Using alert manager
- sarah.whiteacre (Unlicensed)
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Types of NHS Alerts
Re-attendance Alert
The NHSBSA provides a range of services to support the monitoring and risk management of NHS dentistry. It reviews specific areas of activity in order to identify and change behaviours that may be detrimental to the profession, patients or the tax-payer.
Review services include a focus on high rates of courses of treatment that are delivered within 28 days of a previous course. In this case data from the field suggests that quick re-attendance is not always justifiable in a small number of NHS contracts, so the NHSBSA wants to engage with the profession and enable providers to identify practices that may be contributing to these high rates.
Re-attendance defined:
In general, an FP17 submitted for a single patient's new course of treatment falling within 28 days of another course ending, is referred to as 28 day re-attendance.
More specifically, where any Band 1-3 claim follows within 28 days of a previous Band 1-3 claim, for the same patient at the same contract, this is categorised as a 28 day re-attendance claim.
Urgent treatment is not included and neither are patients who attended a different contract within 28 days.
In EXACT the default is 28 days, but the alert can be configured for any period from1 to 99 days.
Implementation of the Alert in EXACT:
Re-Attendance Alerting has been implemented in EXACT, together with an accompanying Re-attendance Report to help NHS EXACT users monitor their performance against NHS Attendance KPIs.
NOTE: Although the NHS monitors compliance with the 28-day re-attendance guideline, the Re-attendance Alert is independent of the NHS - it is an optional tool for practice purposes only and is not monitored by the NHS.
| From EXACT v12.3, when a Provider creates a Course Of Treatment that breaches the configured parameters for Re-attendance alerting, EXACT displays a non-intrusive red-dot alert icon in the COT header. Mouseover this icon to see a tooltip explanation for the Alert. |
Example procedure with the default 28-Day alerting:
A 28 Day Re-attendance Alert triggers at the point when a Provider creates a Treatment Plan.
EXACT then looks back through the patient's history to check whether the patient has had an NHS COT within the last 28 days (default is 28 days) - if YES, EXACT pops an alert for the Provider.
Where practitioners validly need to breach the rule (for example the patient requires urgent treatment), they are able to enter supporting Notes in justification of the breach.
NHS COTs that breach the 28 Day Re-Attendance KPI are visible to the Practice, and a report is available.
Configuration options:
- By default the Re-attendance Alert is 28 days, but is configurable between 1 and 99 days.
- Specify whether or not to display the alert when a CoT is created.
Specify whether or not Alert Notes are required - if they are required the Alert Note will include a statement "If you create a new COT you are required to enter some notes to justify the need for further treatment within this time frame."
Dental Assurance Framework (DAF) Alerts
The NHS Dental Assurance Framework (DAF) has become a nationally recognised KPI framework used for assessing practice performance.
In response to high levels of patient re-attendance within 28 days within the industry, the NHS DAF has set Key Performance Indicators (KPIs) for NHS practices to meet regarding patient re-attendance.
The national average for this KPI is 2.5% of appointments falling within the 28 days re-attendance definition, excluding urgent re-attendance. However, there is likely a wide variance in KPI rate, with practices with more than twice the national average not even included in the worst 500 performers.
The NHSBSA intention is to
- Subject the worst performing practices to a clinical review.
- Ask those practices that escaped the worst-performing label but exceeded the 50% threshold to consider performing a self audit. This would include more than a thousand practices nationally.
Practices are therefore motivated to monitor any actions that can lead to high levels of re-attendance within 28 days.
EXACT DAF Alerting capabilities
NHS DAF Alerting is configurable per practice (not per individual).
Trigger conditions for the alerts are based on NHS requirement specifications and are approved by the NHS.
NHS Practices using EXACT can optionally configure EXACT to
- Report on their DAF KPIs in order to be responsive to their continuous performance.
The NHS DAF KPI Report is also available through MyPractice Cloud (MPC).
- Collate evidence of practice performance against KPIs
- KPI-related actions are logged and auditable
- Associated notes are shown on the NHS DAF Alert Report
- Alert Providers to any possible actions that could contribute to these KPIs.
- Default messages advise that the current Provider activity is being NHS DAF KPI monitored.
- Messages instruct the Provider to input supporting notes or evidence.
- DAF Alerts are configured in the NHS Alert Manager.
Specific DAF alerts implemented in EXACT v12.3
- The Band 3 to Band 3 KPI
- Fluoride varnish check when first opening a COT for a child
- Fissure Sealant check when first opening a COT for a child
These are activated by default on upgrade to v12.3 but the Alert Notes Required field must be manually checked for a practice.
Responding to NHS Alerts
| When a Provider creates a Course Of Treatment, if it breaches the configured parameters for NHS alerting, EXACT displays a non-intrusive red-dot alert icon in the COT header. |
Hover your mouse cursor over the icon to read the alert in the form of a tooltip.
To open the NHS Alert Notes window
Alert Notes are NHS-required justifications for Providers breaching configured NHS parameters. Providers create them in the NHS Alert Notes window that EXACT automatically makes available when a parameter is breached.
You can open this window in multiple ways:
- Directly from within the Chart tab, in response to the Alert icon in the COT header:
| When a Provider creates a Course Of Treatment, if it breaches the configured parameters for NHS alerting, EXACT displays a non-intrusive red-dot alert icon in the COT header. |
Click the red Alert icon to open the window:
- When you attempt to send a Claim:
If you attempt to Send Claim without adding a required Alert Note, EXACTwill automatically pop up the Alert Notes window:
- At the point of TCing a COT:
TC the COT, then in the NHS FP17 window that pops up, select the Alert Notes tab.
From this Alert Notes tab select the [+1] button to open the Add Alert Notes window:
Resubmit button only displays for COT creator:
The popup Alert varies on whether the alerted Provider is the creator of the initial COT:
- Providers who are not the initial COT creator can only Create a COT or Cancel the Treatment Plan.
- Providers who are the initial COT creator are able to Create a COT, Resubmit the previous COT or Cancel the Treatment Plan.
Resubmitting the previous COT
Option to Create a COT:
NHS Alert Notes Window
| Auto-generated instructions to the Provider based on the NHS Alert configuration. |
| Alert Notes fields only display if a justification is required, where you need to justify why you're breaching the NHS guideline. The example above shows the full range of Alert Notes, but this window would display even a single Alert Note requirement. Simply type your justification into each textbox. To speed Note creation you can set up and use Quick Notes - see |
| Quick Notes have standard text content that can be quickly inserted into the Alert Note at the cursor location. Select the Quick Note and click the << button to insert it.
To create a Quick Note, select the [+1] button and complete the Add Quick Note window:
If you have many Quick Notes you can arrange them in Types to speed and simplify locating them - see (Quick Notes are also used in creating Clinical Notes) |
| Types are categories of Quick Notes, where you choose a Type to list just its that Type's associated Quick Notes. Types are only necessary if you have a large number of Quick Notes and it becomes awkward to locate the ones that you want. Use Types to speed and simplify locating appropriate Quick Notes to insert into your NHS Alert Note.
To create Types
NOTE: From v12.4 editing of Note Types is removed from the View Note Types window, resulting in a subtle change in behaviour... |
NHS Alerts Reporting
The NHS Re-attendance report is accessible within EXACT.
The NHS DAF KPI Report is only available through MyPractice Cloud (MPC).
NHS Re-attendance Report
In general, an FP17 submitted for a single patient's new course of treatment falling within 28 days of another course ending, is referred to as 28 day re-attendance.
More specifically, where any Band 1-3 claim follows within 28 days of a previous Band 1-3 claim, for the same patient at the same contract, this is categorised as a 28 day re-attendance claim.
Urgent treatment is not included and neither are patients who attended a different contract within 28 days.
The NHS Re-attendance report is a means for the practice to track compliance to the practice configured guidelines on Re-attendance.
Schedule: This report can be scheduled to be sent by eMail attachment (.CSV Export/PDF format) or printed automatically.
To run the NHS Re-attendance Report
- Select Administration > Reports.
- In the Reports tab, scroll down to the NHS Re-attendance Report and double-click it:
- Select the parameters for the Report:
- Select Patients by means of Query Template:
- Select Performer or Multiple Performers:
- Select a Contract Number by means of the Up/Down arrows or by opening the selection screen.
- Select From and To dates for the report.
- Specify the number of copies.
- Select Patients by means of Query Template:
- Print, Preview, Email or Export in the normal manner.
NHS DAF Alerting Report
The NHS Alert Manager provides a means for practices to setup alerts on NHS policy or service breaches, and to track the data around practice conformance.
Trigger conditions:
The trigger conditions for NHS DAF Alerting are based on NHS requirement specifications approved by the NHS.
In response to a DAF trigger condition a configurable message (unique to to each KPI) displays as a warning. The user who triggered the alert is able to add supporting notes/evidence as to why the action is occurring. The DAF breach action is logged in the database along with the user's supporting notes.
NHS Practices using EXACT can optionally configure EXACT to
- Report on their DAF KPIs in order to be responsive to their continuous performance.
- Collate evidence of practice performance against KPIs
- Alert Providers to any possible actions that could contribute to these KPIs.
DAF Alerting:
NHS DAF Alerting is configurable per practice (not per individual).
Trigger conditions for the alerts are based on NHS requirement specifications and are approved by the NHS.
NHS Practices using EXACT can optionally configure EXACT to
- Report on their DAF KPIs in order to be responsive to their continuous performance.
The NHS DAF Report is also available through MyPractice Cloud (MPC).
- Collate evidence of practice performance against KPIs
- KPI-related actions are logged and auditable
- Associated notes are shown on the NHS DAF Alert Report
- Alert Providers to any possible actions that could contribute to these KPIs.
- Default messages advise that the current Provider activity is being NHS DAF KPI monitored.
- Messages instruct the Provider to input supporting notes or evidence.
- DAF Alerts are configured in the NHS Alert Manager.
To run the NHS DAF Alerting Report
- Select Administration > Reports and double-click the NHS DAF Alerting Report.
- Specify the report parameters in the Print DAF NHS Alerting Report window:
- Select Patients: To Search across all Patients, leave the Select Patients box blank, or to filter the search, choose an existing Query Template or alternatively create a new Query Template.
- Performer(s): Choose the Provider(s) for whom to run the Report - use the Multiple option if necessary:
- Contract Number: Select the Contract Number against which to run the Report.
- From/To Dates: Set the period for reporting.
- Number of Copies: For physical printing.
- Select a report output option: Print, Preview, Email or Export.
The report may take some time to search through the patient selection in order to calculate the results:
When the report generates, a Main Heading section displays which parameters were used to generate the Report, followed by column headings and any matching results:
Date: Actual date on which the DAF Alert Breach occurred.
Patient: Unique Code and Name of a Patient.
Provider: Person who charted the COT.
Breaching COT Columns: The number of the COT that is causing the Alert(s) to be displayed, and the status of that COT.
Breached COT Columns: The number of the COT that was breached
Alert Type: Which event type caused the Alert.
Band 3: A previous Band 3 treatment has been planned/completed, and a new Band 3 COT has been started within the specified period.
Fluoride Varnish: Patients within the specified Age Range should have this service applied to them when they visit, if they have not had fluoride varnish applied within the specified duration.
Fissure Sealant: Patients within the specified Age Range should have fissure sealants applied to them when they visit, if they have not had a sealant within the specified duration.
Alert Notes: If Alert Notes required has been enabled for the alert(s) and notes have been entered, these will display. If no notes have been collected, a Not recorded message displays.
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