At one of our recent PCA webinars, we had a few practices who said their ICB had told them their PCA’s where patients had not responded to invites were too high.
In the past, there were many reports from practices who were told their ‘informed dissent’ coding was too high and, as a result of this, practices only entered these codes at the end of the year to hit their achievement – so some patients were coded and other not and there was a big hit of coding in the last month or so of the QOF year.
For this reason, exception coding (the old informed dissent) was changed – the name was changed to PCA’s, it was reduced from 3 invitations to 2 and rather than practices having to enter these codes once 3 invites had been extended, the system now automatically removes the patient from the denominator (target) as soon as you have sent and appropriately coded the 2nd invite.
If you are running a month of birth recall system, for patients born in April, you may send one invite in April and the 2nd in May – at this point, the patient is removed, however, there will still be a ‘flag’ in the patient records a review is due.
At no point should you delay coding the 2nd invite – some practices are reporting they can only add the 2nd invite at the end of the year. If this is not when the invite was sent, it is not correct – a patient’s medical record should be complete and timely so the invite code needs to be added at the time it was sent.
The guidance states “patients must have been sent a minimum of two invitations at two unique time points in the QOF year separated by a minimum of 7 calendar days (the exception to this are CS005/006). However, care should continue to be offered on an opportunistic basis.”
Patients who chose not to receive intervention (contact you after one invite and say thanks but no thanks) still need to have had a personal contact with a health care professional recorded in their notes (face to face/video). This is the only time an ‘informed dissent’ code is now appropriate. This is just not feasible for many practices so our advice would be to explain to the patient you have to send them two invitations but it is their patient choice as to whether they attend or not (although you strongly advise they do!)
Bulk PCA’s – we have had a few enquiries about bulk adding PCA codes. There are no instances we can think of where it is appropriate to bulk or blanket add PCA codes, every code entered should patient specific.
If you still have any queries or questions around PCA’s, exceptions, exclusions or resolved codes, our PCA webinar has received excellent feedback. To register your interest in a future webinar, please email laura@insightsol.co.uk
