If you find your Mental Health (MH) patient won't "go green" on QOF Timeline no matter how many times you add a MHP code (Mental health care plan) such as 'Review of mental health care plan (867871000000100)' - they probably don't need one. There's likely a data quality issue with the diagnosis and remission history.

Some surgeries may have been using 'Patient unsuitable' exception coding; however, this annual workaround is unnecessary and, depending on the case, potentially even inappropriate. Fixing the data quality for diagnosis will resolve the issue for that record indefinitely.

Summary

If this is a problem at your surgery, ensure all staff that record diagnoses (clinicians/summarisers/coders etc) understand that:

1. The start of a MH episode (first diagnosis) must be marked 'New episode'
2. Subsequent remission entries do not need episodicity - neither 'New episode' nor 'Ongoing episode'
   This removes the patient from QOF indicators, they will remain on the QOF register due to their diagnosis.
3. If a patient relapses (e.g. needs treatment) an updated MH diagnosis must be added and be marked 'New episode'; this will place the patient
   This will place the patient back on the QOF indicators

The following explains in more detail, including ways to check and attempt resolve historic record errors.

Background

MH diagnoses require the start of each episode to be marked 'New episode' - if this episodicity is missing, subsequent entries of MH remission codes will not work and the patient will still appear in QOF MH indicators when they should only be on the MH register.

You can use the QOF Alerts & Analysis node to help check this with the Clinical Data by Code Cluster tab.

Example

George was diagnosed with 'Bipolar disorder' in 1982. In 1995, George's specialist confirmed he has been in remission for over 5 years and no longer requires monitoring.

Unfortunately the original diagnosis is missing 'New episode', so QOF incorrectly believes George needs the full suite of MH indicators completed. The indicators on QOF Timeline are red, prompting staff to complete work unnecessarily:

Having spotted the missing episodicity from the original diagnosis, we can add this, by right-clicking the code and specifying the original diagnosis was a 'New episode'.

On the QOF Alerts & Analysis screen this will display as an icon. On the Journal entry, there will instead be the text "(New Episode)" next to the code.

The start of the episode is now correctly marked 'New episode' and George is correctly exempt from MH QOF indicators (grey on QOF Timeline). He will remain on the MH register indefinitely in case of a relapse.

Multiple episodes

If a patient has had multiple episodes of a condition, or multiple conditions, the start of each episode will need to be marked 'New episode':

Duplicate/repeating diagnoses during an episode

Where a diagnosis has been re-added/duplicated during an episode, these can either have no episodicity or be marked 'Ongoing episode'; however, this is for record clarity, this will not impact QOF as long as there is a suitable starting diagnosis marked 'New episode' and a subsequent remission code. 

In the example below, the duplicate diagnoses in Dec 1982 and Apr 1984 have been marked 'Ongoing episode' (blue arrow).

A patient only has one MH code and it's "remission"?

Ideally: The original diagnosis should be back-dated prior to the entry of remission and marked as new episode.

If there is no evidence of the original diagnosis data available in a record history; mark the singular remission entry as 'New episode'. QOF will consider this both the original diagnosis and remission. For good records keeping, it is advisable to make an entry explaining that the surgery has no records indicating the original MH diagnosis date.