🎯 Hippo Targets Glossary

Code

Name

When to select this

Who is eligible?

What counts as complete

AST007

Annual review for asthma patients

To recall asthma patients aged 6+ who haven’t had a review in the last 12 months

Patients aged 6+ on the asthma register

Asthma review incl. control assessment, medication check, and inhaler technique

AST008

Smoking status for young asthma patients

To recall asthma patients aged 19 or under without a smoking status recorded in 12 months

Asthma patients aged 19 or under

Smoking status recorded in the last 12 months

Code

Name

When to select this

Who is eligible?

What counts as complete

AF006

Stroke Risk Assessment (AF)

To recall AF patients who haven’t had a CHA₂DS₂-VASc stroke risk assessment in 12m

Patients diagnosed with AF with no stroke risk score in 12 months

CHA₂DS₂-VASc score recorded in the last 12 months

AF008

Anticoagulants for High-Risk AF Patients

To recall high-risk AF patients not currently prescribed anticoagulants

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

Anticoagulant (DOAC or warfarin) prescription recorded and a CHA₂DS₂-VASc score <2 in the past 12 months

Code

Name

When to select this

Who is eligible?

What counts as complete

CHD005

Antiplatelets or Anticoagulants (CHD)

To recall CHD patients not on antiplatelet or anticoagulant therapy

Patients on the CHD register with no such meds recorded

Prescription of aspirin, clopidogrel, or anticoagulant

CHD015

Blood Pressure Control (Age ≤79)

To recall CHD patients under 80 with no recent BP or above-target BP

CHD patients aged 79 or under with no BP ≤140/90 in 12 months

BP ≤140/90 mmHg recorded in last 12 months

CHD016

Blood Pressure Control (Age 80+)

To recall CHD patients aged 80+ with no recent BP or above target

CHD patients aged 80+ with no BP ≤150/90 in 12 months

BP ≤150/90 mmHg recorded in last 12 months

Code

Name

When to select this

Who is eligible?

What counts as complete

HF003

ACE-I or ARB for LVSD

To recall HF patients with LVSD not on ACE-I or ARB

Patients with HF due to LVSD and no ACE-I/ARB prescribed

Prescription of ACE-I or ARB recorded

HF006

Beta-blockers for HF with LVSD

To recall HF patients with LVSD not on a licensed beta-blocker

Patients with HF due to LVSD and no beta-blocker recorded

Prescription of licensed beta-blocker (e.g. bisoprolol, carvedilol)

HF007

Annual Review (HF)

To recall HF patients who haven’t had an annual review

Patients on HF register with no review in the last 12 months

Review covering symptoms, functional status, meds, and self-management advice

Code

Name

When to select this

Who is eligible?

What counts as complete

BP002

BP Check (Age ≥45)

To recall patients aged 45+ without a BP recorded in the last 5 years

Patients aged 45 or over with no BP reading in 5 years

Blood pressure recorded in the last 5 years

HYP008

BP Control (Hypertension, Age ≤79)

To recall hypertensive patients under 80 with no recent or high BP

Patients aged ≤79 on hypertension register, no BP ≤140/90 in 12m

BP ≤140/90 mmHg recorded in the last 12 months

HYP009

BP Control (Hypertension, Age 80+)

To recall hypertensive patients aged 80+ with no recent or high BP

Patients aged 80+ on hypertension register, no BP ≤150/90 in 12m

BP ≤150/90 mmHg recorded in the last 12 months

Code

Name

When to select this

Who is eligible?

What counts as complete

STIA007

Antiplatelets or Anticoagulants

To recall stroke/TIA patients not on antiplatelet or anticoagulant therapy

Patients with stroke or TIA with no relevant meds recorded

Prescription of aspirin, clopidogrel, or anticoagulant

STIA014

BP Control (Stroke/TIA, Age ≤79)

To recall stroke/TIA patients under 80 with no recent or high BP

Patients ≤79 with stroke/TIA and no BP ≤140/90 in 12 months

BP ≤140/90 mmHg recorded in the last 12 months

STIA015

BP Control (Stroke/TIA, Age 80+)

To recall stroke/TIA patients aged 80+ with no recent or high BP

Patients ≥80 with stroke/TIA and no BP ≤150/90 in 12 months

BP ≤150/90 mmHg recorded in the last 12 months

Code

Name

When to select this

Who is eligible?

What counts as complete

CS005

Cervical Screening (Ages 25–49)

To recall women aged 25–49 who haven’t had a smear in the last 3 years

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

Cervical screening recorded within the last 3 years

CS006

Cervical Screening (Ages 50–64)

To recall women aged 50–64 who haven’t had a smear in the last 5 years

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

Cervical screening recorded within the last 5 years

Code

Name

When to select this

Who is eligible?

What counts as complete

VI001

8-Month Check (DTaP 3 Doses)

To recall babies approaching 8 months old who haven’t completed DTaP course

Babies turning 8 months with fewer than 3 DTaP doses recorded

3 DTaP doses recorded before 8 months

VI002

18-Month Check (MMR 1 Dose)

To recall children nearing 18 months with no MMR1 recorded

Children turning 18 months with no MMR dose recorded

1 MMR dose recorded before 18 months

VI003

5-Year Check (DTaP Booster + 2 MMR)

To recall children turning 5 missing school-entry immunisations

Children aged 5 with <2 MMR doses or no DTaP booster

2 MMR doses + DTaP booster recorded by age 5

Code

Name

When to select this

Who is eligible

What counts as complete

8WEEK_IMMS

8-week immunisations – DTaP, MenB, and rotavirus

Select this to recall babies aged 8–11 weeks for their first set of immunisations.

Infants aged 8–11 weeks.

All 8-week vaccines given (DTaP, MenB, rotavirus).

12WEEK_IMMS

12-week immunisations – DTaP (2nd), rotavirus (2nd), PCV (1st)

Select this for babies aged 12–15 weeks.

Infants aged 12–15 weeks.

All 12-week vaccines given.

16WEEK_IMMS

16-week immunisations – DTaP (3rd) and MenB (2nd)

Select this for babies aged 16–19 weeks.

Infants aged 16–19 weeks.

All 16-week vaccines given.

PRIMARY_IMMS

Primary course – 3x DTaP, 2x MenB, 1x PCV

Select this for children aged 20 weeks to 23 months who have not completed their full primary immunisation course.

Children aged 20w–23m.

Full primary schedule completed.

PRIMARY_IMMS_CATCHUP

Catch-up – 3x DTaP by age 10

Select this for children aged 2–9 years missing primary immunisations.

Children aged 2–9 years.

3x DTaP, 2x MenB, 1x PCV given.

1Y_IMMS

1-year boosters – MMR (1st), MenB booster, PCV booster

Select this for children aged 12–23 months who have not received their 1-year boosters.

Toddlers aged 12–23m.

All 1-year vaccines given.

1Y_IMMS_CATCHUP

Catch-up MMR – 1st dose (ages 2–10)

Select this for children aged 2–9 years who haven’t had their first MMR.

Children aged 2–9 years.

1st MMR dose recorded.

18M_MMR

18-month booster – 2nd MMR (new from 2026)

Select this for children turning 18 months or older after 1 Jan 2026.

Children aged 18m+.

2nd MMR dose recorded.

RUNOFF_3Y4M_MMRandDTaP

3y4m – 5y catch-up (2nd MMR + DTaP/IPV booster)

Select this for children aged 3y4m–5y.

Preschool-aged children.

2nd MMR + DTaP/IPV booster given.

3Y4M_OLDSCHEDULE_CATCHUP

Catch-up for 6–10 year olds – 2x MMR + DTaP/IPV booster

Select this for children aged 6–9 years who missed preschool boosters.

Children aged 6–9 years.

2nd MMR + DTaP/IPV booster given.

MMR_BROUGHTFORWARD

18m–2y6m (temporary 2026 rollout)

Select this to recall children aged 1y6m–2y6m from Jan–Oct 2026 who’ve had 1st MMR but not 2nd.

Children aged 18–30 months.

2nd MMR recorded.

HIPPOL001–HIPPOL007

Polio booster cohorts (Q4 2022 scheme)

Select the appropriate cohort depending on child’s age and doses received.

Children aged 1–10 years.

Booster recorded based on cohort dose requirement.

Code

Name

When to select this

Who is eligible?

What counts as complete

CHOL003

Statin Prescription for Cholesterol

To recall patients with CVD or diabetes who aren’t on a statin

Patients on the CHD, PAD, Stroke/TIA, or Diabetes registers with no statin prescribed

A statin prescription (e.g. atorvastatin) recorded in EMIS

CHOL004

Cholesterol Control

To recall patients whose most recent cholesterol result is missing or above target

Patients on the CHD, PAD, or Stroke/TIA registers with either:
• No cholesterol test in the last 12 months, or
• A cholesterol result above QOF target

A cholesterol measurement in the last 12 months where:
• LDL ≤ 2.0 mmol/L, OR
• non-HDL ≤ 2.6 mmol/L.
⚠️ If multiple readings exist on the latest date, LDL takes priority according to Business Rules.

Code

Name

When to select this

Who is eligible?

What counts as complete

COPD010

COPD Annual Review

To recall COPD patients who haven’t had a review in the last 12 months

Patients on the COPD register

Review incl. MRC scale, medication check, inhaler technique, and smoking support if needed

COPD014

Pulmonary Rehab Offer

To recall COPD patients (MRC score ≥3) not offered rehab

COPD patients with MRC score ≥3

Offer of referral to pulmonary rehab recorded in patient record

Code

Name

When to select this

Who is eligible?

What counts as complete

COVID_SPRING25_001

Booster – Aged 75+

To recall patients aged 75+ who haven’t had this year’s spring booster

Patients aged 75+ with no booster recorded since 1st April

Spring COVID booster recorded during current campaign period

COVID_SPRING25_002

Booster – Care Home Residents

To recall care home residents who haven’t had the spring booster

Care home patients with no booster since 1st April

Spring COVID booster recorded during current campaign period

COVID_SPRING25_003

Booster – Immunocompromised

To recall immunocompromised patients with no spring booster

Patients coded as severely immunocompromised since 1st April

Spring COVID booster recorded during current campaign period

Code

Name

When to select this

Who is eligible?

What counts as complete

CQCAZA001

Azathioprine blood monitoring

To recall patients on azathioprine who are not up to date with monitoring

Patients prescribed azathioprine within the last 6 months who are overdue blood monitoring

All of: Full Blood Count (FBC), Kidney function (U&Es), Liver function tests (LFTs) recorded within last 12 weeks

CQCLEF001

Leflunomide monitoring

To recall patients on leflunomide who are not up to date with monitoring

Patients prescribed leflunomide within the last 6 months who are overdue monitoring

All of: FBC, U&Es, LFTs, Blood pressure, Weight recorded within last 12 weeks

CQCMET001

Methotrexate blood monitoring

To recall patients on methotrexate who are not up to date with monitoring

Patients prescribed methotrexate within the last 6 months who are overdue blood monitoring

All of: FBC, U&Es, LFTs recorded within last 12 weeks

Code

Name

When to select this

Who is eligible

What counts as complete

CQCDOAC000

Weight – patients on DOAC

Select this if you want to recall DOAC patients with no recent weight recorded.

Patients prescribed DOACs.

Recent weight in EMIS (within 12 months).

CQCDOAC001A

Creatinine level – DOAC

Select this for patients on DOACs who haven’t had a recent creatinine result.

DOAC patients.

Serum creatinine result recorded.

CQCDOAC001B

Creatinine clearance – DOAC

Select this if patients have a creatinine result and weight but no CrCl recorded.

DOAC patients with weight + bloods.

Creatinine clearance (CrCl) calculated.

CQCDOAC002A/B – 004A/B

Annual / 3-month / 6-month CrCl checks

Select depending on CKD stage (3, 4, or 5).

DOAC patients with CKD3–5.

CrCl within correct timeframe (annual / 6 / 3 months).

CQCDOAC005

Annual haemoglobin – DOAC

Select this for annual haemoglobin monitoring.

DOAC patients.

Hb recorded within 12 months.

CQCDOAC006

Review – low Hb on DOAC

Select this if patients with low Hb need review.

DOAC patients flagged with low Hb.

Review coded.

CQCDOAC007

Appropriate kidney function – DOAC

Select this to check renal function is within range.

DOAC patients.

eGFR / CrCl appropriate for safe use.

CQCWARFARIN001–002

INR monitoring / review – Warfarin

Select these to monitor INR and review high results.

Patients on warfarin.

INR monitored and reviewed if high.

CQCMETFORMIN001–002

Renal function / review – Metformin

Select these to check kidney function for metformin.

Patients on metformin.

eGFR or creatinine recorded; review if abnormal.

CQCAMIODERONE001

Function checks – Amiodarone

Select this for patients on amiodarone needing bloods.

Patients on amiodarone.

Kidney, liver, and thyroid results recorded.

CQCLI001–002

Lithium level / Ca, renal, thyroid checks

Select these to ensure lithium monitoring is up to date.

Patients on lithium.

Lithium, calcium, kidney, and thyroid results recorded.

CQCACEARB001 / CQCALDANT001

ACEi / ARB / Aldosterone antagonist – renal checks

Select these to check kidney function for ACEi/ARB or aldosterone antagonists.

Patients on these medicines.

Kidney function test recorded.

Code

Name

When to select this

Who is eligible?

What counts as complete

DEM004

Face-to-Face Review for Dementia

To recall dementia patients with no care plan review in the last 12 months

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

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

Code

Name

When to select this

Who is eligible?

What counts as complete

DM006

ACE-I/ARB for Microalbuminuric Diabetics

To recall diabetics with signs of nephropathy not on ACE-I or ARB

Diabetic patients with microalbuminuria/proteinuria and no ACE-I/ARB prescribed

ACE-I or ARB prescription recorded

DM012

Foot Examination

To recall diabetics who haven’t had a foot check in 12 months

Patients on diabetes register with no foot check in last 12 months

Foot exam with risk classification recorded

DM014

Diabetes Education Referral

To refer newly diagnosed diabetics to education programme

Patients newly diagnosed with diabetes and no referral recorded

Referral to structured education recorded

DM020

HbA1c Control (Non-frail)

To recall non-frail diabetics with high HbA1c

Diabetic patients without frailty and HbA1c >58 mmol/mol

HbA1c ≤58 mmol/mol recorded in the last 12 months

DM021

HbA1c Control (Frail)

To recall frail diabetics needing relaxed glycaemic control

Diabetic patients with frailty and HbA1c >75 mmol/mol

HbA1c ≤75 mmol/mol recorded

DM022

Statins for Diabetics (No CVD, No Frailty)

To recall diabetics aged 40+ with no statin, no CVD, and no frailty

Diabetic patients aged ≥40 with no CVD/frailty and not on statins

Statin prescription recorded

DM023

Statins for Diabetics with CVD

To recall diabetics with cardiovascular disease not currently on statins

Diabetic patients with CVD and no statin prescription

Statin prescription recorded

DM033

BP Control (Non-frail Diabetics)

To support BP control in non-frail diabetics

Non-frail diabetics with BP >140/80 or no recent reading

BP ≤140/80 mmHg recorded in the last 12 months

Code

Name

When to select this

Who is eligible?

What counts as complete

HIPPODM8CP001a

HbA1c

To recall diabetics missing an HbA1c check

Diabetics with no HbA1c result in last 12 months

HbA1c recorded in last 12 months

HIPPODM8CP001b

Blood Pressure

To recall diabetics without a recent BP reading

Diabetics with no BP recorded in last 12 months

BP recorded in last 12 months

HIPPODM8CP001c

Cholesterol

To recall diabetics overdue a cholesterol test

Diabetics with no serum cholesterol in last 12 months

Cholesterol result recorded

HIPPODM8CP001d

Creatinine (Kidney Function)

To recall diabetics needing a serum creatinine test

Diabetics with no creatinine test in last 12 months

Creatinine result recorded

HIPPODM8CP001e

Urine ACR

To recall diabetics overdue their ACR urine test

Diabetics with no albumin:creatinine ratio in last 12 months

ACR result recorded

HIPPODM8CP001f

Foot Check

To recall diabetics without recent foot check

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

Foot check and risk score recorded

HIPPODM8CP001g

BMI

To recall diabetics without a recent BMI

Diabetics with no BMI recorded in last 12 months

BMI recorded

HIPPODM8CP001h

Smoking Status

To recall diabetics with no smoking status on file

Diabetics with no smoking status in last 12 months

Smoking status recorded

Code

Name

When to select this

Who is eligible?

What counts as complete

SFVI001

Flu Jab for Patients Aged 65+

To recall patients 65+ who haven’t had a flu jab this season

Patients aged 65+ with no flu vaccine this season (1 Sept onward)

Flu vaccine recorded for the current season

SFVI002

Flu Jab for At-Risk Patients (18–64)

To recall at-risk patients aged 18–64 with no flu jab

Patients aged 18–64 with LTCs (e.g. diabetes, CVD, COPD) and no flu jab this season

Flu vaccine recorded this season

SFVI003

Flu Jab for Children Aged 2–3

To recall 2–3 year olds without a flu jab

Children aged 2 or 3 on 31 Aug, no flu vaccine recorded this season

Flu vaccine recorded (usually nasal spray) for the season

Code

Name

When to select this

Who is eligible?

What counts as complete

HI-01

Annual Health Check (Learning Disabilities)

To recall LD patients who haven’t had an annual health check

Patients on LD register with no health check recorded since 1 April

Health check completed and recorded, including an action plan

Code

Name

When to select this

Who is eligible?

What counts as complete

HLTC_AF_RVW

AF patients receiving annual review

To recall AF patients overdue a review

Patients with atrial fibrillation (AFIB_REG) without a recent review

Annual review completed — Accepted SNOMED Codes:

713678009, 248411000000105, 793851000000102, 735259005, 735258002

HLTC_AST_RVW

Asthma patients receiving annual review

To recall asthma patients overdue a review

Patients with asthma (AST_REG) without a recent review

Annual review completed — Accepted SNOMED Codes:
394700004, 390872009, 390878008, 390877003, 394701000, 754061000000100, 401182001, 401183006, 394720003, 270442000

HLTC_CARDIO_NO_DM_RVW

CVD patients without diabetes reviewed

To recall CVD patients without diabetes who haven’t had a review

CVD patients not in DM register, overdue a review

Patients who have had a blood test.

HLTC_CHD_RVW

CHD patients receiving annual review

To recall CHD patients overdue a review

Patients with coronary heart disease (CHD_REG) without a recent review

Annual review completed — Accepted SNOMED Codes:
315614006

HLTC_COPD_RVW

COPD patients receiving annual review

To recall COPD patients overdue a review

Patients with COPD (COPD_REG) without a recent review

Annual review completed — Accepted SNOMED Codes:

394703002

HLTC_DM_RVW

Diabetes patients receiving annual review

To recall diabetic patients overdue a review

Patients with diabetes (DM_REG) without a recent review

Annual review completed — Accepted SNOMED Codes:
170777000, 887861000000105, 1842001000006102

HLTC_HF_RVW

Heart failure patients receiving review

To recall heart failure patients overdue a review

Patients with heart failure (HF_REG) without a recent review

Annual review completed — Accepted SNOMED Codes:
134378009, 390885007, 202231000000106, 872361000000105, 247361000000100, 810971000000105, 813991000000101, 851071000000108, 871681000000102

HLTC_HYP_RVW

Hypertension patients receiving review

To recall hypertension patients overdue a review

Patients with hypertension (HYP_REG) without a recent review

Annual review completed. Please be aware that to complete this review, you’ll need to use hypertension annual review code in EMIS (e.g. 401118009).
​
​A simple BP reading on its own won’t be enough to complete the indicator in Hippo

HLTC_MH_RVW

Mental health patients reviewed

To recall SMI patients overdue a review

Patients with SMI (MH_REG) without a recent review

Annual review completed — Accepted SNOMED Codes:
408404002, 401061005, 867871000000100

HLTC_NDH_RVW

NDH patients reviewed

To recall non-diabetic hyperglycaemia (NDH) patients without a review

Patients on NDH register without recent review

Annual review completed — Accepted SNOMED Codes:
999791000000106, 104930100000010010, 9321000000109100314, 100000010558111000237107

HLTC_PAD_RVW

PAD patients receiving review

To recall PAD patients overdue a review

Patients with peripheral arterial disease (PAD_REG) without recent review

Annual review completed — Accepted SNOMED Codes:
1696201000006100, 1006191000000100, 1030411000000100, 1102851000000100, 1010591000000100, 1022191000000100, 1028851000000100, 1108541000000100, 1108551000000100, 1014501000000100, 1026471000000100, 1026481000000100, 1028861000000100

HLTC_STIA_RVW

Stroke/TIA patients receiving review

To recall patients with stroke or TIA overdue a review

Patients with stroke or TIA (STIA_REG) without a recent review

Annual review completed — Accepted SNOMED Codes:

699270006

Code

Name

When to select this

Who is eligible?

What counts as complete

MH002

Care Plan Review

To recall SMI patients without care plan review

Patients with psychosis/bipolar and no care plan in 12 months

Care plan review covering physical and mental health needs

MH003

Blood Pressure

To recall SMI patients with no BP recorded

Patients with SMI and no BP in the last 12 months

BP recorded in last 12 months

MH006

BMI

To recall SMI patients with no BMI recorded

Patients with SMI and no BMI in the last 12 months

BMI recorded in last 12 months

MH007

Alcohol

To recall SMI patients with no alcohol use recorded

Patients with SMI and no alcohol use recorded in 12 months

Alcohol use recorded

MH011

Lipids

To recall SMI patients with no cholesterol check

Patients with SMI and no lipid profile in last 12 months

Lipid profile recorded

MH012

HbA1c

To recall SMI patients with no glucose test

Patients with SMI and no HbA1c in last 12 months

HbA1c result recorded

MH021

SMI Annual Health Check (All 6)

To recall SMI patients who haven’t completed all 6 checks

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

All 6 checks completed and recorded in last 12 months

Code

Name

When to select this

Who is eligible?

What counts as complete

HIPPONHSHC001

Overall Coverage

To recall eligible patients who haven’t completed an NHS HC in 5 years

Patients aged 40–74 with no NHS Health Check in last 5 years

Full NHS HC recorded incl. risk score, BP, BMI, cholesterol, lifestyle

HIPPONHSHC002

Current Year Invite

To monitor patients invited this year who haven’t yet had a check

Patients eligible this year, no check recorded yet

NHS HC recorded during the current financial year

HIPPONHSHC002a

Blood Pressure (NHS HC)

To recall NHS HC patients missing a BP reading

NHS HC patients this year with no BP recorded

BP reading recorded

HIPPONHSHC002b

BMI (NHS HC)

To recall NHS HC patients with no BMI

NHS HC patients with no BMI recorded

BMI recorded

HIPPONHSHC002c

Cholesterol (NHS HC)

To recall NHS HC patients with no cholesterol result

NHS HC patients with no total cholesterol recorded

Cholesterol result recorded

HIPPONHSHC002d

HbA1c (NHS HC)

To recall NHS HC patients with no glucose result

NHS HC patients with no HbA1c recorded

HbA1c result recorded

HIPPONHSHC002e

All Components Completed

To find patients who haven’t finished all 5 checks

NHS HC patients missing one or more of: BP, BMI, cholesterol, HbA1c, lifestyle

All checks and lifestyle components completed

Code

Name

When to select this

Who is eligible?

What counts as complete

HIPPOPNEU001A/B

Lifetime Pneumo Vaccine (Age 65+)

To recall patients aged 65+ with no pneumococcal vaccine ever recorded

Patients aged 65+ with no PPV23 recorded

Pneumococcal vaccine (PPV23) recorded

HIPPOPNEU002A/B

First Pneumo Vaccine (At-Risk <65s)

To recall under-65 at-risk patients never vaccinated

Patients aged 2–64 with LTCs and no PPV23 recorded

Pneumococcal vaccine recorded

HIPPOPNEU003A/B

5-Year Pneumo Booster (High-Risk Only)

To recall patients needing 5-year booster

High-risk patients (e.g. asplenia) due a booster dose

Pneumococcal booster recorded within past 5 years

Code

Name

When to select this

Who is eligible?

What counts as complete

NDH002

Blood Glucose Monitoring (Pre-diabetes)

To recall NDH patients with no glucose check in the last 12 months

Patients with NDH (pre-diabetes) and no HbA1c or fasting glucose recorded

HbA1c or FPG result recorded in the last 12 months

Code

Name

When to select this

Who is eligible?

What counts as complete

SMOK002

Smoking Status – At-Risk Patients

To recall LTC patients with no smoking status in 12 months

Patients with asthma, COPD, diabetes, CVD, SMI, etc. and no status recorded

Smoking status recorded in the last 12 months

SMOK004

Cessation Offer – General Smokers

To offer cessation support to all smokers every 2 years

Patients aged 15+ who are current smokers and no offer in 24 months

Smoking cessation advice or referral recorded in last 24m

SMOK005

Cessation Offer – At-Risk Smokers

To recall smokers with LTCs for a 12-monthly quit offer

Smokers with diabetes, CVD, COPD, SMI, etc. and no cessation offer in 12 months

Cessation support offer recorded in last 12 months