Last review date 03/02/2023

LTC Reviews


Overview

Setup

Sending Invitations

Booking Appointments

Sending Reminders

Pre-assessment Questionnaires

Initial Review & Tests

Follow-Up Review

Interim Reviews

Exception Reporting

LTC Reporting

LTC Review - FAQ


Invitations are sent using clinical reporting and are based on month of birth by default, diagnosis and no review read code added in the current financial year. 

  • 1st invite is set-up to be sent just before the month of their birthday.
  • 2nd invite at least 3 weeks after the first invite.
  • 3rd invite a further 3 weeks after that. 

They are also split so that you can send them by post, email or SMS. 


The first invitation reports are split into 3 different categories and as a Practice you can choose which of these options best suits you and can continue using that process throughout the year.


The 3 different Invitation reports are as follows:


QOF and Best PracticeTo manage Best Practice and QOF conditions together, choose QOF and Best Practice Invitation reports. 
QOF onlyTo invite patients for QOF only; choose the QOF Only Invitation Reports
Dementia and LDIf choosing QOF and Best Practice or QOF Only, the separated Dementia and LD invitation reports can be used alongside these if required


Click on the LTC Overview page to see what conditions are included in each of the above options.


If your Practice does not wish to recall Patients for all of the LTC conditions in the same way and would like to, for example send a different letter to Patients with a particular disease, please see our Excluding Different Conditions Article.  



 

The 1st invitation should be sent by post as the letter gives more personalised information. The 2nd and 3rd invitations can be sent by email or SMS to save on overheads and will refer to the 1st invitation which will have all the personalised details on.


A single word document letter is used for all LTCs and will merge the appropriate LTC information and if tests are needed beforehand. If the patient has poor vision or a learning disability, they will have some information at the top of the letter to advise that they show the letter to someone who can assist with booking appointments.


Towards the end of the financial year you may wish to run the ‘Invites to send at the end of January’ and ‘Invites to send at the end of February’.


Choosing The Patients Recall Month

You can override a patient's default month of birth recall with another chosen month. To do this, just open the 'LTC Review' template and click on the 'Invitations' tab and then click in the top right to open the 'Choose LTC Review Month' template.



You can also do this in batch by going to Clinical Reporting > Ardens > LTC Review > 01 Register | Group Recall Month.  You will notice that each of these months are split between the different Invitation options.


If you wanted to change all the current January recalls to December, run the applicable January report and then batch add the December month read code below followed by the confirmation code.


Month Chosen
JanuaryJan 1993 hyacinth;yz01.
FebruaryFeb 1993 clematis;yz02.
MarchMar 1993 daffodil;yz03.
AprilApr 1993 wisteria;yz04.
MayMay 1993 petunias;yz05.
JuneJun 1993 freesias;yz06.
JulyJul 1993 dianthus;yz07.
AugustAug 1993 foxglove;yz08.
SeptemberSep 1993 begonias;yz09.
OctoberOct 1993 primrose;yz0A.
NovemberNov 1993 primulas;yz0B.
DecemberDec 1993 junipers;yz0C.


Confirmation CodeChronic long term disease management required; XaKdU


Sending Invitations in Bulk

NOTE - if you wish to use our reports for Dementia and LD patients, please follow the below steps on the Dementia and LD patient lists first, followed by the main invite reports for all other LTC patients. 


1. Sending the 1st Invitation in bulk

The invitations are split into 3 different invitation reports; Legacy, QOF and Best Practice and QOF Only.  For more information on these options please refer to the Set up Legacy Support Article or Set up (QOF & Best Practice / QOF Only) Support Article.                                       


The right click option called Actions in SystmOne allows Practices to send communications to patients in bulk.  This can be done by Email, SMS and Post.  


In each invitation month there are reports looking for patients that have had communication consents added to their records as below:



If you wished to send the same communication method to all patients such as a 1st invitation mail merged word letter, choose the All report.


Sending patient Email invitations

The Email report will show you all patients that have had an email consent added to their record.  This report is designed to have emails take president over SMS, so if a patient has both consents, they will receive an email from the practice rather than an SMS.


To email a communication to a patient, select the required patients; right click and select Actions.  Select either Communication Annexe or Send Email.  You will then be able to send an email to the patients in the list and a copy of the email will be saved in the patients record under Communications and Letters in the clinical tree.


In addition to the above; the LTC invitation code also needs to be added to move the patients through the LTC process. To do this, Right Click > Actions > Add Read Code > ‘XabEf – Long term condition care planning invitation first letter’


Sending patient SMS invitations

The SMS report will show a list of patients that just have SMS consent added to their records.


To SMS a communication to the patient, select the required patients; right click and select Actions. Select either Communication Annexe or Send SMS. You will then be able to send an SMS to the patients in the list and a copy of the SMS will be saved in the patients record under Communications and Letters in the clinical tree.


In addition to the above; the LTC invitation code also needs to be added to move the patients through the LTC process. To do this, Right Click > Actions > Add Read Code > ‘XabEf – Long term condition care planning invitation first letter’


Sending patient Letter invitations

The Post report will show a list of patients that have not had any of Email or SMS consent added to their records. 


To create in bulk highlight all patients; right click and select Actions.  Select Print Integrated Word Letters.  When selected you will be able to select the letter you wish to send in bulk along with the letter type.  When selected a preview of the first letter will appear and an option to merge and print.  Doing this will then print out a letter for each of the patients selected and add a copy of this to their records in the communications and Letters node on the clinical tree.


In addition to the above; the LTC invitation code also needs to be added to move the patients through the LTC process. To do this, Right Click > Actions > Add Read Code > ‘XabEf – Long term condition care planning invitation first letter’


For more information on Mail merge letters please see below.


Adding the individual QOF Invitation Codes In bulk

Every patient can also have the specific QOF Invite codes for their invitation added to the record. If this is added a second time 7 days after it is first added, then they will automatically be excepted for that Indicator. 


To make this process as easy as possible, we have created reports highlighting patients that would require specific invitation codes added to their record.  They are available under Clinical Reporting > LTC Reviews > 04 QOF invite code | 1st invite.


The reports are in month order and are broken down by the relevant QOF registers as below.



To bulk add a code, run the applicable report then right click and select Actions > Add Read Code. Then add the required read code as highlighted in the report. For example in the Asthma report add the Y1f90 code. 


Please note: These codes must be added on the same day as the communication was been sent out. 


2. Sending the 2nd Invitation in bulk

This can be done following the same process as above, but using the below reports:



Please note that the Bulk action Read code that needs to be added for each of these patients different and can be done by Right Clicking on the relevant report  > Actions > Add Read Code > ‘XabEh – Long term condition care planning invitation second letter’


Adding the individual QOF Invitation Codes In bulk

This will need to be done in the same way as above but the reports for this are in a different location as detailed below:



Both the 2nd and 3rd invitation reports can be done in the same way and also remember to do this on the same day as you send out the invitations.

3. Sending the 3rd Invitation in bulk

This can be done following the same process as above, but using the below reports:



Please note that the Bulk action Read code that needs to be added for each of these patients can be done by 

Right Clicking on the relevant report  > Actions > Add Read Code > ‘XabEj – Long term condition care planning invitation third letter’


Adding the individual QOF Invitation Codes In bulk

This will need to be done in the same way as above but the reports for this are in a different location as detailed below:



Both the 2nd and 3rd invitation reports can be done in the same way and also remember to do this on the same day as you send out the invitations.


Sending Invitations to under 16 year olds

As the invitation reports only cover individuals aged over 16 years old, we have also created invitation reports for children under the age of 16, these can be found under Clinical Reports > Ardens Ltd > LTC Reviews > 04 Booking | Age Under 16y.


These reports can be run on the same way as as the adult invitation reports by using either QOF Only or QOF and Best Practice patients and  bulk sending invitations can work in the same way as explained above along with bulk adding the QOF Condition Invite Code.



Please Note: These reports are not based on the patients month of birth. However, if you wished to breakdown the 1st Invitation report by patients month of birth, first run the relevant 1st Invitation report, right click on the report and select breakdown results.  On the left hand side their is an option to breakdown the report on demographics, clicking in this folder will give you a tick box option to choose month of birth.  Tick this box and click refresh at the top of the breakdown screen.  The report will then re-run showing patients month of birth.



Online Appointments

If you are not offering online appointments, please copy the invitation letter and then delete the line directing the patients to book their appointment online. The letters also have a standard NHS logo on, if you want your specific organisation logo please just copy & then add your logo instead.


Care Home Residents + Housebound Patients

Care home residents (nursing and residential home) and housebound patients (long term only, not temporarily) are not included in the monthly invitation reports. This is because GP practices usually do these patients all at the same time of the year. It is important therefore to decide within your practice when you wish to do this.


The reports for these can be found in Clinical Reports > Ardens Ltd > LTC reviews > 04 Booking | Visits for Care Home or Housebound.



 

These reports are split between Legacy, QOF + Best Practice and QOF Only.   You can therefore still follow the same invitation process for Visit reviews as you do with the invitation process.  The reports in each of these sections are split to look at reviews not done the 1st April or no review completed in the past 4 months.


Please ensure that your read codes and registers for these patients are kept up to date. If you use a separate clinical report at your practice using residential institute codes for your care home patients instead of read codes, please ensure that they also have the appropriate read code on their record too. To find out more about this please follow our Reporting on Residential Institute Codes and Read Codes Article.


Mailing Systems

These letters can also be sent using an online mailing system (e.g. DocMail, Webpost).  


Please see Copying Ardens Invitation letters section below if you wish to learn how to make your own version of the Ardens Invitation letters.





Copying Ardens Invitation Letters


To review and copy the Ardens Invitation letters go to Set Up - Referrals and Letters - Word Letter Templates.  In the Ardens Directory on the left hand side select Invitations.



We have created individual invitation letters for 1st, 2nd and 3rd invitations covering each of the invitation options as seen in the above screenshot.


If you wish to copy a letter to make your own version, right click on the applicable letter and choose copy.  This will then allow you to create your surgery own copy allowing you add any letter head or remove details of online appointment bookings if required.  


Please Note: Creating your own copy of an Ardens letters will mean that any changes made on the current Ardens version in the future will not update on your copied version.


Selecting Report Outputs


On the invitation reports you can select the relevant LTC Diagnosis report output to see a grid of the patients and their diagnosis. To do this:

  • Run the invitation report and then right click > show patients
  • At the top of this screen, click ‘Select Output’
  • Click ‘Pre-defined report output’. You then have a choice of 'LTC Diagnosis - QOF + Best Practice' or 'LTC Diagnosis - QOF only'. Choose the option depending on which conditions you are inviting in for, and click OK.




You will then see a grid of the patients with their different diagnosis.

  • Click the top of each column on the LTC name to sort the rows by this diagnosis.
  • You can then select the patients that you wish to send an invite to depending on their diagnosis and exclude those you do not want to send an invite to.



Sending invitations within the patients record


It is also possible to send invitations to patients within the patients record by using the invitations tab within the LTC Review template:



This tab will show you the invitations that have been sent on the left hand side and the right hand side will allow you to send either a 1st, 2nd or 3rd invitation.  


When clicking on one of the invitation buttons you will be taken through a protocol asking to choose what type of communication you are sending the patient



Selecting one of the options will take you through the process sending that form of communication to the patient.


Please Note: If you have choose to send the patient a letter and wish to send a Practice specific version you will need to make sure that you choose the relevant letter template by selecting the Choose Template Option on the New Letter Pop Up as detailed below:



Once the communication has been sent, you will then be given the option to both add the LTC Invitation code to the patients record as well as the generic QOF Invitation codes.


This will then be displayed automatically in the new or Tabbed journal with the relevant QOF codes added to the patients record.



NEXT: Booking Appointments