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IT update has seen patients wrongly recorded with cancer diagnosis, claim GPs

Exclusive GPs have raised concerns that they will wrongly recall patients for treatment after they claimed an IT issue meant patients were mistakenly recorded as having cancer.

The same IT issue has led to GPs potentially missing mental health reviews and following up with patients newly diagnosed with diabetes, as well concerns over missing flu vaccine payments.

These are the latest examples of problems following NHS Digital’s move onto the new SNOMED CT clinical vocabulary for QOF Read codes earlier this year, with problems specifically affecting users of EMIS Web.

Practices raised concerns several months ago that they may receive incorrect QOF payments unless the problem was corrected, but GPs are now getting increasingly concerned about patients receiving the correct treatments.

Problems highlighted by GPs speaking to Pulse, as well as in an online EMIS user support forum, were:

  • Problems with cancer, COPD and dementia disease registers, including patients with thrombocytosis being recorded as having a cancer diagnosis; and post-concussive disorder recorded as a form of dementia.
  • QOF not picking up all mental health reviews which GPs should be carrying out.
  • Practices unable to search registers for patients newly diagnosed with diabetes and requiring education.
  • Concerns regarding flu vaccine payments, as a replacement for a previous code to record vaccinations was yet to be replaced in the new system.
  • Since the Read code translation, a number of patient conditions recorded more broadly than previously, meaning GPs have to go into the system and manually re-record patients’ exact diagnoses.

The issues stem from when EMIS Web translated QOF Read codes using version 39 of the QOF business rules, published by NHS Digital earlier this year.

And although problems with Read codes were highlighted over two months ago, NHS Digital has only updated the required business rules this week, enabling EMIS to start to solve the problems.

QOF expert Dr Gavin Jamie, a GP in Swindon whose practice uses EMIS Web, suggested the problems being raised by GPs could cause unnecessary concern for patients.

He said: ‘Calling for an extra cancer review is unlikely to see patients coming to direct harm. The codes seem to be pulling more people in rather than fewer.

‘But if you’re called in for a cancer review because you just had something removed from your head or your leg earlier in the year, you might not actually have talked about cancer – we talk about skin lesions or something, we try to avoid talking about cancer sometimes – the patients are going to be ringing up and saying “what’s this? I didn’t think I had cancer. Do I have cancer?”

‘And inevitably [the recall letter] will arrive on a Saturday two days before the surgery is open…’

NHS Digital said updating of the Read codes followed its usual annual schedule, although a larger number of codes needed amendments this year.

A spokesperson said: ‘NHS Digital is aware of some differences in relation to QOF payment registers and, as part of the usual yearly QOF process, we have received some queries on specific codes.

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‘We are working with EMIS and other GP system suppliers to assess those codes and we will communicate the results of this as part of our routine QOF updates. 

‘All GP system suppliers have started receiving the new business rules and the full set will be delivered early [this] week, which is normal process for this time of year.’

An EMIS spokesperson said: ‘We’re advised that NHS Digital is dealing with this.’

Dr Jamie said: ‘It has been quite a while and to be honest I’d expected [NHS Digital] to have done something about it before now. It takes some time for the system suppliers to put these [business rules updates] into action as well, generally at least a few weeks.

‘With the usual timescales, EMIS users are probably going to be seeing the changes arriving in practices in the New Year. We are in the last four months of the year so practices will be starting to look at their QOF fairly seriously at this point.’

He also added that he did not think all issues would be sorted out by the update.

Dr Jamie said: ‘I’d love to say that I think the next lot [of codes] are going to be perfect and there will be absolutely nothing in there but that is unlikely, and probably workarounds by practices will still be necessary until the end of the year.’

BMA GP Committee chair Dr Richard Vautrey said: ‘Having accurate disease registers and information about patients is fundamental to practices’ ability to provide good care to their patients. Whilst the need to move to SNOMED coding is recognised, these important problems that practices are experiencing need to be rapidly addressed so that patients are not adversely impacted.’

NHS Digital said GP practices with queries relating to the QOF process should contact, while any queries in relation to specific disease registers should be directed to the relevant GP system supplier’s helpdesk.

SystmOne users would not be affected in this manner because TPP is still operating on v. 38 of the business rules.

Note: Following the publication of this article, NHS Digital has issued a statement regarding their continued position that thrombocytosis should be logged as cancer. Read the full statement here

Meanwhile, this article was updated at 9.38am on 5 December to remove ambiguity regarding malignant squamus cell carcinoma. The article had incorrectly suggested QOF should not log SCC as ‘malignant cancer’.