Hippo uses coded information from the patient record to work out what care a patient is due.

So if you've completed a review, recorded that a patient has declined, or added an exception, the exact code you use matters.

The simplest rule is:

🦛 Hippo looks for recognised SNOMED codes, within the timeframe required by that indicator.

Free-text notes aren't used to determine whether an indicator is complete.

This guide explains what counts, why a patient might still appear as due after you've added a code, and how to investigate when something doesn't look right.

Every Hippo indicator has its own rules for what counts as completed care.

For a code to count, it generally needs to meet two conditions:

Hippo checks specific SNOMED code lists for each indicator.

A code with similar wording isn't necessarily equivalent. If its SNOMED concept isn't included in the relevant code list, it won't complete the indicator.

Many indicators require care to have been completed within a particular period.

For example, a QOF indicator may look for activity within the current QOF year, while another indicator might look back 3 months, 12 months or several years.

A valid code outside that window won't count towards the current indicator.

A single code doesn't always complete the whole indicator.

For example, an annual review may require several pieces of information to have been recorded.

If one part is missing, the patient can still appear as due even though part of the review has already been completed.

This is why it's worth checking the specific indicator rules when a patient looks unexpectedly overdue.

Some indicators recognise codes showing that a patient has declined the relevant care.

For QOF indicators, these form part of the Personalised Care Adjustment (PCA) rules.

Depending on the indicator, this can include reasons such as:

If Hippo recognises the relevant code and it falls within the required timeframe, the patient won't be treated as due for that indicator.

This is an important one.

Each indicator checks its own list of accepted decline or exception codes.

Some codes apply across several indicators for the same condition.

For example, a recognised diabetes informed dissent code may apply across multiple diabetes QOF indicators.

Other codes only apply to one particular piece of care.

For example:

Diabetic foot examination declined

may prevent the patient being considered due for the relevant foot examination indicator, but doesn't mean they've declined every part of their diabetes care.

And a decline relating to one condition won't automatically apply to another.

For example:

A hypertension decline won't prevent a patient being recalled for an outstanding diabetes foot examination.

This depends on the indicator.

A decline isn't necessarily permanent.

💡 Individual indicators can have different rules, so check the relevant indicator guidance if you're unsure.

This is particularly common with QOF indicators.

Many QOF Personalised Care Adjustments only apply for the QOF year in which they're recorded.

For example:

Patient declines an annual review in November → they're not recalled again for that indicator during that QOF year → the new QOF year begins on 1 April → they're eligible again.

This doesn't mean Hippo has ignored or removed the previous code.

The previous adjustment has simply fallen outside the timeframe used for the new QOF year.

If the patient continues to decline the care, the appropriate current code will need to be recorded again.

There are a couple of things that can look similar in Hippo but do different jobs.

Hippo's standard Patient recall administration writeback records that recall activity took place.

It does not mean the patient declined the clinical care and doesn't act as a QOF invitation or PCA.

When recording a manual recall outcome through Action Patient, the writeback code used to document the contact isn't necessarily the same as a clinical decline for the underlying indicator.

If you need to record that the patient has declined the care itself, make sure the appropriate clinical SNOMED code is added to their record.

These can sound similar, but they affect Hippo in different ways.

For example, excluding Palliative Care from a campaign doesn't tell Hippo that the patient's clinical care has been completed or declined.

It simply means that campaign won't contact patients in that group.

Similarly, opting a patient out of automated recalls doesn't change what they're clinically due.

SNOMED codes and national code lists can change over time.

A code that was previously used locally may no longer be included in the current national code list for an indicator.

If a patient appears due despite having the care recorded, check:

If something doesn't look right, work through these checks.

Open See Patient and check their outstanding care.

This tells you which indicator is causing the patient to be considered due.

Find the indicator in the Hippo Targets Glossary or relevant indicator article.

Check:

Look for the relevant SNOMED code in EMIS or SystmOne.

Pay particular attention to:

📋 The concept ID – is it the recognised code?

📅 The date – is it within the required window?

🧩 Other requirements – is another part of the indicator still outstanding?

If the question is specifically:

“Why is this patient being included in this campaign?”

use Check Patient Eligibility in Recall Preview.

Enter the patient's NHS number and Hippo will show how they match the campaign's eligibility rules.

This helps distinguish between:

“Why does Hippo think this care is due?”

and:

“Why is this campaign selecting this patient?”

They're related, but they're not always the same question.

There are two slightly different requests you can make.

If you'd like a SNOMED code available when recording an outcome in Hippo, check the relevant dropdown first.

If it isn't available, send us:

We can then add it to the dropdown list.

If you think a code should count as completed or declined care for a particular indicator, send us:

We'll review whether the code is appropriate for that indicator.

The most common reasons are:

Check the indicator rules and the patient's record first.

Yes.

Exceptions and declines are specific to the indicators that recognise them. A hypertension exception doesn't automatically apply to outstanding diabetes care.

No.

Childhood immunisation eligibility is vaccine-specific, so the appropriate vaccination, decline or contraindication information needs to be recorded for the individual vaccine where applicable.

Different indicators can use different code lists and eligibility rules.

A decline accepted by the previous indicator isn't automatically accepted by the new one, so check the rules for the indicator you're now using.

When Hippo says a patient is due, remember these three things:

📋 Right code – is the SNOMED code recognised by that indicator?

📅 Right time – was it recorded within the indicator's required timeframe?

🧩 Right care – have all the parts required to complete that indicator been recorded?

And remember: being excluded from a campaign or opting out of automated recalls doesn't change whether the patient is clinically due.