December 2025 Update

Welcome to the new practices who’ve joined us! We really appreciate the recommendations from many of you, which have brought more practices our way.

Approach to Monitoring and working to Guidelines

As we grow and develop, we’re more conscious than ever of the wide range of approaches that practices take, and how vague NICE and other guidance can be. We want to make sure our system is meeting the requirements that NICE and CQC expect of us all, but beyond that, we think it best to give each of you the ability to tailor the system. Rather than introducing a thousand localisation options, we’re aiming to cover the “must-dos” and then provide the tools for you to do more if you would like.

A recent example is the monitoring of Metformin. We currently monitor UE every 6m if the latest eGFR is <60. This NICE guidance (Metformin | Prescribing information | Diabetes - type 2 | CKS | NICE) suggests doing twice yearly UE for people with additional risk factors such as “elderly people”. We’ve decided we will introduce 6m monitoring for all patients over 80 by default. But if you’d like to add this for more patients, you can do so using our bulk add for regular monitoring - https://welbyinnovate.freshdesk.com/support/solutions/articles/202000093075

We have also refined which patients on metformin have B12 and Folate. We’ve reviewed categories for at-risk of B12 deficiency and changed the setup so only these patients have B12 and Folate monitored annually. Again, if you would like to add B12 and Folate monitoring for all your patients on metformin, you can do so manually using the same approach, and we’ve built the reports to make it easy.

Shared Care Drug Monitoring

Currently, the system looks at the most recent relevant codes to determine who is under secondary care for monitoring. We’re concerned about the risk that patients with historic codes may not be invited to monitoring when they are no longer under secondary care. From next week, we’re going to limit this time frame to codes added in the last 15 months. If you would like to review those patients who are currently recorded as under secondary care, but will soon be included in invites, you can use this report:

For those patients under secondary care for monitoring, the relevant code will now appear in the Manage Recall template, e.g.

As part of our prescribing module, when coding a medication review, we’ll introduce checks, e.g., asking for confirmation that the patient is still under secondary care monitoring.

Other Changes

• Recall
  • AR Visits – we’ve added reports for Follow up visits (section 4) – this reflects the setup in the invites and picks up patients who may have had some reviews coded, but not all work completed
  • AR Questionnaire follow-ups – we’ve added some additional reports to 1a AR Questionnaires / Section 4c – this is to bring together other completed questionnaires that may need follow-up – raised BPs and Cardiovascular Questionnaires
  • Monitoring pop-ups – e.g. asking to monitor HbA1c in 3m – these now include an option to pick an alternative, using the Request One-Off test template
• Prescribing
  • MHRA alert re Penicillamine Allergy - We’ve built a pop-up to flag if this is coded correctly, and a report to review patients who may have been coded in error with a Penicillamine allergy – Prescribing / 1 Clinical Actions / z Penicillamine allergy - ?Incorrectly Recorded (Penicillamine not ever issued & no Penicillin allergy recorded) - add code x02MQ to remove from report
  • Other updates, restructuring of clinical reports, and developing a Prescribing Planner is scheduled for February
• Pathology
  • SGLT2 prescribing – we’ve updated the reasons to consider an SGLT2 in light of updated guidance - Kidney conditions: CKD and SGLT2 inhibitors | Indicators | NICE
  • Thyroxine dose decrease pathway – this now includes patients over 60y old who’ve had a TSH below the lower limit of normal, with T4 in range or not taken
  • Blood Pressure targets – we have primarily been working to the NICE targets - Recommendations | Hypertension in adults: diagnosis and management | Guidance | NICE. One area of difference has been for Stroke/TIA patients, who are often recommended to be treated to a lower target. We have decided to remove this separate target and only work to the NICE targets. However, you can set lower targets for these patients, either individually or in bulk. This article explains how - https://welbyinnovate.freshdesk.com/en/support/solutions/articles/202000093520-how-do-i-review-blood-pressure-targets-. The change will be from next week.
  • Urine ACR – we have come across a few isolated incidents of a lost urine ACR being filed by the AutoReview rules. This is only an issue for Urine ACRs, as some results come back with no numeric value, because the ACR is too low to calculate. We’ve made changes to prevent this from occurring and created a report that can be used to review any affected results :

• There are a few changes we plan to make to Pathology, but that will require updating the Pathology Planner. We are going to make these on 17 December and will provide a brief Webinar the next day to run through the updates - https://events.teams.microsoft.com/event/c9b2cee2-94db-416a-8674-17500ef2270e@9e9607b7-90db-4eca-9e7f-e80f2ed8af67

Congratulations if you’ve made it to the end! Looking forward to seeing lots of you on Wednesday at our SystmOne Config webinar - https://bit.ly/WelbyWebinar. As ever, we’ll be recording it and will make it available.