This bulletin contains information about the following topics:

  1. 2014/15 DES – CQRS Update
  2. Avoiding Unplanned Admissions Update
  3. Extended Hours Monitoring Form 2014/15
  4. Dementia DES 2013/14 claims and approach for 2014/15
  5. Revised Pertussis Claim Process
  6. Childhood Flu and Shingles (catch up) Service Specifications
  7. Influenza & Pneumococcal and Shingles (Routine) Specifications
  8. Neonatal Hepatitis B Vaccination Programme
  9. Assessment of Injuries in children
  10. Premises Team Updates
  11. Contingency Plans – Informing the Area Team
  12. Cold Chain Guidance
  13. Important Deadlines
  1. 2014/15 DES – CQRS Update

Previously circulated by email on 30/06/2014

The Rotavirus (routine childhood immunisation) vaccination programme 2014/15 service has now been offered to all practiceson CQRS.

Claims can now be submitted for:

  • Rotavirus (routine childhood immunisation) vaccination programme 2014/15
  • Learning Disability health check scheme 2014/15
  • MMR aged 16 and over vaccination programme 2014/15
  • Meningitis C (freshers) vaccination programme 2014/15
  • Hepatitis B (newborn) vaccination programme 2014/15
  • Shingles Routine Immunisation Service 2013/14 – runs to 31/08/14
  • Shingles Catch-up (aged 79) Immunisation Service 2013/14 – runs to 31/08/14

For Quarter 1 there will be no automated extractions via GPES, so all claims should be submitted manually. It seems highly likely at this stage that manual submissions will also be required for Quarter 2.

Guides on these enhanced services on CQRS can be found here:

The following services are expected to be made available on CQRS probably by the end of August:

•Shingles 2014/15 (new programme from 1st Sept 2014)

•Childhood Flu

•Seasonal Flu & Pneumococcal


•Avoiding Unplanned Admissions – Components 2, 3 & 4


Completing CQRS DES claims for 2013/14

It is apparent that some practices have yet to complete all the DES claims for 2013/14. This may be because incorrect or incomplete claims have been submitted.

If you have not done so already we would encourage practices to review the claims made, which can be done using the Payment Declaration report.

Please follow the steps below which will produce a report which you can then check against your EXETER statements.

In CQRS, select “Reports”, followed by “Declarations”

Select “Payment Declaration” – a screen similar to the screen shot below will be shown –:

Complete the time periods you wish to report on

A sample of a report is shown below:

You will see a variety of entries in the Status column:

Awaiting Data / Means that no claim has been successfully submitted for the period ending on this date. See note 1 below
Awaiting Service Provider Approval / You have submitted a claim, but you have not ‘declared’ the achievement. See note 2 below
Awaiting Commissioning Organisation Approval / You have submitted a claim, but the Area Team has not yet approved.
Approved / Area Team has approved – claim waiting Financial Approval
Payment Requested / Financial Approval has been made – claim waiting to be sent to payment organisation
Sent to SSD (Final State) / Payment has been sent to Exeter for payment
Payment not Needed (Final State) / No payment required as sum claimed = £0.00
Cancelled / Claim has been cancelled.


Awaiting Data will be shown if:

  • No claim was made (you may of course have no claims to make for certain months)
  • You may have claimed for multiple months under one month on CQRS, hence some months being shown as ‘Awaiting Data’
  • You submitted a claim with an incorrect date – remember Achievement date MUST be the last calendar day of the month (Learning Disabilities - last day of quarter; Alcohol – must be 31/03/14) for which you are claiming. This cannot be amended – you need to submit a new Achievement entry with the correct date.
  • Management Indicators have not been completed with zeros.

2. Avoiding Unplanned Admissions Update

Previously circulated by email on 27/06/2014

We wanted to give you an update on the Avoiding Unplanned Admissions Enhanced Services as there were a couple discrepancies in the original paperwork.

For background:

  • The reporting annex of the ES indicates that each practice should individually communicate bypass numbers to care homes and also to hospitals and the ambulance service.
  • The text of the Service specification states that the Area Team will compile all these numbers and then the Area Team will send lists onto care homes, A&E and hospitals.

In light of this discrepancy and being mindful of practicalities our proposal is:

  • All Practices to supply their bypass number directly to the care homes that they work with.
  • All practices to supply their bypass number to the Area Team for us to distribute to A&E and the Ambulance Services via by 31 July 2014(the Area Team will seek to take this forward with the CCGs)

We have also updated the reporting template, see attached, to clearly identify which area needs to be completed in which quarter along with the submission dates that we must receive the template by. Failure to complete the template within the timeline may result in a delayed payment.

If you have any queries please email

3. Extended Hours Monitoring Form 2014/15

Previously circulated by email on 07/07/2014

Please find attached the extended hours monitoring form for 2014/15. Completed forms should be sent to

You may have noticed that the new national extended hours specification states that practices are required to reschedule sessions cancelled due to bank holidays within the same week. The Area Team will be flexible with this as the reconciliation is based on individual practice year end variance. This process will allow practices to make up any shortfall or cancelled sessions during the year.

CQRS Update

4.Dementia DES – 13/14 claims & approach for 14/15

Validation of the Component 2 claims for the Dementia DES for 2013/14 exposed some misinterpretation of the terms of the DES by practices.

The key steps in the DES are as follows:

1)Identify patients ‘at-risk’ of Dementia

2)Opportunistic initial questioning of at-risk patients to establish if there are concerns about the patient’s memory. Also establishment of patient consent to proceed.

3)Assessment for dementia offered & completed – GPCOG or other similar standardised instrument. Claims under component 2 of the DES must only be made on this basis.

4)A suitable referral &/or provide suitable treatment.

All the above activity must be read-coded as per the Technical Requirements for 2014/15 GMS Contract Changes

Amongst the main issues identified were:

a)Practices claiming on the ‘initial questioning’ only

b)Some practices have carried out a blanket assessment of all patients and not done the initial screening. This does not meet the spirit or the terms of the DES as they are not carrying out the initial assessment to ascertain if there are causes for concern.

The Component 1 payment is made upfront in anticipation of practice participation in the DES. Should no dementia assessments be completed NHS England will seek clarification of the level of the practice’s participation in the DES & will clawback funding if appropriate.

It is important to note that the specification and guidance for the 2014/15 ES expands on the 13/14 guidance in that it now requires contractors to provide a more comprehensive care plan for patients diagnosed as having dementia and increase support provided to carers.

5. Revised Pertussis Claim Process

Previously circulated by email 13/06/2014

As you may be aware PHE (Public Health England) has changed the reporting process for the Prenatal Pertussis Vaccination Programme for 2014/15.

It is important that you are aware that there are 2 distinct elements to this:

1)Vaccine coverage reporting will be implemented on an automated monthly basis via the ImmForm website.As an automated collection, only GP practices who are with a GP IT Supplier that has the capability to extract data automatically will participate in this survey. It is anticipated that the following suppliers will participate: EMIS (LV and Web), INPS (Vision), Microtest, TPP (SystmOne). Please consult Immform for more details on this approach.

2)Financial claims will NOT be possible via Immform.Therefore with immediate effect please use the attached form for all Pertussis claims.

The form should be submitted monthly, however also includes the option to submit catch-up claims for previous months. This form should be submitted to . Any queries should also be directed to this e-mail address.

6. Childhood Flu and Shingles (catch up) Specifcations

Previously circulated by email 25/06/2014

Please find attached the recently revised service specifications for both Childhood Seasonal Flu and Shingles (catch up) for your information. These enhanced services were included on the Contract Portfolio sign-up sheet sent out to practices on 30 April 2014, although full details were not available at that time.

If you have any queries please contact

7.Influenza & Pneumococcal and Shingles (Routine) Specifications

Previously circulated by email 09/07/2014

Please find attached the recently revised service specifications for both Influenza and Pneumococcal and Shingles Routine for your information. These enhanced services were included on the Contract Portfolio sign-up sheet sent out to practices on 30 April 2014, although the details were not available at that time.

Practices will be required to report data manually on to CQRS on a monthly basis from September/October until such time as GPES is available to extract data.

Payments are due to commence in October 2014 and will be made on a monthly basis.

Please note that, for 2014-15, this does now include Pneumococcal for those at-risk aged 2 -64, in addition to the over 65s. All of these claims will be via CQRS and therefore any local claim process for the under 65s will now cease with immediate effect.

Practices who wish to participate in this Enhanced Services will be required to sign up on CQRS.

Payment is available to participating GP practices under this ES as an item of service payment of £7.64 per dose to eligible patients and in accordance with paragraph 20 and provisions within the ES specification.

If you have any queries please contact

8. Neonatal Hepatitis B Vaccination Programme

The neonatal hepatitis B dry blood spot test (heel prick) aims to ensure that all babies born to women identified as Hepatitis B positive are immunised promptly according to the recommended schedule and have their appropriate serology test at 12 months.

Delivering this programme requires a series of actions to be performed seamlessly across services.

Babies born to mothers who are carriers of hepatitis B infection are at high risk of becoming chronic carriers (90%) if infected perinatally; they are also at risk of developing complications with progressive liver disease (20-25%), cirrhosis or liver cancer in later life.

To improve compliance with serology testing at 12 months, the Area Team is planning to introduce the heel prick test this autumn. Practices can either take or refer for a blood test for hepatitis B surface antigen. Training sessions will be provided on 23 September in Corby, 25 September, Bedford and Welwyn Garden City, morning and afternoon respectively. A further training session is planned for Northampton.

9. Assessment of Injuries in children

During the last year there have been a number of Serious Case Reviews across the Area Team and one theme that has been identified is the management of bruising in non-mobile children. The Nursing Team have worked with GPs and the Chair of the RCGP Primary Care Safeguarding Group to provide information on what action should be taken if a child presents with bruising. The following information should be used alongside local LSCB policies and procedures.

There are a number of injury patterns that cause immediate concern in terms of child protection amongst which are:

  • Any bruising in non-mobile baby particularly facial bruising, see NSPCC’s All Babies Count;
  • Multiple bruising, with bruising in ‘protected’ areas or unusual bruises of different ages, see NSPCC Inform.

The alert practitioner may observe unusual signs when the child is brought with an incidental respiratory infection, nappy rash or apparently minor illness and rashes. Many local authority areas now have bruising protocols to be followed if the presentations described above are encountered. Please make sure you are aware of your local safeguarding board policies and procedures. If you have any concerns/questions please contact your Named Safeguarding GP. Details of local referral routes and contact details have previously been circulated to practices.

If a child presents with injury it is important to note whether the injuries are consistent with the history provided and the child’s developmental stage, but be aware developmental age is not always related to chronological age.

Think about the following:

  • Information regarding areas of bruising that is of concern: face/neck/ear, in infants this is of special significance as it may be a sign of or precursor to more serious injury;
  • Any facial/head/neck injury;
  • Bruising on buttocks and lower back;
  • Bilateral bruising;
  • Bruising on upper arms/thighs/small clusters etc or ‘protected’ areas;
  • Inconsistent history;
  • Late presentation of injury;
  • Injury not consistent with history or age/stage of child- especially important in infants who may not be mobile;
  • Unexplained injuries in non-mobile children particularly but all children;
  • Presence of other injuries- all presentations but especially those in infants under 12 months even if seemingly minor require full detailed examination;
  • Patterns of repeat injuries.

Ref RCGP/NSPCC Safeguarding Children Toolkitistration of Looked After Children (LAC)

10. Premises Team Updates

Please find attached updates from the NHS England Premises Team with regard to Section 106 Planning Obligations and Sale and Leaseback of Premises:

11. Contingency Plans – Informing the Area Team

Any practice experiencing problems which impact on their ability to deliver GP services i.e. power failure, should contact us here at the Area Team as soon as possible (see contact numbers at the back of the newsletter). Please ensure the practice contingency plan includes the requirement to contact the Area Team.5

12. Cold Chain Guidance

At a recent patient safety meeting, a serious incident was reviewed which highlighted that a practice had not been routinely monitoring the temperature of its vaccination fridge and had been overstocking it.

Vaccines may lose their effectiveness if they become too hot or too cold at any time. Anyone handling vaccines should follow appropriate policies to ensure cold chain compliance; if they do not they will be in breach of contract. Any use of vaccines that have deviated from recommended storage/transportation conditions is the responsibility of the vaccinator; the manufacturer will no longer be liable. Chapter 3 of the Green Book provides details on storage of vaccines, maintenance of the cold chain, fridge thermometers and temperature monitoring. Please see the chapter for further details.

Storage requirements are described in the manufacturers’ summaries of product characteristics (SPCs). Vaccines that have gone outside of specified storage requirements should not be used without a risk assessment, based on a thorough understanding of the likely impact of the temperature variation on the effectiveness of the vaccine. These vaccines should be quarantined, within the cold chain and neither used nor destroyed until advice has been obtained. Information on what to do in the case of a fridge failure is available at the following helpsheet

This includes information on how to contact manufacturers, how to report wastage and how to order replacement stock.

In the first 6 months of this year, avoidable cold chain incidents resulted in wasted vaccine costing over £44k across the Hertfordshire and South Midlands Area Team, mostly these were due to fridge doors being left open, switched off or stock being left out of fridges.

12. Important Deadlines

Description / Deadline
Extended Hours Q1 Submission / Due 11/07/2014
Bypass number for the Unplanned Admissions DES / Due 31/07/2014
CQRS Sign Up – Influenza, pneumococcal and shingles / 31/08/2014

Thank you

The GP Team

General Enquires

Director of Commissioning
Dominic Cox / / 0113 8248900
Associate Director of Primary Care
Anne – Marie Frost / / 0113 824 8916
07557 633579
Contract Manager
Lynn Dalton / / 0113 824 8836
07918 368407
Assistant Contract Managers
Pam Lewin / / 0113 824 8878
07918 368461
Keiren Leigh / / 0113 824 8919
07918 368351
Andrew Tarry / / 0113 824 8895
07918 368405
Andy Saunders / / 0113 824 8888
07918 368392
Primary Care Support
Lisa Redfearn / / 0113 824 8884
07918 368391
Cathy Harris / / 0113 824 8855
07918 368796
Janice Omar / Janice.Omar@ / 0113 824 8877
07918 368377
Laura Hughes / / 0113 824 8913
07918 368428
Admin Support
Sheila Addison / / 0113 8248825
Louise Greenhalgh / / 0113 824 8914