We’ve added two new CQC Potential Missed Diagnosis indicators to help practices identify patients whose blood test results meet diagnostic criteria for diabetes or chronic kidney disease, but don’t yet have the correct diagnosis coded.
These indicators highlight patients who may need a formal diagnosis so they can be added to the right registers and receive appropriate monitoring and treatment.
🔍 What’s new
These indicators look for:
Blood test results that meet clinical diagnostic thresholds
Patients who do not already have a valid diagnosis or explanation recorded
Important:
These are inverse indicators.
Complete = the patient does have a valid diagnosis or explanation
Not complete = the patient may need review and coding
1️⃣ CQC_MISDIAG_DM — Possible Missed Diabetes Diagnosis
Identifies patients whose HbA1c results indicate diabetes but who do not have a diabetes diagnosis coded.
What it checks
Two HbA1c results ≥48 mmol/mol
Results recorded within the last 2 years
Results taken more than 2 weeks apart
Whether the patient already has a valid diagnosis or explanation recorded
What counts as complete
A patient is considered complete if they have any of the following recorded after the diagnostic results:
A current diabetes diagnosis
A diabetes resolved code
Gestational diabetes recorded within 12 months
Steroid-induced diabetes recorded within 12 months
A haemoglobinopathy diagnosis (which affects HbA1c accuracy)
Patients without one of these will appear for review.
Why this matters
Uncoded diabetes means patients may miss:
Retinal screening and foot checks
Structured diabetes reviews
Medication optimisation
Cardiovascular risk management
Early coding helps ensure patients receive safe, structured long-term care.
2️⃣ CQC_MISDIAG_CKD — Possible Missed CKD Stage 3–5 Diagnosis
Identifies patients with persistently reduced kidney function who do not have a CKD stage 3–5 diagnosis recorded.
What it checks
Two eGFR results <60 mL/min
Results recorded within the last 2 years
Results taken more than 2 weeks apart
Whether the patient already has a valid CKD diagnosis or explanation recorded
What counts as complete
A patient is considered complete if they have any of the following recorded after the low eGFR results:
A current CKD stage 3–5 diagnosis
A CKD resolved code
A CKD stage 1–2 code (indicating recovery or improvement)
Patients without one of these will appear for review.
Why this matters
Uncoded CKD increases the risk of:
Incorrect medication dosing
Exposure to nephrotoxic drugs
Missed monitoring and referrals
Faster disease progression
Correct coding supports safer prescribing and appropriate follow-up.
📘 Diagnostic thresholds used
Diabetes (HbA1c)
≥48 mmol/mol on two occasions, more than 2 weeks apart
Chronic Kidney Disease (eGFR)
<60 mL/min on two occasions, more than 2 weeks apart
💡 Why this matters
These indicators help practices to:
Identify patients with likely diabetes or CKD who are not yet coded
Add diagnoses where clinically appropriate
Ensure patients are included on the correct disease registers
Enable safer prescribing and monitoring
Improve population health data and CQC compliance
✅ These indicators are now live
You can add them to your Recall Campaigns to help ensure patients with evidence of chronic disease are not missed and receive the care they need.