The NHS Diabetes Eye Screening (DES) Programme sent our mass-communication to practices via NEL Primary Care Communications on the 30 May 2022.
The communication included a written request to GP practices to support the accurate coding of diabetic patients to ensure that invitations to Eye Screening for these patients were not missed. This action was required to be completed by mid-July 2022.
Background & Context
The NHS DES programme identified an issue relating to SNOMED coding in primary care and its impact on identification of eligible individuals for diabetic eye screening.
Explanation of identified issue and important Safety Action
The NHS Diabetic Eye Screening (DES) programme uses a software system called ‘GP2DRS’ to accurately identify people with diabetes on your patient list who are eligible for eye screening. It does this by using SNOMED codes that are indicative of a diagnosis of diabetes.
In October 2021, an issue was highlighted where various SNOMED codes relating to “On examination diabetic foot” were found in patients’ notes in general practice but no other diagnostic diabetes codes were in their records.
These codes do not trigger an invite for diabetic eye screening as they are not indicative on their own for a diagnosis of diabetes. However, a small percentage (approx. 5%) of these individuals do have diabetes but have no other diagnostic codes for diabetes on their GP electronic medical record. Therefore, the individuals with non-diagnostic codes for diabetes require validation and a diagnostic code for diabetes added to their medical record in their GP practice so they can be called for screening if appropriate.
Investigations indicate the majority of these non-diagnostic codes were added to pre-diabetic individuals or other non-diabetes conditions who do not require diabetic eye screening.
There are roughly 3,400 patient records across North East London that need to be checked and amended. You can find a recent report which identified numbers of patients at PCN/practice-level in Annex 1 of this letter, or this can be downloaded from the webpage.
What are the next steps?
The NEL Diabetes Programme Team, along with our place-based Diabetes clinical leads, have requested and developed a search from CEG to be created for practices to identify these patients who need to either be correctly coded with a valid diagnostic code for Diabetes or to remove/re-code the diabetes-related code (if patient is non-diabetic).
Actions for GP Practice by 16 December 2022
- Use the search developed by CEG to identify the patients registered at the practice affected by the issue.
The search can be found here:
- Review and validate each patient to ensure that medical records are updated with a diagnostic code for diabetes if appropriate to ensure individuals are referred to and receive diabetic eye screening.
How to validate patients on GP IT software:
- Search the record for each individual patient from the CEG Search, using their NHS number and search text ‘Diabet’. These patients will have one of the following 17 codes added to their record:
- Review each patient record to determine if they do have diabetes. If they do have diabetes, add an additional and definitive ‘Diagnosed with diabetes mellitus’ SNOMED code to their record.
- If they do not have diabetes, please remove the related-diabetic code and re-code with appropriate non-diabetic code.
- Search for next patient until list is complete.
- Then no further action is required.
Deadline for GP practice
We would like to see this work completed, at the latest, by the 16 December 2022, to ensure that we mitigate any impacts on patients and their Diabetic Eye Screening invites. We will be re-running a report on a two-monthly basis to monitor progress.
If you have any further queries or require further information about this project, please contact the NEL Diabetes Transformation team by emailing nelondonicb.stpdiabetes@nhs.net. A webpage has also been created to facilitate any further updates relating to this issue: http://coronavirus.wel.nhs.sitekit.net/covid-updates/nhs-diabetic-eye-screening-programme-diabetic-coding-issue/613033.
Yours sincerely,
Dr Ann Baldwin, GP & NHS NEL ICB NDPP Clinical Lead
Dr Anju Gupta, GP & BHR Diabetes Clinical Lead
Dr Jyoti Sood, GP & NEL Training Hub Clinical Lead
Dr Khyati Bakhai, GP & Tower Hamlets Diabetes Clinical Lead
Dr Tamara Hibbert, GP & Newham Diabetes Clinical Lead
Dr Shaine Mehta, GP & City & Hackney Diabetes Clinical Lead
CC: Jeremy Kidd, NHS NEL ICB LTC & Prevention Lead, NHS NEL Diabetes Commissioners
Annex 1:
Please find report (as of 22.09.22), which identifies numbers of patients at PCN, and practice-level on Diabetes register with diabetes-related codes (i.e. Diabetic Foot coded).