIA or stroke who have a
record of smoking status in the last 15 months, except those who have never
smoked where smoking status should be recorded at least once since
diagnosis
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3
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25-90%
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STROKE 4. The percentage of patients with a history of TIA or stroke
who smoke and whose notes contain a record that smoking cessation advice or
referral to a specialist service, if available, has been offered in the
last 15 months
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2
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25-70%
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STROKE 5. The percentage of patients with TIA or stroke who have a
record of blood pressure in the notes in the preceding 15 months
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2
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25-90%
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STROKE 6. The percentage of patients with a history of TIA or stroke
in whom the last blood pressure reading (measured in last 15 months) is 150/90 or less
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5
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25-70%
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STROKE 7. The percentage of patients with TIA or stroke who have a
record of total cholesterol in the last 15 months
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2
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25-90%
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STROKE 8. The percentage of patients with TIA or stroke whose last
measured total cholesterol (measured in last 15 months) is 5 mmol/l or less
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5
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25-60%
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STROKE 9. The percentage of patients with a stroke shown to be
non-haemorrhagic, or a history of TIA, who have a record that aspirin, an
alternative anti-platelet therapy, or an anti-coagulant is being taken
(unless a contraindication or side-effects are recorded)
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4
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25-90%
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STROKE 10. The percentage of patients with TIA or stroke who have
had influenza immunisation in the preceding 1 September to 31 March
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2
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25-85%
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Hypertension
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Indicator
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Points
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Payment Stages
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Records
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BP 1. The practice can produce a register of patients with
established hypertension
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9
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Diagnosis and initial management
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BP 2. The percentage of patients with hypertension whose notes
record smoking status at least once
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10
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25-90%
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BP 3. The percentage of patients with hypertension who smoke, whose
notes contain a record that smoking cessation advice or referral to a
specialist service, if available, has been offered at least once
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10
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25-90%
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Ongoing Management
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BP 4. The percentage of patients with hypertension in whom there is
a record of the blood pressure in the past 9 months
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20
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25-90%
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BP 5. The percentage of patients with hypertension in whom the last
blood pressure (measured in the last 9 months) is 150/90 or less
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56
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25-70%
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Diabetes Mellitus (Diabetes)
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Indicator
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Points
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Payment Stages
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Records
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DM 1.The practice can produce a register of all patients with
diabetes mellitus
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6
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Ongoing Management
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DM 2. The percentage of patients with diabetes whose notes record
BMI in the previous 15 months
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3
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25-90%
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DM 3. The percentage of patients with diabetes in whom there is a
record of smoking status in the previous 15
months, except those who have never smoked where smoking status should be
recorded once
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3
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25-90%
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DM 4. The percentage of patients with diabetes who smoke and whose
notes contain a record that smoking cessation advice or referral to a
specialist service, where available, has been offered in the last 15 months
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5
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25-90%
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DM 5. The percentage of diabetic patients who have a record of HbA1c
or equivalent in the previous 15 months
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3
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25-90%
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DM 6. The percentage of patients with diabetes in whom the last
HbA1C is 7.4 or less (or equivalent test/reference range depending on local
laboratory) in last 15 months
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16
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25-50%
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DM 7. The percentage of patients with diabetes in whom the last
HbA1C is 10 or less (or equivalent test/reference range depending on local
laboratory) in last 15 months
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11
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25-85%
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DM 8. The percentage of patients with diabetes who have a record of
retinal screening in the previous 15 months
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5
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25-90%
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DM 9. The percentage of patients with diabetes with a record of the
presence or absence of peripheral pulses in the previous 15 months
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3
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25-90%
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DM 10. The percentage of patients with diabetes with a record of
neuropathy testing in the previous 15 months
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3
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25-90%
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DM 11. The percentage of patients with diabetes who have a record of
the blood pressure in the past 15 months
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3
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25-90%
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DM 12. The percentage of patients with diabetes in whom the last
blood pressure is 145/85 or less
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17
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25-55%
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DM 13. The percentage of patients with diabetes who have a record of
micro-albuminuria testing in the previous 15 months (exception reporting
for patients with proteinuria)
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3
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25-90%
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DM 14. The percentage of patients with diabetes who have a record of
serum creatinine testing in the previous 15 months
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3
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25-90%
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DM 15. The percentage of patients with diabetes with proteinuria or
micro-albuminuria who are treated with ACE inhibitors (or A2 antagonists)
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3
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25-70%
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DM 16. The percentage of patients with diabetes who have a record of
total cholesterol in the previous 15 months
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3
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25-90%
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DM 17. The percentage of patients with diabetes whose last measured
total cholesterol within the previous 15 months is 5mmol/l or less
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6
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25-60%
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DM 18. The percentage of patients with diabetes who have had
influenza immunisation in the preceding 1 September to 31 March
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3
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25-85%
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Chronic Obstructive Pulmonary Disease (COPD)
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Indicator
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Points
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Payment Stages
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Records
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COPD 1. The practice can produce a register of patients with COPD
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5
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Initial diagnosis
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COPD 2. The percentage of patients in whom diagnosis has been
confirmed by spirometry including reversibility testing for newly diagnosed
patients with effect from 1 April 2003
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5
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25-90%
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COPD 3. The percentage of all patients with COPD in whom diagnosis
has been confirmed by spirometry including reversibility testing
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5
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25-90%
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Ongoing Management
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COPD 4. The percentage of patients with COPD in whom there is a
record of smoking status in the previous 15 months
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6
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25-90%
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COPD 5. The percentage of patients with COPD who smoke, whose notes
contain a record that smoking cessation advice or referral to a specialist
service, if available, has been offered in the past 15 months
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6
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25-90%
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COPD 6. The percentage of patients with COPD with a record of FeV1
in the previous 27 months
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6
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25-70%
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COPD 7. The percentage of patients with COPD receiving inhaled
treatment in whom there is a record that inhaler technique has been checked
in the preceding 27 months
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6
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25-90%
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COPD 8. The percentage of patients with COPD who have had influenza
immunisation in the preceding 1 September to 31 March
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6
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25-85%
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Epilepsy
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Indicator
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Points
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Payment Stages
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Records
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EPILEPSY 1. The practice can produce a register of patients
receiving drug treatment for epilepsy
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2
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Ongoing Management
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EPILEPSY 2. The percentage of patients aged 16 and over on drug
treatment for epilepsy who have a record of seizure frequency in the
previous 15 months
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4
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25-90%
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EPILEPSY 3. The percentage of patients aged 16 and over on drug
treatment for epilepsy who have a record of medication review in the
previous 15 months
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4
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25-90%
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EPILEPSY 4. The percentage of patients aged 16 and over on drug
treatment for epilepsy who have been seizure free for the last 12 months
recorded in the last 15 months
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6
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25-70%
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Hypothyroidism
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Indicator
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Points
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Payment Stages
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Records
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THYROID 1. The practice can produce a register of patients with
hypothyroidism
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2
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Ongoing Management
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THYROID 2. The percentage of patients with hypothyroidism with
thyroid function tests recorded in the previous 15 months
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6
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25-90%
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Cancer
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Indicator
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Points
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Payment Stages
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Records
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CANCER 1. The practice can produce a register of all cancer patients
diagnosed after 1 April 2003
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6
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Ongoing Management
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CANCER 2. The percentage of patients with cancer diagnosed from 1
April 2003 with a review by the practice recorded within six months of
confirmed diagnosis. This should include an assessment of support needs, if
any, and a review of co-ordination arrangements with secondary care
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6
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25-90%
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Mental Health (MH)
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Indicator
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Points
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Payment Stages
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Records
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MH 1. The practice can produce a register of people with severe
long-term mental health problems who require and have agreed to regular
follow-up
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7
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Ongoing Management
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MH 2. The percentage of patients with severe long-term mental health
problems with a review recorded in the preceding 15 months. This review
includes a check on the accuracy of prescribed medication, a review of
physical health and a review of co-ordination arrangements with secondary
care
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23
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25-90%
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MH 3. The percentage of patients on lithium therapy with a record of
lithium levels checked within the previous 6 months
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3
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25-90%
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MH 4. The percentage of patients on lithium therapy with a record of
serum creatinine and TSH in the preceding 15 months
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5
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25-70%
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MH 5. The percentage of patients on lithium therapy with a record of
lithium levels in the therapeutic range within the previous 6 months
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5
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25-70%
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Asthma
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Indicator
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Points
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Payment Stages
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Records
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ASTHMA 1. The practice can produce a register of patients with
asthma, excluding patients with asthma who have been prescribed no
asthma-related drugs in the last twelve months
|
7
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Initial management
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ASTHMA 2. The percentage of patients aged eight and over diagnosed
as having asthma from 1 April 2003 where the diagnosis has been confirmed
by spirometry or peak flow measurement
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15
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25-70%
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Ongoing Management
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ASTHMA 3. The percentage of patients with asthma between the ages of
14 and 19 in whom there is a record of smoking status in the previous 15 months
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6
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25-70%
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ASTHMA 4. The percentage of patients aged 20 and over with asthma
whose notes record smoking status in the past 15 months, except those who
have never smoked where smoking status should be recorded at least once
|
6
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25-70%
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ASTHMA 5. The percentage of patients with asthma who smoke, and
whose notes contain a record that smoking cessation advice or referral to a
specialist service, if available, has been offered within the last 15
months
|
6
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25-70%
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ASTHMA 6. The percentage of patients with asthma who have had an
asthma review in the last 15 months
|
20
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25-70%
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ASTHMA 7. The percentage of patients aged 16 and over with asthma
who have had influenza immunisation in the preceding 1 September to 31
March
|
12
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25-70%
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