Code

Name

Who & when to recall

What counts as complete

Cadence

AST008 💰

Smoking status (young asthmatics)

Asthma patients aged ≤19, no smoking status in last 12m

Personal smoking status, second-hand smoke exposure, or no second-hand smoke exposure recorded in the last 12 months.

Annual

AST014

Objective testing for new diagnoses

Patients diagnosed with asthma on or after 1 April 2025, without objective test evidence recorded within 3 months before/after diagnosis

Age-appropriate objective test recorded in that window — adults (17+): FBC, FeNO, spirometry, peak-flow variability (if spirometry unavailable), or bronchial challenge; children (5–16): FeNO, spirometry, peak-flow variability, skin-prick test, IgE + FBC together, or bronchial challenge

Event-based (per diagnosis)

AST015

Annual asthma review (v51)

Patients aged 5+ on the asthma register with no qualifying annual review in the last 12 months

Asthma review in the last 12 months with a written personalised action plan on the same day and an exacerbation count recorded within 1 month before the review

Annual

Code

Name

Who & when to recall

What counts as complete

Cadence

NWLAS02Na 🆕

Health assessment — height

Asylum seekers registered on or after the enhanced-service start date

Height recorded with a value above zero at any point since the enhanced-service start

One-off (per registration)

NWLAS02Nb 🆕

Health assessment — weight

Asylum seekers registered on or after the enhanced-service start date

Weight recorded at any point since the enhanced-service start

One-off (per registration)

NWLAS02Nc 🆕

Health assessment — BMI

Asylum seekers registered on or after the enhanced-service start date

BMI recorded at any point since the enhanced-service start

One-off (per registration)

NWLAS02Nd 🆕

Health assessment — blood pressure

Asylum seekers registered on or after the enhanced-service start date

Blood pressure recorded at any point since the enhanced-service start

One-off (per registration)

NWLAS02Ne 🆕

Health assessment — pulse

Asylum seekers registered on or after the enhanced-service start date

Pulse rate or pulse rhythm recorded at any point since the enhanced-service start

One-off (per registration)

NWLAS02Nf 🆕

Health assessment — smoking status

Asylum seekers registered on or after the enhanced-service start date

Smoking status or cessation advice recorded at any point since the enhanced-service start

One-off (per registration)

NWLAS03N 🆕

Health assessment — medication review

Asylum seekers registered on or after the enhanced-service start date

Medication review recorded at any point since the enhanced-service start

One-off (per registration)

NWLAS04N 🆕

Health assessment — flu vaccination

Asylum seekers registered on or after the enhanced-service start date

Flu vaccination given or declined at any point since the enhanced-service start

One-off (per registration)

NWLAS05N 🆕

Health assessment — safeguarding

Asylum seekers registered on or after the enhanced-service start date

Safeguarding assessment recorded at any point since the enhanced-service start

One-off (per registration)

NWLAS06N 🆕

Health assessment — mental health assessment

Asylum seekers registered on or after the enhanced-service start date

PHQ-9 score or psychological review recorded at any point since the enhanced-service start

One-off (per registration)

NWLAS07N 🆕

Health assessment — care plan

Asylum seekers registered on or after the enhanced-service start date

Care plan recorded at any point since the enhanced-service start

One-off (per registration)

Code

Name

Who & when to recall

What counts as complete

Cadence

HIGHRISK_UPPERGI

High-risk upper GI cancer screening

Patients aged ≥50 in the upper-GI screening population (GORD/acid suppression, ≥3 PPI/H2RA courses, hiatus hernia, etc.; excludes palliative care, upper-GI cancer, Barrett's, severe frailty) with ≥1 high-risk factor: obese BMI, current/ex-smoker, or family history of oesophageal cancer; not yet assessed.

Screening for oesophageal malignancy recorded, or patient coded not contactable.

Event-based

NELCA_PROSTATE

Prostate screening — PSA or urology referral done

Men aged 50–70, or from 45 with Black or mixed ethnicity or a family history of prostate or breast cancer. Excludes prostate cancer, prostate removal, active palliative care, severe frailty and screening declines

PSA test or two-week-wait urology referral recorded in the last 24 months

Rolling (24 months)

NONHIGHRISK_UPPERGI

Non-high-risk upper GI cancer screening

Same UPPERGI_POP (aged ≥50) patients without those high-risk factors; not yet assessed.

Screening for oesophageal malignancy recorded, or patient coded not contactable.

Event-based

PANCAN_SG1

Pancreatic cancer case finding, weight loss group

Patients aged 60+ at date of new-onset diabetes (NOD) diagnosis, with unexplained weight loss

Pancreatic cancer risk assessment, suspected-cancer code, or 'not contactable' code (on/after 1 Dec 2025) recorded

Event-based

PANCAN_SG1_0426

Pancreatic cancer case finding, with unexplained weight loss (Apr 2026 onwards)

Patients aged 60 or over at the date of new-onset diabetes or HbA1c above 48 mmol/mol, with unexplained weight loss, diagnosed on or after 1 April 2026, within the last 3 years

Pancreatic cancer risk assessment, suspected-cancer code or "not contactable" code recorded

Event-based

PANCAN_SG1_1125to0326

Pancreatic cancer case finding, with unexplained weight loss (Nov 2025 – Mar 2026)

Patients aged 60 or over at the date of new-onset diabetes or HbA1c above 48 mmol/mol, with unexplained weight loss, diagnosed between 1 November 2025 and 31 March 2026

Pancreatic cancer risk assessment, suspected-cancer code or "not contactable" code recorded

Event-based

PANCAN_SG2

Pancreatic cancer case finding — no weight loss recorded

Patients aged 60+, newly diagnosed with NOD, no unexplained weight loss recorded

Pancreatic cancer risk assessment, suspected-cancer code, 'not contactable' code, or weight-declined code (on/after 1 Dec 2025) recorded

Event-based

PANCAN_SG2_0426

Pancreatic cancer case finding, with no weight loss recorded (Apr 2026 onwards)

Patients aged 60 or over at the date of new-onset diabetes or HbA1c above 48 mmol/mol, with no weight loss recorded, diagnosed on or after 1 April 2026, within the last 3 years

Pancreatic cancer risk assessment, suspected-cancer code, weight-declined code or "not contactable" code recorded

Event-based

PANCAN_SG2_1125to0326

Pancreatic cancer case finding, with no weight loss recorded (Nov 2025 – Mar 2026)

Patients aged 60 or over at the date of new-onset diabetes or HbA1c above 48 mmol/mol, with no weight loss recorded, diagnosed between 1 November 2025 and 31 March 2026

Pancreatic cancer risk assessment, suspected-cancer code, weight-declined code or "not contactable" code recorded

Event-based

PCHR001

Prostate cancer screening invitation.

Men aged 45–70; men aged 45–49 only if Black/Caribbean ethnicity or family history of prostate cancer. Excludes screening objections, declines, palliative care, and recent registration (within 3 months).

Screening invitation recorded

Event-based

Code

Name

Who & when to recall

What counts as complete

Cadence

CRM01A

AF case-finding by ECG or pulse rhythm

CRM register patients aged 55+, on the register before 1 Jan 2027, with no atrial fibrillation known before 1 Apr 2026

ECG or pulse-rhythm assessment recorded in the current financial year

Annual

CRM02a

CRM care process — hba1c

Patients on the NWL CRM register

HbA1c value recorded in the 15 months to the end of the QOF year

Annual

CRM02b

CRM care process — blood pressure

Patients on the NWL CRM register

Systolic and diastolic BP reading recorded in the 15 months to the end of the QOF year

Annual

CRM02c

CRM care process — lipids

Patients on the NWL CRM register

Cholesterol or lipid value recorded in the 15 months to the end of the QOF year

Annual

CRM02d

CRM care process — urine acr

Patients on the NWL CRM register

Urine ACR value recorded in the 15 months to the end of the QOF year

Annual

CRM02e

CRM care process — egfr

Patients on the NWL CRM register

eGFR value recorded in the 15 months to the end of the QOF year

Annual

CRM02f

CRM care process — bmi

Patients on the NWL CRM register

BMI value recorded in the 15 months to the end of the QOF year

Annual

CRM02g

CRM care process — waist circumference

Patients on the NWL CRM register

Waist circumference value recorded in the 15 months to the end of the QOF year

Annual

CRM02h

CRM care process — smoking status

Patients on the NWL CRM register

Smoking status code recorded in the 15 months to the end of the QOF year

Annual

CRM02i

CRM care process — mental health screen

Diabetic patients on the NWL CRM register

Depression and anxiety screen (PHQ plus GAD, or PHQ-4) recorded in the 15 months to the end of the QOF year

Annual

CRM02j

CRM care process — foot check

Diabetic patients on the NWL CRM register

Left and right foot-check codes both recorded in the 15 months to the end of the QOF year

Annual

CRM02k

CRM care process — retinal screening

Diabetic patients on the NWL CRM register

Retinal screening recorded in the 27 months to the end of the QOF year

27-monthly

CRM02l

CRM care process — FIB-4 score

Diabetic or MASLD patients on the NWL CRM register

FIB-4 fibrosis score recorded in the 39 months to the end of the QOF year

39-monthly

CRM03 🎯

BP control, CKD / diabetes / hypertension

CRM register patients on the CKD, diabetes or hypertension register

Latest BP at or below the target that applies to the patient

Annual

CRM03a 🎯

BP control ≤130/80, under 80 and not frail

CRM register patients under 80, not frail, on the CKD, diabetes or hypertension register

Latest BP in the 15 months to the quality-service end date at or below 130/80

Annual

CRM03b 🎯

BP control ≤150/90, 80+ or frail

CRM register patients aged 80+, or frail, on the CKD, diabetes or hypertension register

Latest BP in the 15 months to the quality-service end date at or below 150/90

Annual

CRM04 🆕

Moderate or high-intensity statin

On the CKD, stroke/TIA, CHD, PAD, diabetes or heart failure register; or on the AF, hypertension, NDH or MASLD register with QRISK above 10%

Moderate- or high-intensity statin issued within 6 months of the QOF year end

Annual

CRM05 🆕

ACE inhibitor or ARB for kidney disease

On the CKD register with a raised urine ACR; or on the diabetes register with a raised urine ACR or reduced eGFR

ACE inhibitor or ARB issued in the 6 months before the QOF year end

Annual

CRM06 🆕

SGLT-2 inhibitor

Patients aged 17–79, not moderately or severely frail, with qualifying CKD by eGFR/uACR band, type 2 diabetes, or on the heart failure register

SGLT-2 inhibitor issued in the 6 months before the QOF year end

Annual

CRM10 🎯

Diabetes — all three treatment targets

Patients on the QOF diabetes register

Latest HbA1c, BP and non-HDL cholesterol in the 15 months to the quality-service end date all at or below target, relaxed for frail or elderly patients

Annual

CRM10a 🎯

Diabetes — HbA1c target

Patients on the QOF diabetes register

Latest HbA1c in the 15 months to the quality-service end date at or below the applicable target

Annual

CRM10b 🎯

Diabetes — blood pressure target

Patients on the QOF diabetes register

Latest BP in the 15 months to the quality-service end date at or below the applicable target

Annual

CRM10c 🎯

Diabetes — non-HDL target

Patients on the QOF diabetes register

Latest non-HDL cholesterol in the 15 months to the quality-service end date at or below the applicable target

Annual

CRM11 🎯🆕

Newly diagnosed diabetes, HbA1c ≤48

Patients aged 17–70 on the diabetes register, first diagnosed in the last 2 years

Latest HbA1c in the 15 months to the achievement date at or below 48 mmol/mol

Annual

CRM12 🎯🆕

BP control, Black / Black British hypertensives

Patients aged 79 or under on the hypertension register with Black or Black British ethnicity recorded

Latest clinic BP in the last 12 months at or below 130/80, or latest home/ambulatory reading at or below 125/75

Annual

Code

Name

Who & when to recall

What counts as complete

Cadence

CD001 🎯

BP control, CHD/stroke/TIA, aged ≤79

CHD, stroke or TIA patients aged 79 or under, without moderate/severe frailty, with BP ≤140/90.

a BP within range is recorded

Annual

CD002 🎯

BP control, CHD/stroke/TIA, aged ≥80

CHD, stroke or TIA patients aged 80 or over, without moderate/severe frailty, with BP ≤150/90.

a BP within range is recorded

Annual

Code

Name

Who & when to recall

What counts as complete

Cadence

AF006

Stroke risk assessment

AF patients with no CHA₂DS₂-VASc score in the last 12m

CHA₂DS₂-VASc score recorded

Annual

AF008

Anticoagulants for high-risk AF

AF patients with CHA₂DS₂-VASc ≥2 and no anticoagulant prescribed

Anticoagulant (DOAC or warfarin) prescription recorded

One-off (until prescribed)

Code

Name

Who & when to recall

What counts as complete

Cadence

CHD005

Antiplatelets or anticoagulants

Patients on the CHD register with no antiplatelet / anticoagulant prescribed

Aspirin, clopidogrel, or anticoagulant prescription recorded

One-off (until prescribed)

CHD015 🎯

BP control (age ≤79)

CHD patients aged 79 or under, no BP ≤140/90 in last 12m

BP ≤140/90 mmHg recorded

Annual

CHD016 🎯

BP control (age 80+)

CHD patients aged 80+, no BP ≤150/90 in last 12m

BP ≤150/90 mmHg recorded

Annual

Code

Name

Who & when to recall

What counts as complete

Cadence

HF003

ACE-I or ARB for LVSD

Patients with HF due to LVSD, no ACE-I or ARB prescribed

ACE-I or ARB prescription recorded

One-off (until prescribed)

HF006

Beta-blocker for LVSD

Patients with HF due to LVSD, no licensed beta-blocker prescribed

Licensed beta-blocker (e.g. bisoprolol, carvedilol) prescription recorded

One-off (until prescribed)

HF007

Annual HF review

Patients on the HF register, no review in last 12m

HF review and medication review (HF-specific or generic med review) both recorded in the last 12 months.

Annual

HF008

HF diagnosis confirmation

Patients with a new HF diagnosis on or after 1 April 2023 with no echo or specialist assessment recorded in the 6m before the diagnosis (or, if registered after diagnosis, no echo/specialist assessment within 6m of registration)

Echocardiogram or specialist assessment recorded

Event-based (per diagnosis)

Code

Name

Who & when to recall

What counts as complete

Cadence

BP002

BP check (age ≥45)

Patients aged 45+ with no BP recorded in last 5 years

Blood pressure recorded

Every 5 years

HYP010 🎯

BP control – hypertension, no frailty (age ≤79)

Hypertensive patients aged ≤79, without moderate or severe frailty, no BP ≤140/90 recorded

BP ≤140/90 mmHg recorded

Annual

HYP011 🎯

BP control – hypertension, no frailty (age 80+)

Hypertensive patients aged 80+, without moderate or severe frailty, no BP ≤150/90 recorded

BP ≤150/90 mmHg recorded

Annual

Code

Name

Who & when to recall

What counts as complete

Cadence

STIA007

Antiplatelets or anticoagulants

Stroke/TIA patients with no antiplatelet / anticoagulant prescribed

Aspirin, clopidogrel, dipyridamole, ticagrelor, or anticoagulant prescription recorded

One-off (until prescribed)

STIA014 🎯

BP control (age ≤79)

Stroke/TIA patients aged ≤79, no BP ≤140/90 in last 12m

BP ≤140/90 mmHg recorded

Annual

STIA015 🎯

BP control (age 80+)

Stroke/TIA patients aged 80+, no BP ≤150/90 in last 12m

BP ≤150/90 mmHg recorded

Annual

Code

Name

Who & when to recall

What counts as complete

Cadence

CS005

Cervical screening (ages 25–49)

Women aged 25–49 with no smear recorded in last 3 years

Cervical screening recorded within the last 3y6m

Every 3y6m

CS006

Cervical screening (ages 50–64)

Women aged 50–64 with no smear recorded in last 5 years

Cervical screening recorded within the last 5y6m

Every 5y6m

HIPPO_CS005

Cervical screening 25–49, third-invite variant

Women aged 25 to 49. Unlike CS005, patients are excluded once a third screening invitation has been recorded within the current round

Cervical screening test in the last 3 years and 6 months

3.5-yearly

HIPPO_CS006

Cervical screening 50–64, third-invite variant

Women aged 50 to 64. Unlike CS006, patients are excluded once a third screening invitation has been recorded within the current round

Cervical screening test in the last 5 years and 6 months

5.5-yearly

Code

Name

Who & when to recall

What counts as complete

Cadence

12WEEK_IMMS

12-week immunisations

Children aged 12–16 weeks

12-week schedule complete

One-off (age trigger)

16WEEK_IMMS

16-week immunisations

Children aged 16–20 weeks

16-week schedule complete

One-off (age trigger)

18M_MMR

18-month MMR (2nd dose)

Children >18 months, born on/after 01/07/2024

2nd MMR dose recorded

One-off (age trigger)

1Y_IMMS

1-year boosters

Children aged 1–2

1st MMR, MenB booster, PCV booster recorded

One-off (age trigger)

1Y_IMMS_CATCHUP

1-year catch-up

Children aged 2–9 with incomplete 1-year imms

Outstanding 1-year imms recorded

One-off catch-up

3Y4M_OLDSCHEDULE_CATCHUP

Old-schedule catch-up (ages 6–10)

Children aged 6–9 missing MMR2 and/or DTaP/IPV booster

2 MMR doses + DTaP/IPV booster recorded before age 10

One-off catch-up

8WEEK_IMMS

8-week immunisations

Children aged 8–12 weeks (registered)

1st DTaP, 1st MenB, 1st Rotavirus all recorded (or coded exclusion)

One-off (age trigger)

PRIMARY_IMMS

Primary imms

Children >20 weeks and <2 years

Full primary schedule recorded

One-off (age trigger)

PRIMARY_IMMS_CATCHUP

Primary imms catch-up

Older children with incomplete primary imms

Outstanding primary imms recorded

One-off catch-up

RUNOFF_3Y4M_MMRandDTaP

Legacy run-off cohort

Closing out the old 3y4m cohort

2 MMR + DTaP/IPV booster recorded

One-off catch-up

VI001

QOF DTaP – 8-month check

Children aged 8–20 months on search date, no DTaP3 recorded by 248 days, not registered too late

3rd DTaP dose recorded before 248 days of age

One-off (age trigger)

VI002

QOF MMR – 18-month check

Children crossing 18 months, no MMR1 recorded by 558 days

1st MMR dose recorded before 558 days of age

One-off (age trigger)

VI003

QOF Five-year booster check

Children aged 5, missing 2nd MMR and/or DTaP/IPV booster

Both 2nd MMR and DTaP/IPV booster recorded before age 5

One-off (age trigger)

Code

Name

Who & when to recall

What counts as complete

Cadence

CHOL003

Statin prescription

Do not start this campaign before October. There is no payment benefit earlier in the year.

Patients on the CHD, PAD, stroke/TIA, or CKD stage 3+ register (age 18+ for CKD), excluding those also on the unresolved diabetes register (they're handled by DM034/DM035 instead), with no statin prescribed

Statin (e.g. atorvastatin) prescription recorded

One-off (until prescribed)

CHOL004 🎯

Cholesterol control

Patients on the CHD, PAD, or stroke/TIA register (excludes haemorrhagic stroke) with no cholesterol test in the last 12 months, or with a result above target (LDL ≤2.0 mmol/L, or non-HDL ≤2.6 mmol/L if LDL not available)

Cholesterol test recorded with result within target range

Annual

Code

Name

Who & when to recall

What counts as complete

Cadence

CKD_BP

BP monitoring

Patients on the CKD register

BP within the NICE target for the patient, recorded this QOF year

Annual

CKD_CHOL

Statin or lipid-lowering therapy

Patients on the CKD register

Statin or other lipid-lowering therapy recorded this QOF year

Annual

CKD_EGFR

eGFR monitoring

Patients on the CKD register

eGFR recorded within the NICE monitoring interval for the patient’s CKD stage

Risk-based (NICE interval)

CKD_UACR

Urine ACR monitoring

Patients on the CKD register

Urine ACR recorded within the NICE monitoring interval for the patient’s CKD stage

Risk-based (NICE interval)

Code

Name

Who & when to recall

What counts as complete

Cadence

COPD010

COPD annual review

Patients on the COPD register, no review in last 12m

COPD review, exacerbation count, and MRC scale all recorded in the last 12 months.

Annual

COPD014 💰

Pulmonary rehab offer

COPD patients with MRC score ≥3, not previously offered rehab

Offer of referral to pulmonary rehab recorded

One-off (per MRC trigger)

HLTC_COPD_RVW

COPD annual review (NICE)

Patients on the COPD register with no COPD-specific or general LTC review recorded this financial year

Annual review recorded — accepted SNOMED code: 394703002 (or any GEN_RVW code)

Annual

Code

Name

Who & when to recall

What counts as complete

Cadence

COVID_SPRING_ENHANCED_001 🍂

COVID spring booster, 75 and over

Patients aged 75 or over

COVID-19 booster this spring

Seasonal

COVID_SPRING_ENHANCED_003 🍂

COVID spring booster, immunocompromised

Immunocompromised patients

COVID-19 booster this spring

Seasonal

COVID_WINTER_ENHANCED_001

Winter booster – aged 75+

Patients aged 75+ at PPED (31/01/2026) with no booster recorded in the last 4 months

COVID vaccine recorded in the 4 months prior to winter PPED

Seasonal (autumn/winter)

COVID_WINTER_ENHANCED_003

Winter booster – immunocompromised

Patients <75 at PPED who are immunocompromised per Green Book 25/26: persistent immunosuppression (and not since resolved), immunodeficiency, solid organ transplant, immunosuppressive drugs in last 12m, or chemo/radiotherapy in last 6m

COVID vaccine recorded in the 4 months prior to winter PPED (31/01/2026)

Seasonal (autumn/winter)

Code

Name

Who & when to recall

What counts as complete

Cadence

CQCAZA001

Azathioprine monitoring

Patients issued azathioprine in last 6m

FBC + U&Es + LFTs all recorded in last 12 weeks

Continuous

CQCLEF001

Leflunomide monitoring

Patients issued leflunomide in last 6m

FBC + U&Es + LFTs + BP + weight all recorded in last 12 weeks

Continuous

CQCMET001

Methotrexate monitoring

Patients issued methotrexate in last 6m

FBC + U&Es + LFTs all recorded in last 12 weeks

Continuous

Code

Name

Who & when to recall

What counts as complete

Cadence

CQCDOAC000

DOAC – weight recorded

All patients on a DOAC

Weight recorded in last 12m

Continuous

CQCDOAC001A

DOAC – serum creatinine ever recorded

All patients on a DOAC

Serum creatinine recorded at least once

Continuous

CQCDOAC001B

DOAC – CrCl calculable, ever

DOAC patients with weight (last 12m) + serum creatinine

Creatinine clearance recorded at least once

Continuous

CQCDOAC002A

DOAC – serum creatinine in last 12m

All patients on a DOAC

Serum creatinine recorded in last 12m

Continuous

CQCDOAC002B

DOAC – CrCl calculable in last 12m

DOAC patients with weight + serum creatinine in last 12m

Creatinine clearance recorded in last 12m

Continuous

CQCDOAC003A

DOAC + CKD4/5 – serum creatinine in last 3m

DOAC patients with current CKD4/5

Serum creatinine recorded in last 3m

Continuous

CQCDOAC003B

DOAC + CKD4/5 – CrCl calculable in last 3m

DOAC + CKD4/5 patients with weight (12m) + serum creatinine (3m)

Creatinine clearance recorded in last 3m

Continuous

CQCDOAC004A

DOAC + CKD3 – serum creatinine in last 6m

DOAC patients with current CKD3

Serum creatinine recorded in last 6m

Continuous

CQCDOAC004B

DOAC + CKD3 – CrCl calculable in last 6m

DOAC + CKD3 patients with weight (12m) + serum creatinine (6m)

Creatinine clearance recorded in last 6m

Continuous

CQCDOAC006

DOAC – low-Hb anticoag review

DOAC patients whose last Hb was <90

Anticoagulation review recorded after the low-Hb result

Event-based (per low Hb)

CQCDOAC007

DOAC – appropriate kidney function

All patients on a DOAC

CrCl ≥30 if on dabigatran; CrCl ≥15 otherwise

Continuous

CQCDOAC008A 🆕

DOAC, CrCl 15–29 — full blood count

Patients on a DOAC whose most recent creatinine clearance, recorded in the last 12 months, is 15 to 29 mL/min

Full blood count recorded in the last 12 months

Continuous

CQCDOAC008B 🆕

DOAC, CrCl 15–29 — liver function test

Patients on a DOAC whose most recent creatinine clearance, recorded in the last 12 months, is 15 to 29 mL/min

Liver function test recorded in the last 12 months

Continuous

CQCDOAC008C 🆕

DOAC, CrCl 15–29 — urea and electrolytes

Patients on a DOAC whose most recent creatinine clearance, recorded in the last 12 months, is 15 to 29 mL/min

Urea and electrolytes recorded in the last 3 months

Continuous

CQCDOAC009A 🆕

DOAC, CrCl 30–59 — full blood count

Patients on a DOAC whose most recent creatinine clearance, recorded in the last 12 months, is 30 to 59 mL/min

Full blood count recorded in the last 12 months

Continuous

CQCDOAC009B 🆕

DOAC, CrCl 30–59 — liver function test

Patients on a DOAC whose most recent creatinine clearance, recorded in the last 12 months, is 30 to 59 mL/min

Liver function test recorded in the last 12 months

Continuous

CQCDOAC009C 🆕

DOAC, CrCl 30–59 — urea and electrolytes

Patients on a DOAC whose most recent creatinine clearance, recorded in the last 12 months, is 30 to 59 mL/min

Urea and electrolytes recorded in the last 6 months

Continuous

CQCDOAC010A 🆕

DOAC, CrCl 60+ — full blood count

Patients on a DOAC whose most recent creatinine clearance, recorded in the last 12 months, is 60 mL/min or above

Full blood count recorded in the last 12 months

Continuous

CQCDOAC010B 🆕

DOAC, CrCl 60+ — liver function test

Patients on a DOAC whose most recent creatinine clearance, recorded in the last 12 months, is 60 mL/min or above

Liver function test recorded in the last 12 months

Continuous

CQCDOAC010C 🆕

DOAC, CrCl 60+ — urea and electrolytes

Patients on a DOAC whose most recent creatinine clearance, recorded in the last 12 months, is 60 mL/min or above

Urea and electrolytes recorded in the last 12 months

Continuous

Code

Name

Who & when to recall

What counts as complete

Cadence

CQC_MISDIAG_CKD

Missed CKD diagnosis

Patients with most recent eGFR <60 plus a 2nd low eGFR in last 2 years, no CKD diagnosis coded

CKD-resolved code, CKD 1–2 code, or CKD 3–5 diagnosis recorded after the diagnostic result

Continuous

CQC_MISDIAG_DM

Missed diabetes diagnosis

Patients with two HbA1c results ≥48 mmol/mol in last 2 years, no diabetes diagnosis coded

DM-resolved, prediabetes (after the diagnostic result), gestational/steroid-induced DM (last 12m), haemoglobinopathy, or current DM diagnosis recorded

Continuous

Code

Name

Who & when to recall

What counts as complete

Cadence

CQCACEARB001

ACE-I / ARB – kidney function

All patients on ACE-I or ARB

U&Es (creatinine or eGFR) recorded in last 12m

Continuous

CQCALDANT001

Aldosterone antagonist + HF – kidney function

Patients on spironolactone/eplerenone with current HF (not resolved)

U&Es recorded in last 6m

Continuous

CQCAMIODERONE001

Amiodarone – kidney / liver / thyroid

All patients on amiodarone

U&Es + LFTs + TFTs all recorded in last 6m

Continuous

CQCLI001

Lithium – level monitoring

All patients on lithium

Lithium level recorded in last 3m

Continuous

CQCLI002

Lithium – calcium / kidney / thyroid

All patients on lithium

U&Es + calcium + thyroid function all recorded in last 6m

Continuous

CQCMETFORMIN001

Metformin – kidney function

All patients on metformin

eGFR recorded in last 12m

Continuous

CQCMETFORMIN002

Metformin – satisfactory kidney function

Metformin patients with an eGFR in last 12m

Most recent eGFR ≥30

Continuous

CQCWARFARIN001

Warfarin – INR monitoring

All patients on warfarin

INR recorded in last 3m, or patient flagged as INR self-monitor in last 12m

Continuous

CQCWARFARIN002

Warfarin – high INR review

Warfarin patients with one INR >8 in last 6m, or two INR >5 in last 6m

Anticoagulation review recorded after the triggering high INR

Event-based (per high INR)

CQC_HYPO

Hypothyroidism: TSH monitoring

Patients issued thyroid replacement therapy in the last 12 months without a TSH in the last 12 months.

TSH result recorded in the last 12 months.

Continuous

Code

Name

Who & when to recall

What counts as complete

Cadence

CQCSAFETYALERT001

Hydrochlorothiazide – skin cancer info

Patients prescribed hydrochlorothiazide in last 6m

Skin cancer risk information recorded after first HCTZ issue

Continuous

CQCSAFETYALERT002

High-dose SSRI in 65+

Patients aged 65+ issued high-dose SSRI (citalopram 40mg or escitalopram 20mg) in last 3m

Medication review in last 3m

Continuous

CQCSAFETYALERT003

Clopidogrel + PPI interaction

Patients issued clopidogrel and omeprazole/esomeprazole in last 3m

Medication review in last 3m

Continuous

CQCSAFETYALERT004

Febuxostat with CVD

Patients issued febuxostat in last 3m and with PAD/CHD/stroke/TIA

Medication review in last 3m

Continuous

CQCSAFETYALERT005

Fentanyl patch started without prior opioid

Patients started on fentanyl patch in last 12m, no other opioid in the 3m before

Medication review since starting the fentanyl patch

Event-based (per new start)

CQCSAFETYALERT006

Mirabegron – BP monitoring

Patients issued mirabegron in last 3m

BP recorded in last 12m

Continuous

CQCSAFETYALERT008

SGLT-2i – ketoacidosis & Fournier's education

Patients issued an SGLT-2 inhibitor in last 6m

Ketoacidosis education and Fournier's gangrene education recorded after SGLT-2i start

Continuous

CQCSAFETYALERT009

Simvastatin 40/80mg + CYP3A4 CCB

Patients issued simvastatin 40/80mg and amlodipine/diltiazem/verapamil in last 3m

Medication review in last 3m

Continuous

CQCSAFETYALERT010

Teratogenic drugs in women of childbearing potential

Female patients aged 8–<55 issued teratogenic drugs in last 3m, no confirmed infertility

Medication review in last 3m

Continuous

Code

Name

Who & when to recall

What counts as complete

Cadence

DEM004

Face-to-face dementia review

Patients with dementia and no care plan review in last 12m

Face-to-face care plan review covering physical, mental, social needs

Annual

Code

Name

Who & when to recall

What counts as complete

Cadence

HIPPODM8CP001a

HbA1c

Diabetics with no HbA1c in last 12m

HbA1c result recorded

Annual

HIPPODM8CP001b

Blood Pressure

Diabetics with no BP in last 12m

BP recorded

Annual

HIPPODM8CP001c

Cholesterol

Diabetics with no serum cholesterol in last 12m

Cholesterol result recorded

Annual

HIPPODM8CP001d

Creatinine

Diabetics with no creatinine in last 12m

Creatinine result recorded

Annual

HIPPODM8CP001e

Urine ACR

Diabetics with no albumin:creatinine ratio in last 12m

ACR result recorded

Annual

HIPPODM8CP001f

Foot Check

Diabetics with no foot check or risk score in last 12m

Foot check + risk score recorded

Annual

HIPPODM8CP001g

BMI

Diabetics with no BMI in last 12m

BMI recorded

Annual

HIPPODM8CP001h

Smoking Status

Diabetics with no smoking status in last 12m

Smoking status recorded

Annual

Code

Name

Who & when to recall

What counts as complete

Cadence

DM006

ACE-I/ARB for microalbuminuric diabetics

Diabetics with microalbuminuria/proteinuria, no ACE-I/ARB prescribed

ACE-I or ARB prescription recorded

One-off (until prescribed)

DM012

Foot examination

Diabetics with no foot check in last 12m

Foot exam with risk classification recorded

Annual

DM014

Diabetes education referral

Newly diagnosed diabetics with no referral to structured education

Referral to structured education recorded

One-off (per diagnosis)

DM020 🎯

HbA1c control (non-frail)

Non-frail diabetics with HbA1c >58 mmol/mol in last 12m

HbA1c ≤58 mmol/mol recorded

Annual

DM021 🎯

HbA1c control (frail)

Frail diabetics with HbA1c >75 mmol/mol

HbA1c ≤75 mmol/mol recorded

Annual

DM034

Statins for diabetics (no CVD, no frailty)

Diabetics aged ≥40 with no CVD, no moderate/severe frailty, not on a statin (excludes type 2 with CVD risk <10% in last 3 years)

Statin prescription recorded (or alternative lipid-lowering therapy if statin declined/clinically unsuitable)

One-off (until prescribed)

DM035

Statins for diabetics with CVD

Diabetics with CVD (excluding haemorrhagic stroke) and no statin

Statin prescription recorded (or alternative lipid-lowering therapy if statin declined/clinically unsuitable)

One-off (until prescribed)

DM036 🎯

BP control – diabetes (age ≤79, non-frail)

Diabetics aged ≤79 without moderate/severe frailty, no BP ≤140/90 in last 12m

BP ≤140/90 mmHg recorded (clinic) — equivalent HBPM target 135/85

Annual

DM037

Diabetes 8 care processes (combined)

Diabetics missing one or more of the 8 care processes (BMI, BP, HbA1c, cholesterol, smoking status, foot check, eGFR, urine ACR)

Relevant care recorded as above

Annual/One-off

Code

Name

Who & when to recall

What counts as complete

Cadence

HIPPO_ECG_HF

Heart Failure: ECG in the last 12 months

Patients on the heart failure register (unresolved), missing ECG

ECG in last 12 months

Annual

HIPPO_ECG_HYP

Hypertension: ECG in the last 3 years

Patients on the hypertension register (unresolved), missing ECG

ECG in last 3 years

Every 3 years

HIPPO_ECG_SMI

SMI: ECG in last 12 months

Patients on the SMI register (not in remission), missing ECG

ECG in last 12 months

Annual

Code

Name

Who & when to recall

What counts as complete

Cadence

HIPPOFIT001

Patients with FIT results outstanding

Patients provisioned a FIT test with no result recorded yet

FIT result recorded after kit provision accepted.

Event-based (7 days after provision)

HIPPOFIT002

Patients with failed FIT outcomes

Patients with an accepted, non-declined FIT provision who don't yet have a failed FIT outcome recorded

Failed FIT outcome code recorded post-provision.

Event-based

HIPPOFIT003

FIT provisioned code review

Patients who should have had a FIT-provisioned code recorded but didn't

FIT provision code recorded where a result exists but provision is missing.

Event-based

HIPPOFIT004

Post-FIT safety netting survey

Patients whose FIT safety-netting pathway has started

Survey sent/recorded

Event-based (~21 days after pathway start)

Code

Name

Who & when to recall

What counts as complete

Cadence

VI01W26 🍂

Flu, 65 and over (enhanced)

Patients aged 65 or over

Seasonal flu vaccination this campaign

Seasonal

VI02W26 🍂

Flu, at-risk adults (enhanced)

At-risk patients

Seasonal flu vaccination this campaign

Seasonal

VI03W26 🍂

Flu, children aged 2–3 (enhanced)

Children aged 2 to 3. At-risk children are handled by VI04W26 and are not counted here

Seasonal flu vaccination this campaign

Seasonal

VI04W26 🍂🆕

Flu, at-risk children

At-risk children aged 6 months to under 18

Seasonal flu vaccination this campaign

Seasonal

Code

Name

Who & when to recall

What counts as complete

Cadence

HPV_18TO24_CATCHUP

HPV catch-up (ages 18–24)

Females aged 18–24. Males aged 18–24 born on/after 01/09/2006.

HPV vaccination recorded

One-off catch-up

Code

Name

Who & when to recall

What counts as complete

Cadence

HI-03

Annual health check (LD), aged 14+

LD patients aged ≥14 on the LD register with no health check and action plan recorded in the current year

Health check completed and recorded, including an action plan and an ethnicity code on file

Annual

Code

Name

Who & when to recall

What counts as complete

Cadence

HLTC_AF_RVW

AF patients receiving annual review

Patients on the AF register (AFIBLAT, not resolved), no review or general LTC review recorded this FY

Annual review recorded — accepted SNOMED codes: 713678009, 248411000000105, 793851000000102, 735259005, 735258002 (or any GEN_RVW code)

—

HLTC_AST_RVW

Asthma patients receiving annual review

Patients on the asthma register, no asthma or general LTC review recorded this FY

Annual review recorded — accepted SNOMED codes: 394700004, 390872009, 390878008, 390877003, 394701000, 754061000000100, 401182001, 401183006, 394720003, 270442000 (or any GEN_RVW code)

—

HLTC_CARDIO_NO_DM_RVW

CVD patients without diabetes, reviewed

Patients in HLTC_CARDIO_RVW but not in HLTC_DM_RVW

Must also be in the numerator for the CVD review indicator

—

HLTC_CHD_RVW

CHD patients receiving annual review

Patients on the CHD register, no CHD or general LTC review recorded this FY

Annual review recorded — accepted SNOMED code: 315614006 (or any GEN_RVW code)

—

HLTC_DM_RVW

Diabetes patients receiving annual review

Patients on the diabetes register, no diabetes or general LTC review recorded this FY

Annual review recorded — accepted SNOMED codes: 170777000, 887861000000105, 1842001000006102 (or any GEN_RVW code)

—

HLTC_HF_RVW

Heart failure patients receiving review

Patients on the HF register, no HF or general LTC review recorded this FY

Annual review recorded — accepted SNOMED codes: 134378009, 390885007, 202231000000106, 872361000000105, 247361000000100, 810971000000105, 813991000000101, 851071000000108, 871681000000102 (or any GEN_RVW code)

—

HLTC_HYP_RVW

Hypertension patients receiving review

Patients on the hypertension register, no hypertension or general LTC review recorded this FY

Annual review recorded — accepted SNOMED code: 401118009 (or any GEN_RVW code). A simple BP reading on its own won't complete this indicator — the actual hypertension annual review code must be recorded in EMIS.

—

HLTC_MH_RVW

Mental health patients reviewed

Patients on the SMI register, no MH or general LTC review recorded this FY

Annual review recorded — accepted SNOMED codes: 408404002, 401061005, 867871000000100 (or any GEN_RVW code)

—

HLTC_NDH_RVW

NDH patients reviewed

Adults on the NDH (pre-diabetes) register, no NDH or general LTC review recorded this FY. Excludes patients with current diabetes diagnosis.

Recent HbA1c or fasting glucose result counts — accepted SNOMED codes: 999791000000106, 1049301000000100, 1049321000000109, 1003141000000105, 58111000237107 (or any GEN_RVW code). Note: lab result codes, not just review codes

—

HLTC_PAD_RVW

PAD patients receiving review

Patients with PAD diagnosis (not excluded), no PAD or general LTC review recorded this FY

Annual review or recent lipid result counts — accepted SNOMED codes: 1696201000006100 (PAD annual review), 1006191000000100, 1030411000000100, 1102851000000100, 1010591000000100, 1022191000000100, 1028851000000100, 1108541000000100, 1108551000000100, 1014501000000100, 1026471000000100, 1026481000000100, 1028861000000100 (or any GEN_RVW code)

—

HLTC_STIA_RVW

Stroke/TIA patients receiving review

Patients on the stroke/TIA register, no STIA or general LTC review recorded this FY

Annual review recorded — accepted SNOMED code: 699270006 (or any GEN_RVW code)

—

Code

Name

Who & when to recall

What counts as complete

Cadence

MH002

Care plan review

Patients with psychosis/bipolar and no care plan in last 12m

Care plan review covering physical and mental health needs

Annual

MH003

Blood Pressure

SMI patients with no BP in last 12m

BP recorded

Annual

MH006

BMI

SMI patients with no BMI in last 12m

BMI recorded

Annual

MH007

Alcohol

SMI patients with no alcohol use recorded in last 12m

Alcohol use recorded

Annual

MH011

Lipids

Patients on the mental health register without a lipid profile in the last 12 months (high-risk group: on antipsychotics, or with CHD/stroke/TIA/PAD/CKD3+/FH hypertension/DM, current smoker, or BMI ≥23 Asian / ≥25 other" with "BMI ≥23 for non-White ethnicity (incl. unrecorded ethnicity) / ≥25 for White ethnicity or last 24 months (lower-risk group: none of the above).

Lipid profile recorded

Annual (high-risk group) / Every 2 years (lower-risk group)

MH012

HbA1c

SMI patients with no HbA1c in last 12m

HbA1c or blood glucose result recorded

Annual

MH021 💰

SMI annual health check (all 6)

SMI patients missing ≥1 of: BP, BMI, alcohol, smoking, lipids, HbA1c

All 6 checks completed and recorded in last 12m

Annual

Code

Name

Who & when to recall

What counts as complete

Cadence

HIPPONHSHC001

Overall coverage

Patients aged 40–74 with no NHS HC in last 5 years, not already on the CHD/CKD/diabetes/hypertension/AF/stroke-TIA registers, without familial hypercholesterolaemia/HF/PAD, without a statin issued or a CVD risk score >20 in the last 12 months, and not already mid-check

NHS Health Check 'complete' code recorded

Every 5 years

HIPPONHSHC002

Current-year invite

Patients eligible this year, no check recorded yet

NHS HC recorded during the current financial year

Per FY

HIPPONHSHC002a

BP (NHS HC)

NHS HC patients this year with no BP recorded

BP reading recorded

Per FY

HIPPONHSHC002b

BMI (NHS HC)

NHS HC patients with no BMI recorded

BMI recorded

Per FY

HIPPONHSHC002c

Cholesterol (NHS HC)

NHS HC patients with no total cholesterol recorded

Cholesterol result recorded

Per FY

HIPPONHSHC002d

HbA1c (NHS HC)

NHS HC patients with no HbA1c recorded

HbA1c result recorded

Per FY

HIPPONHSHC002e

All components completed

NHS HC patients who have had BP, BMI, cholesterol, and HbA1c all recorded in the last 12 months, but with no formal NHS HC event code yet

Formal NHS HC event code recorded

Per FY

Code

Name

Who & when to recall

What counts as complete

Cadence

HIPPOPNEU001A

Lifetime pneumococcal vaccine, 65 and over

Patients aged 65 or over

Pneumococcal vaccination recorded at any time after age 2

One-off (age trigger)

HIPPOPNEU001B

Pneumococcal vaccine this year, 65 and over

Patients aged 65 or over with no previous pneumococcal vaccination

Pneumococcal vaccination recorded this QOF year

Annual

HIPPOPNEU002A

Lifetime pneumococcal vaccine, at-risk 2–64

At-risk patients aged 2 to 64

Pneumococcal vaccination recorded at any time after age 2

One-off (until vaccinated)

HIPPOPNEU002B

Pneumococcal vaccine this year, at-risk 2–64

At-risk patients aged 2 to 64 with no previous pneumococcal vaccination

Pneumococcal vaccination recorded this QOF year

Annual

Code

Name

Who & when to recall

What counts as complete

Cadence

NDH002

Blood glucose monitoring

Patients aged 18+ on the non-diabetic hyperglycaemia (NDH) register with no HbA1c or fasting plasma glucose recorded in the last 12 months

HbA1c or FPG result recorded

Annual

NDH003

Blood glucose monitoring

As above, + patients with a history of gestational diabetes

HbA1c or FPG result recorded

Annual

Code

Name

Who & when to recall

What counts as complete

Cadence

OB004

Obesity: referral to weight management

Adults with obesity not yet referred to a weight management programme within 90 days of the BMI being recorded

Referral to weight management programme

Annual

OB005

Obesity: shared decision-making discussion

Eligible patients not yet offered a shared decision-making discussion, NICE-approved medicines management and referral to a behavioural support programme

Shared decision-making discussion, weight-management pharmacotherapy offer, and behavioural support programme referral all recorded in the current QOF year.

Annual

SMOK002

Smoking status – at-risk patients

LTC patients (asthma, COPD, diabetes, CVD, SMI, etc.) with no status recorded in last 12m

Smoking status recorded

Annual

SMOK004

Cessation offer – general smokers

Patients aged 15+ who smoke and have had no cessation offer in last 24m

Smoking cessation advice or referral recorded

Every 24 months

SMOK005 💰

Cessation offer – at-risk smokers

Smokers with LTCs (diabetes, CVD, COPD, SMI, etc.) and no cessation offer in last 12m

Cessation support offer recorded

Annual

Code

Name

Who & when to recall

What counts as complete

Cadence

RSV001

RSV – older adult routine

Patients aged ≥75 with no RSV vaccine; rejects contraindications and 12m declines

RSV vaccine recorded

One-off (age 75 trigger)

Code

Name

Who & when to recall

What counts as complete

Cadence

HIPPOSHING_CX_01

Shingrix dose 1 (immunocompromised, 18+)

Patients aged ≥18 flagged by practice as 'requires shingles vaccine' (REQSHVAC code)

1st Shingrix dose recorded

One-off (until vaccinated)

HIPPOSHING_CX_02

Shingrix dose 2 (immunocompromised, 18+)

Same cohort as CX_01 with 1st Shingrix recorded ≥8 weeks (56 days) ago

2nd Shingrix dose recorded ≥8 weeks after 1st

Dose-dependent (≥8w after dose 1)

HIPPOSHING_IC_01

Shingrix dose 1 (immunocompetent)

Immunocompetent patients in the eligible shingles cohort, catch-up extended to age 80. Programme ends 31 Aug 2028.

First Shingrix dose recorded

One-off (until vaccinated)

HIPPOSHING_IC_02

Shingrix dose 2 (immunocompetent)

Same cohort as IC_01 (catch-up extended to age 80) with 1st Shingrix recorded ≥6 months ago. Programme ends 31 Aug 2028.

2nd Shingrix dose recorded ≥8 weeks after 1st

Dose-dependent (≥6m after dose 1)

VI004

Shingles vaccine (ages 70–79)

Patients who turn 80 in the reporting year (or 81 with specific first-dose timing rules) without a shingles vaccination recorded between ages 70–79

Shingles vaccine recorded (GP, other healthcare provider, or second-dose code)

One-off

Code

Name

Who & when to recall

What counts as complete

Cadence

HIPPOGOUTMON001

Gout monitoring: Allopurinol/febuxostat monitoring

Patients issued allopurinol or febuxostat in last 3 months due blood and urine monitoring

Urate, U&Es, HbA1c, lipid profile and uACR in last 12 months

Annual

SPSMMONGSTABAA

ACE inhibitor / ARB monitoring

Patients issued an ACEI or ARB in the last 3 months, missing monitoring

U&Es and BP in last 12 months (or bloods and BP declined)

Annual

SPSMMONGSTABACI

Acetylcholinesterase inhibitor monitoring

Patients issued an AChE inhibitor in the last 3 months, missing monitoring

Pulse in last 6 months (or examination declined)

6-monthly

SPSMMONGSTABALF

Alfacalcidol monitoring

Patients issued alfacalcidol in the last 3 months, missing monitoring

Bone profile, parathyroid hormone, U&Es and magnesium in last 3 months (or bloods declined)

3-monthly

SPSMMONGSTABCARB

Carbimazole monitoring

Patients issued carbimazole in last 3 months

TFTs recorded or bloods declined in last 3 months

3-monthly

SPSMMONGSTABCORT

Corticosteroid monitoring

Patients with ≥3 corticosteroid issues in last 12 months, latest in last 3 months, missing monitoring

HbA1c, U&Es, lipids and BP in last 12 months (or bloods and BP declined)

Annual

SPSMMONGSTABCPZE

Carbamazepine monitoring

Patients issued carbamazepine in the last 3 months, missing monitoring

U&Es, LFTs and vitamin D in last 12 months (or bloods declined)

Annual

SPSMMONGSTABDIG

Digoxin monitoring

Patients issued digoxin in last 3 months

Calcium, U&Es and Mg in last 12 months (or bloods declined)

Annual

SPSMMONGSTABEPL

Eplerenone monitoring

Patients issued eplerenone in the last 3 months, missing monitoring

U&Es in last 6 months (or bloods declined)

6-monthly

SPSMMONGSTABFURO

Furosemide monitoring

Patients issued furosemide in last 3 months

U&Es in last 6 months (or bloods declined)

6-monthly

SPSMMONGSTABHYD

Hydroxycarbamide monitoring

Patients issued hydroxycarbamide in last 3 months

FBC, LFTs, U&Es, LDH and urate in last 3 months (or bloods declined)

3-monthly

SPSMMONGSTABMERC

Mercaptopurine monitoring

Patients issued mercaptopurine in last 3 months

FBC, LFTs, U&Es in last 3 months (or bloods declined)

3-monthly

SPSMMONGSTABMES

Mesalazine monitoring

Patients issued mesalazine in the last 3 months, missing monitoring

FBC, LFTs and U&Es in the last 12 months

Annual

SPSMMONGSTABMINO

Minocycline monitoring

Patients with ≥2 minocycline issues in last 6 months, latest in last 3 months, missing monitoring

U&Es, LFTs and FBC in last 3 months (or bloods declined)

3-monthly

SPSMMONGSTABMYCO

Mycophenolate mofetil monitoring

Patients issued mycophenolate mofetil in the last 3 months, missing monitoring

LFTs, FBC and U&Es in last 12 weeks (or bloods declined)

3-monthly

SPSMMONGSTABNIT

Nitrofurantoin monitoring

Patients with ≥3 nitrofurantoin issues in last 12 months, latest in last 3 months, missing monitoring

U&Es and LFTs in last 12 months (or bloods declined)

Annual

SPSMMONGSTABPEN

Penicillamine monitoring

Patients issued penicillamine in the last 3 months, missing monitoring

LFTs, FBC, U&Es and urinalysis in last 3 months (or bloods and urine dip declined)

3-monthly

SPSMMONGSTABPHEN

Phenytoin monitoring

Patients issued phenytoin in the last 3 months, missing monitoring

U&Es, LFTs and vitamin D in last 12 months (or bloods declined)

Annual

SPSMMONGSTABPIO

Pioglitazone monitoring

Patients issued pioglitazone in last 3 months

LFTs, HbA1c and weight in last 12 months (or bloods and weight declined)

Annual

SPSMMONGSTABSTAT

Statin monitoring (SPS ongoing)

Patients issued a statin in last 3 months

LFTs and lipids in last 12 months (or bloods declined)

Annual

SPSMMONGSTABSULF

Sulfasalazine monitoring

Patients issued sulfasalazine in the last 3 months, missing monitoring

U&Es, LFTs and FBC in last 12 months (or bloods declined)

Annual

SPSMMONGSTABTHEO

Theophylline monitoring

Patients issued theophylline in the last 3 months, missing monitoring

FBC, U&Es and theophylline level in last 12 months (or bloods declined)

Annual

SPSMMONGSTABVALP

Valproate monitoring

Patients issued valproate in the last 3 months, missing monitoring

FBC, LFTs and BMI in last 12 months (or bloods and weight declined)

Annual