Hippo Labs uses the official NHS England QOF Business Rules to help practices manage patients with Chronic Obstructive Pulmonary Disease (COPD) — ensuring accurate diagnosis, annual reviews, and timely access to pulmonary rehabilitation.
💬 Just a reminder: these indicators aren’t clinical guidelines — they’re operational definitions used for QOF measurement. They define which patients appear for recall, how achievement is calculated, and where gaps may occur.
📋 The COPD Register (COPD015)
The COPD register includes all patients with a diagnosis of COPD.
It forms the foundation for all COPD indicators.
Patients appear on the register if they:
Had a COPD diagnosis before 1 April 2023, or
Were diagnosed on or after 1 April 2023 with a quality-assured post-bronchodilator spirometry FEV1/FVC ratio <0.7, recorded:
Within 3 months before or 6 months after diagnosis, or
Within 6 months of registration (for newly registered patients with an existing COPD diagnosis).
Are unable to undertake spirometry, with this recorded in the notes.
✅ In short: all patients with a current, confirmed COPD diagnosis should appear on the register.
🩺 The Indicators
These indicators apply only to patients on the COPD register. Together, they measure diagnostic quality, annual reviews, and pulmonary rehabilitation access.
🔁 COPD010 — Annual COPD Review
Measures:
% of COPD patients who have had a review in the last 12 months including both:
A record of the number of exacerbations, and
An MRC breathlessness score (Medical Research Council dyspnoea scale).
Counts as complete if:
All three of the following are recorded within the last 12 months:
COPD review,
Number of exacerbations, and
MRC score.
Exclusions (Personalised Care Adjustments):
Care unsuitable (clinical reason)
Declined COPD review
Two invitations ≥7 days apart with no attendance (removed for payment only — Hippo continues to flag for recall)
Newly diagnosed or registered within 3 months
⚠️ Common pitfalls:
Recording the review without an MRC score or exacerbation count
Using free-text instead of coded entries
Recording elements on separate dates
Assuming two invites removes the recall — practices should continue to offer opportunistic reviews
✅ In short: every COPD patient should have a complete review each year, with both MRC score and exacerbation count coded.
🏃♀️ COPD014 — Pulmonary Rehabilitation Referral
Measures:
% of COPD patients with an MRC score ≥3 in the past 12 months who were referred to pulmonary rehabilitation (excluding those who have already attended).
Counts as complete if:
MRC score ≥3 recorded in the last 12 months, and
A referral to pulmonary rehabilitation recorded on or after that date.
Exclusions (Personalised Care Adjustments):
Service unavailable
Pulmonary rehab unsuitable
COPD review unsuitable
Declined pulmonary rehab or COPD care
Two invitations for COPD review ≥7 days apart with no attendance (removed for payment only)
Newly diagnosed or registered within 3 months
⚠️ Common pitfalls:
Failing to record the MRC score (patients won’t be identified for referral)
Recording rehab attendance before the qualifying MRC score
Missing codes for decline or service unavailable
Using referral text instead of a coded entry
✅ In short: all COPD patients with an MRC score ≥3 should have a coded referral to pulmonary rehabilitation — unless unsuitable or declined.
🧩 Putting It All Together
Indicator | Focus | Who It Applies To | What It Shows | What to Do |
COPD010 | Annual review | All COPD patients | Completeness of COPD monitoring and follow-up | Record review, exacerbation count, and MRC score within 12 months |
COPD014 | Pulmonary rehab referral | COPD patients with MRC ≥3 | Access to rehabilitation for patients with significant breathlessness | Record referral (or valid decline/unsuitable code) after MRC ≥3 |
COPD015 | Register | All patients with COPD diagnosis | Accurate inclusion of patients with confirmed diagnosis | Record spirometry-confirmed COPD or reason spirometry not done |
🌟 Why This Matters
Following these indicators helps practices:
Maintain a validated, up-to-date COPD register
Ensure patients receive a complete annual review
Identify patients with significant breathlessness who need rehabilitation
Demonstrate QOF compliance and proactive chronic disease management
✅ In short: the COPD indicators ensure accurate diagnosis, complete annual reviews, and timely pulmonary rehab referrals for every patient with COPD.
📚 Sources
NHS England QOF Business Rules v50.0 (COPD, April 2025)
Primary Care Domain Reference Sets (TRUD Portal)