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Data Services for Commissioners -

Commissioner Assignment Method Flow Chart 2015/16: Accompanying Guidance and Reference Tables

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Data Services for Commissioners

Commissioner Assignment Method Flow Chart 2015/16: Accompanying Guidance and Reference Tables

Version number: 11

First published: 7 December 2015

Prepared by: DSfC Programme Data Development Team

Classification: OFFICIAL

The National Health Service Commissioning Board was established on 1 October 2012 as an executive non-departmental public body. Since 1 April 2013, the National Health Service Commissioning Board has used the name NHS England for operational purposes.

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Contents

Contents ..................................................................................................................... 4

1 Document Purpose .............................................................................................. 5

2 Aligned Flow Chart Version and Status ............................................................... 5

3 Document Audience ............................................................................................. 5

4 Commissioner Assignment Method Objective ..................................................... 5

5 CDS Scope .......................................................................................................... 6

6 When to Assign Commissioner Code .................................................................. 6

7 Determining Usual Place of Residence ................................................................ 8

8 Flow Chart Methodology ...................................................................................... 9

9 Flowchart Key .................................................................................................... 10

10 Definitions of Assigned Commissioners ............................................................. 10

11 Flow Chart Annotations ...................................................................................... 20

12 Appendix A - NHS England Direct Commissioning Framework Responsibilities Matrix 2015/16 ................................................................................................... 51

13 Appendix B – Specialised and Highly-Specialised Service Line Codes ............. 55

14 Appendix C - Specialised Services Cross Border Flows within the UK .............. 69

15 Appendix D – Mapping Table to Identify Secondary Dental Activity .................. 76

16 Appendix E – Identification of Correct Commissioning Organisation for Infertility Care ................................................................................................................... 82

17 Appendix F – Mapping Table of Detention Centre Addresses and Regional Geography Commissioners Responsible for Paying for Treatment for Referrals from that Detention Centre ................................................................................. 84

18 Appendix G – Glossary .................................................................................... 102

19 Appendix H – Pseudo Postcodes for EU Member States and Other States with Similar Arrangements (starred) ........................................................................ 103

20 Appendix I – CAM Flow Chart .......................................................................... 104

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1 Document Purpose

This document provides further clarification and supporting information for the Commissioner Assignment Method flow chart.

2 Aligned Flow Chart Version and Status

This guidance relates to the version of the flow chart that is designed around the commissioning business rules for the 2015/16 financial year (flow chart file name [Commissioner Assignment Method v11.pdf] and Appendix I).

3 Document Audience

This document is designed to support those organisations (hereafter referred to as ‘providers’) who derive and provide commissioner code data within commissioning datasets. These organisations may be healthcare providers (e.g. acute or mental health trusts, independent sector hospitals) or commissioning support organisation (e.g. the HSCIC and its Data Services for Commissioners, Regional Offices (DSCROs)).

4 Commissioner Assignment Method Objective

The Commissioner Assignment Method, builds upon, complements and clarifies the August 2013 ‘Who Pays? Determining Responsibility for Payment to Providers’ guidance published by NHS England in August 20131. The Commissioner Assignment Method flow chart is designed to assist English secondary care providers of healthcare to allocate the correct commissioner code within specified commissioning datasets (CDS) for the healthcare activities they provide. The commissioner code is recorded within the CDS field ORGANISATION CODE (CODE OF COMMISSIONER) within the Service Agreement Details data group2. The commissioner code describes which commissioning organisation has payment responsibility, differentiating activity paid for by NHS England (including subdivisions thereof), Clinical Commissioning Group (CCG) commissioners and other commissioners as appropriate. It embodies the explicit commissioning hierarchy for CCG and NHS England commissioned services as described in the Gateway Reference Letter to NHS England Area Teams – Secondary Dental Care (Gateway Reference No. 00781), dated 20 November 20133.

SecondarydentalcareAFHJ11November2013 (commissioning hierarchy gateway letter).pdf

1 http://www.england.nhs.uk/wp-content/uploads/2014/05/who-pays.pdf 2 http://www.datadictionary.nhs.uk/data_dictionary/data_field_notes/o/org/organisation_code_(code_of_commissioner)_de.asp?shownav=0 3 http://api.ning.com/files/7U-JG7rftqTejdbtY-gzdLpa5h9PmjniQwHOGWBfCUjwxVN5Rx54WNkxGOFYYG51y-tYNiD7gFxOjD9m7m3hQyqR*D2SG--v/SecondarydentalcareAFHJ11November2013.pdf

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This shows the order of precedence for the different NHS England commissioned services, where more than one apply for a particular patient (e.g. member of the armed forces receiving specialised care).

5 CDS Scope

The following CDS v6.2 types are within the scope of the Commissioner Assignment Method flow chart:

CDS Name

010 Accident & Emergency Attendances

020 Outpatient Appointments

120 Admitted Patient Care Finished Birth Episodes

130 Admitted Patient Care Finished General Episodes

140 Admitted Patient Care Finished Delivery Episodes

150 Admitted Patient Care Other Birth Events

160 Admitted Patient Care Other Delivery Events

180 Admitted Patient Care Unfinished Birth Episodes

190 Admitted Patient Care Unfinished General Episodes

200 Admitted Patient Care Unfinished Delivery Episodes

6 When to Assign Commissioner Code

The Commissioner Assignment Method should be applied, based on CDS data content, at the following dates for the described CDS types:

CDS Type Date

010 (Accident & Emergency Attendances)

Arrival Date At Accident and Emergency Department

020 (Outpatients) Appointment Date

120 (Admitted Patient Care Finished Birth Episodes)

DISCHARGE DATE (HOSPITAL PROVIDER SPELL)

130 (Admitted Patient Care Finished General Episodes)


140 (Admitted Patient Care Finished DISCHARGE DATE (HOSPITAL

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CDS Type Date

Delivery Episodes PROVIDER SPELL)

150 (Admitted Patient Care Other Birth Events)


160 (Admitted Patient Care Other Delivery Events)


180 (Admitted Patient Care Unfinished Birth Episodes)

START DATE (HOSPITAL PROVIDER SPELL)

190 (Admitted Patient Care Unfinished General Episodes)


200 (Admitted Patient Care Unfinished Delivery Episodes


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7 Determining Usual Place of Residence

This paper assumes the same rules for deciding usual place of residence of a patient, as described in Annex B in the August 2013 ‘Who Pays? Determining Responsibility for Payment to Providers’ guidance. The guidance therein is also maintained for determining the residency status of asylum seekers, patients residing in approved premises, bail accommodation, patients who move during treatment, people taken ill abroad, students and boarding school pupils and persons detained under the Mental Health Act (1983).

Providers should also ensure for any patients with a ‘No Fixed Abode’ postcode (ZZ99 3VZ) or ‘Address Not Known’ postcode (ZZ99 3WZ), or ‘England UK - not specified’ (Z99 3CZ) that they identify a usual place of residence based upon the address of the main site of the provider delivering the care and use this address when determining commissioning payment responsibilities. Providers should not, however, transmit the postcode of the main site of the provider delivering the care, in the CDS itself for any patients who have no fixed abode as the ZZ99 3VZ postcode value may need to be used to differentiate this population group within health outcomes and equalities analyses.

Providers should endeavour to record the full address and postcode for patients from the UK home countries (Scotland, Wales, Northern Ireland). Providers should only use the pseudo postcodes for these countries (ZZ99 3GZ – Wales; ZZ99 1WZ – Scotland; ZZ99 2WZ Northern Ireland) if it is impossible to determine the full address and postcode for a patient.

Where a patient’s usual place of residence is overseas providers should record the full address and use the relevant pseudo postcode to indicate the country of usual residence. The pseudo post code list is maintained by the Office of National Statistics (ONS) as part of the ONS NHS Postcode Directory and can be found at the following HSCIC website:

http://systems.hscic.gov.uk/data/ods/datadownloads/onsdata

Serving members of the armed forces will be registered with a Defence Medical Services (DMS) primary care practice. These are located within the UK or overseas. Registration details are held on the Ministry of Defence’s (MoD) health information system ‘DMICP’ (Defence Medical Information Capability Programme). DMICP is integrated to the Patient Demographic Service on the Spine and the Spine’s demographic data for armed forces personnel are ‘civilianised’ by this integration. This is for security reasons as it prevents serving members of the armed forces being easily identifiable whilst in hospital. The civilianisation process removes rank and other military terminology from the patient demographic data and also replaces the patient’s actual place of residence with a civilian form of the address of the DMS practice they are registered with. This address should be used as part of the Commissioner Assignment Method and not the actual address of the patient. The same principle applies to serving personnel who are based overseas at a BFPO address and who return to the UK for treatment. The BFPO address should not be recorded as the usual place of residence for the security reason noted above. Instead the patient’s DMS practice address should be used.

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8 Flow Chart Methodology

The flow chart runs through a set of question steps, predominantly of a ‘Yes/No’ type. These questions lead ultimately to an answer to which identifies the commissioning organisation or organisation type with payment responsibility for the care represented by the CDS activity record. Providers need to write the correct Organisation Data Services organisation code for this organisation in the ORGANISATION CODE (CODE OF COMMISSIONER)4 field in the CDS. The correct codes to denote commissioning responsibilities for the 2015/16 financial year are described in the NHS England Direct Commissioning Framework Responsibilities Matrix 2015/16 (Appendix A). These organisations are also described in more detail in section 10 below.

For the sake of clarity the Commissioner Assignment Method flowchart includes annotations for each process step which link to further explanatory detail in the table below. This detail includes derivation logic for each step, where required. This derivation logic uses fields from the in-scope CDS types, and where this is the case the field names are in uppercase, as per the convention in the NHS Data Dictionary. The flow chart logic also relies on a number of reference files and look-up tables. These are either references to national files or a provided look-up file. The latter are detailed in the appendices to this document.

In some cases the derivation logic for a process step explains explicitly how to deal with stated default data values for CDS fields and how the relevant question should be answered for these values. If the derivation logic does not explicitly state how to deal with unstated default codes, invalid or null values within a CDS field then the derivation logic should be followed explicitly. For example if a question requires a specified value or values to be present in a CDS field for the answer to be ‘Yes’, then any other value in the CDS field, including nulls, would be answered ‘No’. This approach should ensure that a commissioner code can be assigned to all CDS records.

4 http://www.datadictionary.nhs.uk/data_dictionary/data_field_notes/o/org/organisation_code_(code_of_commissioner)_de.asp?shownav=0

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9 Flowchart Key

10 Definitions of Assigned Commissioners

Assigned Commissioners

Commissioner Comments / Logic

Host CCG The host CCG of a healthcare provider is the CCG within which the address of the provider’s main site is located.

‘Host CCG’ is derived as follows:

1. Establish main site of the healthcare provider by taking first three digits (i.e. ignoring any site code suffixes) of the CDS field: ORGANISATION CODE (CODE OF PROVIDER)

2. Derive postcode of the address of the provider’s main site by looking up the derived provider code in column1 the ODS reference file ‘etr.csv’ and extracting the provider’s postcode (from column 10)

3. Look up the extracted provider postcode in the ONS NHS Postcode Directory and derive the responsible CCG from field 18 in the Postcode Directory for the matching record.

In the absence of any previous official guidance for identifying the host CCG there may be local

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variations of this method for determining the Host CCG in current use that differ from this definition.

It is recognised that the above definition may not reflect current local practice, particularly in some metropolitan areas, where it is known that hospital sites may cross many CCG boundaries within a single trust. Should the above approach be applied it is possible that in these areas that the provider’s main site will have a different postcode to the point of treatment, which could lead to host CCG being a different organisation to what this guidance would suggest.

Commissioners and providers should be encouraged to use the definition for host CCG suggested by this document. Where this would result in a shift of local activity between CCGs, local commissioners and finance leads should be engaged to ensure appropriate adjustments are made locally. It is recognised that it may not be possible to implement the change to this definition of host CCG immediately.

Responsible CCG The responsible CCG is based on the CCG which a patient’s registered GP belongs to, or for patients who are not registered with any GP, the CCG within which the patient is usually resident.

Responsible CCG commissioner is derived as follows:

CDS field GENERAL MEDICAL PRACTICE CODE (PATIENT REGISTRATION) if this value is either Null or Missing, or V81999 (registered GP Practice Code not known) or V81998 (registered GP Practice code not applicable) or V81997 (No registered GP Practice) then take the value from the CDS field POSTCODE OF USUAL ADDRESS and look this postcode value up in the ONS NHS Postcode Directory and derive the responsible CCG commissioner from the value in the Directory’s ‘CCG’ field (field 18) for the matching record;

ELSE look up the value in the ODS ‘epraccur’ file and derive the responsible CCG commissioner from ‘epraccur’ field 15 (‘Commissioner - Code for the Commissioning Organisation (derived

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geographically)’ )

If there is no match to a record in ‘epraccur’ then revert to the postcode methodology.

If the CDS field: POSTCODE OF USUAL ADDRESS is populated with an ‘Unable to be allocated’ pseudo postcode (ZZ99 3WZ or ZZ99 3VZ) or is null then identify a usual place of residence based upon the address of the main site of the provider delivering the care and use this address when determining commissioning payment responsibilities.

Private Patient/Overseas Visitor

Patients are liable for all NHS charges relating to their care - whether as a non-charges exempt overseas visitor or as a private patient.

Providers will be required to assess a patient’s liability for NHS-charges and record appropriate data in the OVERSEAS VISITOR STATUS CLASSIFICATION and ADMINISTRATIVE CATEGORY fields of the CDS in order to further demonstrate the answer this question.

If the CDS field OVERSEAS VISITOR STATUS CLASSIFICATION is populated with the value ‘4’ (to pay all charges) OR if the CDS field ADMINISTRATIVE CATEGORY is populated with the value ‘02’ (Private Patient) then the answer to this question is ‘Yes’ else the answer is ‘No’.

NHS England Armed Forces Commissioning Hub

‘Who Pays?’ guidance states that NHS England is responsible for commissioning secondary and community health services for members of the armed forces who are registered with an English Defence Medical Services (DMS) GP Practice, for the members’ families where they are registered with an English DMS practice, and also for reservists whilst mobilised, irrespective of their registration status.

Providers should use the ‘Parent Organisation Code’ for the A91* practices in the epraccur

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reference file – ‘13Q’ as the commissioner code for NHS England-commissioned armed forces activity. 13Q is the code of the ‘NHS England Commissioning Hub 1’, which was set up to support the implementation of Choose and Book services for DMS practices. This field will unambiguously identify the correct commissioner organisation for the eligible armed forces population in commissioning data sets.

NHS England Specialised Commissioning Hub

Where a CDS record has been identified as being for specialised care then the relevant responsible NHS England Specialised Commissioning Hub will be responsible for paying for the care received.

The 10 NHSE Regional Geographies with commissioning responsibility for specialised services (‘Specialised Commissioning Hubs’) have agreed contracts for specialised services with specified UK providers. The Specialised Commissioning Hubs are described in the NHS England Direct Commissioning Framework Responsibilities Matrix 2015/16 (Appendix A) .The baselines for the 10 Specialised Commissioning Hubs also include funding to cover the cost of certain highly-specialised services provided to patients from all of the UK Home countries under the ‘Pre-1991’ agreement and care provided to Northern Ireland residents under the Northern Ireland Highly-Specialised Services Contract and care provided to Scottish residents under the Scotland Highly-Specialised Services Contract.

Providers MUST NOT use the redundant organisation code ‘YDD82’ as a commissioner code within the CDS. The prescribed specialised services identification rules software requires this code to be used within its input data to ensure correct application of the software logic, but it is not a valid commissioner code within the CDS.

The relevant responsible NHS England Regional Geography is derived as follows:

Take the value from the CDS field ORGANISATION CODE (CODE OF PROVIDER)

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And look this value up in the list of specified UK providers who have agreed contracts with NHS England Specialised Commissioning Hubs, as specified in the mapping file managed by the HSCIC Organisation Data Services team (http://systems.hscic.gov.uk/data/ods/datadownloads/atprovmap) and then use this to derive the corresponding NHS England Specialised Commissioning Hub code..

NHS Scotland National Services Division

The Scottish devolved administration is responsible for paying for all other specialised care, not covered by pre-existing legacy agreements with NHS England, for its residents at English providers.

The National Services Division of NHS Scotland is the responsible commissioner for specialised care for Scottish residents by managing a pool of funds (risk share scheme) on behalf of Health Boards to pay for individual patient referrals for a “prescribed” list of specialised services in England which are not included in the service agreement with NHS England 5

Providers should use the ODS code ‘SD002’ for the NHS Scotland Health National Services Division, as defined in the ODS ‘scotpur’ reference file, as the commissioner code for this activity.

Scottish Health Board Scottish Health Boards (SHBs) have a responsibility to provide for the health care of patients living within their boundaries, i.e. patients who are “ordinarily resident” in their area6. Scottish Health Boards are responsible for paying for non-specialised admitted and outpatient activity for their residents. The responsible Scottish Health Board is derived from the patient’s postcode of place of usual residence, via the ONS NHS Postcode Directory.

Scottish Health Boards are also responsible for paying for care provided to patients registered

5 http://www.nsd.scot.nhs.uk/%5C%5C/services/specialised/index.html 6 http://www.sehd.scot.nhs.uk/mels/CEL2013_06.pdf

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within Scottish Defence Medical Services Practices. Because there is no mapping between Scottish DMS practices and Scottish Health Boards the correct Scottish Health Board should be derived from a patient’s postcode of usual address which will be the postcode of the DMS practice itself.

Providers should use the ODS for codes in the rang SA9 to SZ9, as defined in the ODS ‘scotpur’ reference file, as the commissioner code for this activity. Take the value from the CDS field POSTCODE OF USUAL ADDRESS and look this postcode value up in the ONS NHS Postcode Directory and derive the responsible Scottish Health Board from the value in the Directory’s field 18 for the matching record.

Northern Ireland Health and Social Care Board

The Northern Ireland Health and Social Care Board is responsible for paying for all other specialised care, not covered by pre-existing legacy agreements with NHS England, for its residents in English providers. It is also responsible for paying for non-specialised admitted and outpatient activity for its residents.

The Northern Ireland Health and Social Care Board discharges its commissioning responsibilities via its five Local Commissioning Groups (LCGs) who commission care for their resident population7, therefore the responsible LCG is derived from the patient’s postcode of place of usual residence.

The Northern Ireland Health and Social Care Board, via its LCGs, is also responsible for paying for care provided to patients registered within Northern Irish Defence Medical Services Practices. Because there is no mapping between Northern Irish DMS practices and LCGs the correct LCG should be derived from a patient’s postcode of usual address which will be the postcode of the DMS practice itself.

7 http://www.niassembly.gov.uk/globalassets/documents/raise/publications/2011/health/14511.pdf

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Take the value from the CDS field POSTCODE OF USUAL ADDRESS and look this postcode value up in the ONS NHS Postcode Directory and derive the responsible Northern Ireland Local Commissioning Group from the value in the Directory’s field 18 for the matching record. Northern Ireland Local Commissioning Group values will be in the range ZC1 to ZC5

Welsh Local Health Board and Welsh Health Specialised Services Committee

The Welsh devolved administration is responsible for paying for all other specialised care, not covered by existing legacy agreements with NHS England, for its residents at English providers. It also holds payment responsibility for patients residing near the English/Welsh Border as defined within the Protocol for Cross-Border Healthcare Services8. It is also responsible for paying for care provided to patients registered within Welsh Defence Medical Services Practices.

NHS Wales discharges its specialised services commissioning responsibility through the Welsh Health Specialised Services Committee (Wales)9. Other commissioning responsibilities are covered by the various Welsh Local Health Boards who are responsible for planning, funding, designing, developing and securing the delivery of primary, community and in-hospital care services for residents in their respective areas and the responsible body will be established on the basis of the LHB area where the person is usually resident10. Therefore the responsible LHB is derived from the patient’s postcode of place of usual residence. Because there is no mapping between Welsh DMS practices and Welsh Local Health Boards the correct Welsh Local Health Board should be derived from a patient’s postcode of usual address which will be the postcode of the DMS practice itself.

There is no national ODS code for the Welsh Health Specialised Services Committee (Wales) so the ODS codes for the Welsh Local Health Boards (in the range 7A1-7A7) should be used as the commissioner code for this activity using postcode or practice look-ups to derive the correct

8 http://www.england.nhs.uk/wp-content/uploads/2013/03/england-wales-protocol.pdf 9 http://wales.gov.uk/docs/legislation/inforcenonsi/nationalhealth/091001direct35eng.doc 10 http://wales.gov.uk/docs/dhss/publications/130405body-guidanceen.pdf

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organisation.

Take the postcode recorded in the CDS field: POSTCODE OF USUAL ADDRESS and look this up in the ONS NHS Postcode Directory where the relevant Welsh Local Health Board organisation code is listed under field 18 for the matching record.

If the CDS field: POSTCODE OF USUAL ADDRESS is populated with the default pseudo postcode for Wales (ZZ99 3GZ) rather than a specific Welsh postcode then it will not be possible to allocate a specific Welsh Local Health Board organisation code and instead the code for the Welsh Government (W01) should be used instead.

Responsible Local Authority Local Authorities have a duty to improve the health of the people in their areas, funded by a ring-fenced grant. Local Authorities fulfil this duty by commissioning a range of services from providers. Some of these services are mandatory (e.g. sexual health, smoking cessation).

If the Local Authority services are commissioned from a secondary care provider and a standard CDS flow is used to record the activity then the responsible commissioner in the dataset will need to be the relevant Local Authority organisation.

The Who Pays? Guidance states that Local Authorities have the power to determine who their relevant population is for the services they commission (Annex B, Point 1, third bullet). However the default assumption is that each Local Authority will be responsible for commissioning relevant services for their resident population, specifically those people whose usual place of residence is within the geographic boundary of the Local Authority.

Take the value from the CDS field POSTCODE OF USUAL ADDRESS and look this postcode value up in the ONS NHS Postcode Directory and derive the responsible Local Authority from the

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value in the Directory’s field 9 for the matching record.

Responsible NHSE Regional Geography for Secondary Dental Services

All NHS England Regional Geographies have commissioning and payment responsibility for secondary dental care (see Appendix B), therefore the correct Regional Geography code should be used to populate the commissioner code within the CDS for secondary dental activity records.

Each NHS England Regional Geography commissioning team commissions secondary dental services for their responsible population which is defined as anyone registered with a GP practice belonging to a CCG within the regional geography’s boundary or anyone, not registered with any GP, who lives within a CCG located within the regional geography’s boundary

CDS field GENERAL MEDICAL PRACTICE CODE (PATIENT REGISTRATION) if this value is either V81999 (registered GP Practice Code not known) or V81998 (registered GP Practice code not applicable) or V81997 (No registered GP Practice) then take the value from the CDS field POSTCODE OF USUAL ADDRESS and look this postcode value up in the ONS NHS Postcode Directory and derive the code for the responsible Regional Geography from the value in the Directory’s ’Regional Geography’ field (field 24) for the matching record;

ELSE look up the value in the ODS ‘epraccur’ file and derive the code for the responsible Regional Geography from ‘epraccur’ field 4 (‘High Level Health Geography)


.

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Responsible NHSE Regional Geography for Health and Justice Commissioning

Ten NHS England Regional Geographies are responsible for health and justice commissioning (see Appendix A). These regional geography teams commission secondary care based on which prison or detention centre referred the patient. The responsible regional geography – detention centre mapping can be inferred from in Appendix 1 of ‘Securing Excellence in Commissioning for Offender Health’11 which lists the relationship between the old NHS England Area teams (which map on a 1:1 basis to the new NHS England Regional Geographies) and prison/detention centres. This has been used to construct a mapping table (Appendix F) which shows which of the 10 NHS England Regional Geographies are responsible for which prison/detention centre.

Take the postcode value from the CDS field: POSTCODE OF USUAL ADDRESS and look this up in column D of Appendix F.

The responsible Regional Geography commissioner can be obtained from Column E for the matching record.

11 http://www.england.nhs.uk/wp-content/uploads/2013/03/offender-commissioning.pdf

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11 Flow Chart Annotations

Assignment Process

Code Description Comments / Logic Assigned Commissioner

RPop Residential Population Check Checks to see whether an overseas visitor patient is part of the UK residential population for funding purposes.

Section 7 of Annex A of the ‘Who Pays…?’ guidance distinguishes between those charges-exempt overseas visitors who are part of the residential population and those who are not. This distinction is purely to determine whether the Host CCG or Responsible CCG should pay for the care provided to the charges-exempt overseas visitor. If a charges-exempt overseas visitor patient is registered with an English GP (and who may also give an English address as their place of usual residence12) then they are considered part of the residential population for funding purposes. Charges-exempt overseas visitors who are not registered with an English GP (and who may also not give an English address as their place of usual residence) are not considered as part of the residential population for funding purposes.

Yes:- Responsible CCG

No:- Host CCG

12 Note usual residence does not mean the same as ordinary residence – see Comments/Logic regarding question (C)

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Assignment Process


Take the value from the CDS field GENERAL MEDICAL PRACTICE CODE (PATIENT REGISTRATION);

if this value is neither V81999 (registered GP Practice Code not known) or V81998 (registered GP Practice code not applicable) or V81997 (No registered GP Practice)

AND if the value in the national GP file ‘epraccur’ has a ‘National Grouping’ value (field 3) NOT equal to ‘W00’ OR if this value is not blank

AND if the record has a Status Code in the national GP file ‘epraccur’ (field 13) of either A (active) or P (proposed) on the CDS Assignment Date ( as defined in section 6)

THEN the patient is registered with an English GP Practice and the answer to this question is ‘Yes’.

A&E- 1

This question checks whether the patient is usually resident in England.

If the CDS field: POSTCODE OF USUAL ADDRESS is a postcode from within England (i.e. where the value of the ‘Country’ field for that postcode in the ONS NHS Postcode Directory is equal to E92000001, then the

Yes:- question I

No:- Host CCG

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Assignment Process


answer to question 2 is ‘Yes’, else the answer is ‘No’


A This question identifies those patients liable for NHS charges – whether as a non-charges exempt overseas visitor or as a private patient.

Providers will be required to assess a patient’s liability for NHS charges and record appropriate data in the OVERSEAS VISITOR STATUS CLASSIFICATION and ADMINISTRATIVE CATEGORY fields of the CDS in order to further demonstrate the answer this question.

If the CDS field OVERSEAS VISITOR STATUS CLASSIFICATION is populated with the value ‘4’ (to pay all charges) OR if the CDS field ADMINISTRATIVE CATEGORY is populated with the value ‘02’ (Private Patient) then the answer to this question is ‘Yes’ else the answer is ‘No’

Yes:- A-1

No:- C

A-1 The commissioner for self-funded care will continue to be the ODS

This is in line with existing NHS data standards for ORGANISATION CODE (CODE OF COMMISSIONER).

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Assignment Process


default code ‘VPP00’.

B Specialised and highly-specialised services are identified via the correct and complete application of the Identification Rules for Prescribed Specialised Services (the IR)13

NHS England has developed a prescribed specialised services identification rules software tool, now maintained by the HSCIC14, which can be used to identify spells and outpatient attendances that represent specialised activity and which are also chargeable via a national tariff as part of Payment by Results. It is important to note that the identification rules software tool is not, of itself, sufficient means to identify specialised activity in CDS flows as full application of the IR requires the use of additional non-SUS datasets and logic. Providers should apply the rules in full using these other resources as required. Appendix B shows which specialised service lines can be identified by the specialised services identification rules software and which cannot.

It is also important to note that for admitted patient care consultant episode CDS records the identification rules software tool will allocate a specialised service line at episode level for those episodes with qualifying data content but may or may not allocate a specialised

Note this rule is used multiple times.

Following Box D or E(Yes outcome)

Yes:- B-1

No:- Assign commissioner code for relevant Welsh LHB/Scotland Health Board/N Ireland Local Commissioning Group

Following box E (No outcome)

Yes:- B-2

13 http://www.england.nhs.uk/wp-content/uploads/2012/11/pss-ir.pdf 14 http://www.hscic.gov.uk/casemix/prescribedspecialisedservices

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Assignment Process


service line code at spell level for a number of reasons. These are specified at the top of page 5 of the NHS England document: ‘Identification rules for prescribed specialised services: guide for trust information managers’15. In addition the software tool also does not flag a spell as specialised, if a provider marks up episodes within the spell as being exempt from national Payments by Results tariffs (see: http://www.datadictionary.nhs.uk/data_dictionary/data_field_notes/c/co/commissioning_serial_number_de.asp?shownav=0 for more information).

A general rule is that if any part of a spell is specialised then the whole spell should be considered as specialised. Therefore if the identification rules software tool flags an episode or episodes in a spell as specialised but does not flag the spell as specialised then the spell should still be considered as a specialised spell. Likewise if the full application of the IR logic indicates that a spell is specialised, even if the identification rules software tool of itself does not identify any spell or episode within it as specialised, then the spell is still specialised.

The exceptions to the above rule is where a spell

No:- Box F.

15 www.england.nhs.uk/wp-content/uploads/2012/11/pss-ir-managers.pdf

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Assignment Process


contains unbundled chemotherapy or radiotherapy Healthcare Resource Groups (HRGs) that are specialised and paid for by NHS England, where there are no other episode or spell level flags for specialised care, and where the core HRG for the spell is not either SB97Z or SC97Z (same day chemotherapy or radiotherapy delivery respectively). In this scenario the specialised service line code should only be written into the episode that contains the unbundled HRGs (i.e. the entire spell is not deemed as specialised). Likewise a spell may contain the following unbundled specialised critical care HRGs: XA01Z-XA04Z, XA06Z and XB01Z-XB08Z (paid for by NHS England) and have a core HRG that is chargeable to a CCG.

For these and other instances where the only specialised care is expressed via unbundled HRGs then the relevant specialised service line code should only be written into the episode that contains the unbundled HRGs (i.e. the entire spell is not deemed as specialised).

Where an entire spell is designated as specialised using the above logic then providers should record a specialised service line code into the NHS SERVICE AGREEMENT LINE NUMBER CDS field for every

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Assignment Process


episode record in the spell. The service line code used should be the service line for the spell as a whole (i.e. each episode in a specialised spell will contain the same spell-level service line code). Likewise the relevant Specialised Commissioning Hub code should be written into the Organisation Code (Code of Commissioner) CDS field for every episode in a spell deemed as specialised.

If an outpatient attendance is designated as specialised then Providers should record a specialised service line code into the NHS SERVICE AGREEMENT LINE NUMBER CDS field for the outpatient attendance CDS record.

A listing of all service line codes and descriptions for specialised and highly-specialised care for the 2015/16 financial year are included as Appendix B. The format of these codes is an 8-digit alphanumeric text string which starting with the 5 characters ‘NCBPS’.

The current version of the identification rules software tool, part of the wider IR process, requires providers to write the legacy organisation code ‘YDD82’ into the commissioner code field of the input file for the identification rules software tool. This code represented the code for the National Commissioning Group who,

27

Assignment Process


prior to 01 April 2013, was responsible for commissioning highly-specialised services. The identification rules software tool used this code as part of its spell logic16. Because of this dependency providers must still ensure that the YDD82 code is included in the input file for the identification rules software tool for any record that is highly-specialised. However this code must then be replaced with the correct organisation code in the CDS file.

B-1 NHS England commissions 5 highly specialised services on behalf of patients from Scotland, Wales and Northern Ireland. These ‘Pre-1991’ services were commissioned prior to health becoming a devolved function.

Scotland and Northern Ireland have additional agreements for extra highly specialised services that are commissioned by NHS England.

Appendix C lists the highly specialised services that are included in the ‘Pre-1991’ agreement.

The extra services for Scotland and Northern Ireland are listed in Appendix E part A (Scotland) and part B (Northern Ireland).

Providers need to check whether the specialised service line code is in these lists.

If the CDS field NHS SERVICE AGREEMENT LINE NUMBER contains a value contained within the list of specialised service line codes in column B or column C of Appendix E then the answer to this question is ‘Yes’

No:-

• Welsh Local Health Board

• Scotland National Services Division

• N Ireland Health and Social Care Board

Yes:- NHSE Specialised Commissioning Hub (based on Provider

16 See top of page 5 in http://www.england.nhs.uk/wp-content/uploads/2012/11/pss-ir-managers.pdf

28

Assignment Process


else the answer is ‘No’. Mapping Table)

B-2 NHS England Regional Geographies have agreed contracts with specific providers of specialised services. This question checks whether the specialised care has been provided by a contracted provider.

The specialised service contracts specify which services are provided by which providers and which NHS England Specialised Commissioning Hub holds the contract with each provider listed. A mapping Excel file detailing contracted specialised service providers and NHS England Specialised Commissioning Hubs is maintained by the HSCIC Organisation Data Services team and can be found here: http://systems.hscic.gov.uk/data/ods/datadownloads/atprovmap

If a provider identifies activity as specialised but that provider does not have a contract for specialised services with an NHS England Specialised Commissioning Hub then the Responsible CCG pays for the activity and not NHS England.

Take the value from the CDS field ORGANISATION CODE (CODE OF PROVIDER)

And look this value up in column C of the list of specified UK providers who have agreed contracts with NHS England Specialised Commissioning Hubs), if a matching record can be found then the answer to this

Yes:- NHSE Specialised Commissioning Hub (based on Provider Mapping Table)

No:- Responsible CCG

29

Assignment Process


question is ‘Yes’ else the answer is ‘No’

B-3 Checks whether the care provided is highly specialised.

Is the derived service line code one of those listed as a Highly Specialised Service Line in the list of Specialised and Highly-Specialised Service Line Codes ( Appendix B)

Yes:- B-4

No:- Residential Population Check (RPop)

B-4 This question requires providers to identify whether the CDS record is for care provided to a patient who is usually resident in an EU member state who has right of access to English highly-specialised services under arrangements governed by EU cross-border directives.

Providers should record a ZZ99 pseudo-postcode within the CDS to identify a patient’s country of residence. The total list of EU states is defined as: Austria, Belgium, Bulgaria, Croatia, Cyprus (Southern), Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Republic of Ireland, Romania, Slovakia, Slovenia, Spain, Sweden and the UK), plus Iceland, Liechtenstein and Norway.

Switzerland has a separate agreement with the European Union which, in effect, applies Regulations 883/2004 and 987/09 to Switzerland. Appendix H lists the ‘ZZ99’ pseudo postcode for each of the member states above.

If the CDS field: POSTCODE OF USUAL ADDRESS is a pseudo postcode representing an country whose

Yes:- NHSE Specialised Commissioning Hub (based on Provider Mapping Table)

No:- Residential Population Check (RPop)

30

Assignment Process


residents have right of access to English highly-specialised services (relevant pseudo postcode values are listed in appendix H), then the answer to this question is ‘Yes’, else the answer is ‘No’


C This question checks whether the patient is ordinarily resident within the UK

Chapter 3 in the Department of Health guidance document for the overseas visitor charging regulations “Guidance on implementing the overseas visitor hospital charging regulations 201517” describes what is meant by the term ‘ordinarily resident’ and what tests can be performed to determine if a patient is ordinarily resident in the UK. Note that ‘ordinarily resident’ is different to ‘usually resident’. The former relates to a person’s eligibility for free NHS treatment, whereas the latter relates to a person’s actual address where they are

Yes:- D (Welsh cross-border protocol)

No: - Is activity highly-specialised? (B-3)

17 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/418634/Implementing_overseas_charging_regulations_2015.pdf

31

Assignment Process


living.

Any patient deemed to be not ordinarily resident in the UK should have the CDS field OVERSEAS VISITOR STATUS CLASSIFICATION populated with the values of 1,2, 3 or 4, depending on their charging status.

If OVERSEAS VISITOR STATUS CLASSIFICATION = 1,2, 3 or 4 then the answer to this question is ‘No’ else the answer is ‘Yes’

D Under an agreement18 between Wales and England, for those patients usually resident in a defined set of Welsh administrative areas and English counties19 on the Wales-England border and registered with an Welsh GP, then a Welsh Local Health Board will be responsible for paying for the patient’s care and not an English NHS organisation

The appropriate Welsh Local Health Board is responsible for paying for care for patients registered with a Welsh GP and usually resident in one of the defined Welsh administrative areas or English counties described within the cross border agreement between Wales and England.

Residency in the relevant geographies is based on CCG boundaries in England and Welsh administrative areas in Wales.

Welsh DMS practices are not in scope, so members of the armed forces registered with a Welsh DMS practice

Yes:- B, Is activity specialised?

No:- D-1

18 http://wales.gov.uk/docs/dhss/publications/130327protocolen.pdf 19 Flintshire, Wrexham, Powys, Monmouthshire, Denbighshire, Western Cheshire, Shropshire County, Herefordshire and Gloucestershire

32

Assignment Process


are not considered to be registered with a Welsh GP.

If the value recorded in the CDS field GENERAL MEDICAL PRACTICE CODE (PATIENT REGISTRATION) maps to one of the following Welsh Local Health Board codes (7A1, 7A2, 7A3, 7A4, 7A5, 7A6 or 7A7) in the ODS GP Practices in England and Wales reference file ‘epraccur’ AND [if the post code value from the CDS field: POSTCODE OF USUAL ADDRESS maps in the ONS NHS Postcode Directory to either one of the following CCG codes (via ONS NHS Postcode Directory field 18): ‘01R’ (NHS South Cheshire); ‘02F’ (NHS West Cheshire); ‘12F’ (NHS Wirral); ‘05F’ (NHS Herefordshire); ‘05N’ (NHS Shropshire); ‘05X’ (NHS Telford and Wrekin); ‘11M’ (NHS Gloucestershire); ‘12A’ (NHS South Gloucestershire) OR if the post code value from the CDS field: POSTCODE OF USUAL ADDRESS maps in the ONS NHS Postcode Directory to one of the following Welsh Unitary Authorities (via ONS NHS Postcode Directory field 9): ‘W06000005’ (Flintshire); ‘W06000006’ (Wrexham); ‘W06000023 (Powys); ‘W06000021’ (Monmouthshire’); ‘W06000004’ (Denbighshire] then the answer to this question is ‘Yes’ else the answer is ‘No’

33

Assignment Process


D-1 Under an agreement[4] between Wales and England, for those patients usually resident in a defined set of Welsh administrative areas and English counties[5] on the Wales-England border and registered with an English GP, then an English NHS Organisation will be responsible for paying for the patient’s care.

As described in rule D above, the Wales-England Border agreement covers responsibility and payments for care for patients residing in one of the defined Welsh administrative areas or English counties defined within the cross border agreement.

If the value recorded in the CDS field for GENERAL MEDICAL PRACTICE indicates an English GP based on CCG code, and the patient has a home address as determined from the POSTCODE OF USUAL ADDRESS in either of the Welsh Local Health Board or English border areas as defined in box D, then they have an English commissioner and the answer is Yes.

If they live outside of the border agreement area or within the agreement area but without a GP, the answer is no. If the patient is not registered with a GP, but resides in the border area, the responsibility and payments is covered by residence rules as covered in the subsequent question.

No: Go to question E.

Yes: Go to question B.

E This question checks whether the patient is usually resident within

Residency will need to be defined by the postcode of the patient’s usual address. For serving members of the

Yes:- B, is activity specialised (Non-English

[4] http://wales.gov.uk/docs/dhss/publications/130327protocolen.pdf [5] Flintshire, Wrexham, Powys, Monmouthshire, Denbighshire, Western Cheshire, Shropshire County, Herefordshire and Gloucestershire

34

Assignment Process


Scotland, Wales or Northern Ireland armed forces based in the UK, the address of their DMS practice will be used as a proxy for their place of usual residence.

If the CDS field: POSTCODE OF USUAL ADDRESS is a postcode from a UK home country (i.e. where the value of the ‘Country’ field for that postcode in the ONS NHS Postcode Directory is equal to either

W92000004, S92000003 or N92000002) then the answer to question 2 is ‘Yes’, else the answer is ‘No’


Scottish Health Boards (SHBs) have a responsibility to provide for the health care of patients living within their boundaries, i.e. patients who are “ordinarily resident” in their area20 therefore the responsible SHB will be derived from the patient’s postcode of place of usual

UK residents)?

No:- B, is activity specialised (English residents)?

20 http://www.sehd.scot.nhs.uk/mels/CEL2013_06.pdf

35

Assignment Process


residence.

Northern Ireland Local Commissioning Groups (LCGs) commission services for their respective resident population 21, therefore the responsible LCG is derived from the patient’s postcode of place of usual residence.

Welsh Local Health Boards (LHBs) in Wales are responsible for planning, funding, designing, developing and securing the delivery of primary, community and in-hospital care services for residents in their respective areas and the responsible body will be established on the basis of the LHB area where the person is usually resident22. Therefore the responsible LHB is derived from the patient’s postcode of place of usual residence.

To determine the correct ORGANISATION CODE (CODE OF COMMISISONER) for the devolved administration health organisation responsible for paying for the care take the value from the CDS field POSTCODE OF USUAL ADDRESS and look this postcode value up in the ONS NHS Postcode Directory and derive the responsible Welsh Local Health Board or Northern Ireland Local Commissioning Group from the

21 http://www.niassembly.gov.uk/globalassets/documents/raise/publications/2011/health/14511.pdf 22 http://wales.gov.uk/docs/dhss/publications/130405body-guidanceen.pdf

36

Assignment Process


value in the Directory’s field 18 for the matching record. The responsible Scottish Health Board can be derived from the Directory’s field 16.

The Scottish Health Boards values will be in the range: SA9 to SZ9

Northern Ireland Local Commissioning Group values will be in the range ZC1 to ZC5

Welsh Local health Boards values will be in the range 7A1 to 7A7

If the CDS field: POSTCODE OF USUAL ADDRESS is populated with the default pseudo postcode for Wales (ZZ99 3GZ) rather than a specific Welsh postcode then it will not be possible to allocate a specific Welsh Local Health Board organisation code and instead the code for the Welsh Government (W01) should be used instead.

If the CDS field: POSTCODE OF USUAL ADDRESS is populated with the default pseudo postcode for Northern Ireland (ZZ99 2WZ) rather than a specific Northern Ireland Postcode then it will not be possible to allocate a specific Northern Ireland Local Commissioning Group organisation code and instead the code for the Northern Ireland Health and Social Care Board (ZB1) should be

37

Assignment Process


used instead.

If the CDS field: POSTCODE OF USUAL ADDRESS is populated with the default pseudo postcode for Scotland (ZZ99 1WZ) rather than a specific Scottish postcode then it will not be possible to allocate a specific Scottish Health Board organisation code and instead the code for the Scottish Government Health and Social Care Directorate (SD001) should be used instead.


F This question checks whether the activity record represents activity carried out by a public health function

The scope of the mandated public health services within England is described in the DH document “Public Health in Local Government – Commissioning Responsibilities” gateway reference number 16747(12)23. It may also be possible that providers covered by these CDS records

Yes:- Go to F-1

No:- G

23 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216712/dh_131901.pdf

38

Assignment Process


are providing services covered by the NHS England Section 7a agreement24 or via agreements with Welsh Local Health Boards.

The services described in these documents may not be measured or otherwise described by the commissioning datasets that are the focus of this guidance. However if a provider does flow activity data for these services via an in-scope commissioning dataset then the answer to this question is ‘Yes’.

Even then it may not be possible to unequivocally identify, using commissioning dataset fields alone, the data relating to activity from a public health service. Instead it will be necessary to use local systems and data to do this. Providers should be able to provide these data as additional evidence for validation and assurance purposes if required to do so under local commissioning arrangements.

If these data identify the CDS record as public health activity then the answer to this question is ‘Yes’ else the

24 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/389168/S7A_1516_FINAL.pdf

39

Assignment Process


answer is ‘No’.

F-1 This question checks whether the patient is resident within England

if the CDS field: POSTCODE OF USUAL ADDRESS is a postcode from an English address (i.e. where the value of the ‘Country’ field for that postcode in the ONS NHS Postcode Directory is equal to E92000001,) then the answer to this question is ‘Yes’ else the answer is ‘No’.


If No – responsible Welsh Local Health Board commissioner

If Yes – go to F-2

F-2 This question checks whether activity data represents a public health service covered by the Section 7a agreement

In England certain public health services are commissioned by NHS England under the Section 7a agreement25. If the CDS record describes activity from a service falling within the scope of the section 7A agreement then the commissioner for the service will be an NHS England Regional Geography. Otherwise the

If Yes – responsible NHS England Regional Geography

If No – Local Authority

25 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/389168/S7A_1516_FINAL.pdf

40

Assignment Process


commissioner will be the patient’s Local Authority of Residence.

NHS England commissions public health section 7a services on a responsible population basis. The responsible population of an NHS England Regional Geography is any one registered with a GP belonging to CCG within the Regional Geography’s geographical boundary, or for people who are not registered with a GP, anyone resident within a CCG within the Regional Geography’s geographical boundary.

CDS field GENERAL MEDICAL PRACTICE CODE (PATIENT REGISTRATION) if this value is either V81999 (registered GP Practice Code not known) or V81998 (registered GP Practice code not applicable) or V81997 (No registered GP Practice) then take the value from the CDS field POSTCODE OF USUAL ADDRESS and look this postcode value up in the ONS NHS Postcode Directory and derive the code for the responsible Regional Geography from the value in the Directory’s ’Regional Geography’ field (field 24) for the matching record;

ELSE look up the value in the ODS ‘epraccur’ file and derive the code for the responsible Regional Geography

41

Assignment Process


from ‘epraccur’ field 4 (‘High Level Health Geography)


To determine the responsible Local Authority commissioner for a non-Section 7a public health service take the value from the CDS field POSTCODE OF USUAL ADDRESS and look this postcode value up in the ONS NHS Postcode Directory and derive the responsible Local Authority from the value in the Directory’s field 9 for the matching record.

G ‘Securing excellence in commissioning NHS dental services’ describes secondary dental activity as activity carried out by GDC-recognised dental specialties within general and dental hospital and dental teaching-hospital based services.

Annex A of ‘Securing excellence in commissioning NHS dental services’ lists which specialties and services constitute secondary dental activity. This has been used to construct a preliminary mapping table to identify secondary dental activity based on certain values of Treatment Function Code and/or Main Specialty Code (see Appendix D). The Securing Excellence document describes a future need to disaggregate the dental component of Oral Maxillofacial Surgery activity which might be facilitated by the use of ICD-10 and OPCS4 codes, however this disaggregation is not currently part of the derivation logic.

Yes:- Responsible NHSE Regional Geography for Secondary Dental Services

No:- H

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Assignment Process


If the value in the CDS field ACTIVITY TREATMENT FUNCTION CODE is in the following list: 140 (oral surgery), 143 (orthodontics), 142 (paediatric dentistry), 141(restorative dentistry), 217 (paediatric maxillofacial surgery), 450 (dental medicine specialties) and 144 (oral and maxillofacial surgery) then the answer to this question is ‘Yes’ else the answer is ‘No’.

All NHS England Regional Geographies have commissioning and payment responsibility for secondary dental care (see Appendix A), therefore the correct Regional Geography code should be used to populate the commissioner code within the CDS for secondary dental activity records.

NHS England commissions secondary dental services on a responsible population basis as it took over this responsibility from Primary Care Trusts on 01 April 2013. The responsible population of an NHS England Regional Geography is any one registered with a GP belonging to CCG within the Regional Geography’s geographical boundary, or for people who are not registered with a GP, anyone resident within a CCG within the Regional Geography’s geographical boundary.

CDS field GENERAL MEDICAL PRACTICE CODE

43

Assignment Process


(PATIENT REGISTRATION) if this value is either V81999 (registered GP Practice Code not known) or V81998 (registered GP Practice code not applicable) or V81997 (No registered GP Practice) then take the value from the CDS field POSTCODE OF USUAL ADDRESS and look this postcode value up in the ONS NHS Postcode Directory and derive the code for the responsible Regional Geography from the value in the Directory’s ’Regional Geography’ field (field 24) for the matching record;

ELSE look up the value in the ODS ‘epraccur’ file and derive the code for the responsible Regional Geography from ‘epraccur’ field 4 (‘High Level Health Geography)

If there is no match to a record in ‘epraccur’ then revert to the postcode methodology

H Does the CDS activity record describe any form of infertility care or treatment?

For admitted patient care CDS records, the criteria described in the HSCIC guidance for submitting sensitive data to SUS26 can be used to identify infertility care records.

If the CDS field PRIMARY DIAGNOSIS or the CDS field

Yes:- Responsible CCG unless otherwise advised

No:- I

26 http://www.hscic.gov.uk/media/13680/Submitting-Sensitive-or-Anonymous-Records-to-SUS-v10/pdf/Submitting_Sensitive_or_Anonymous_Records_to_SUS_v1.0.pdf

44

Assignment Process


SECONDARY DIAGNOSIS (ICD) includes any of the following ICD10 diagnosis codes:

N46 plus all 4th digit suffices, N97 plus all 4th digit suffices, Z31 plus all 4th digit suffices Z35.0

OR if the CDS field PRIMARY PROCEDURE (OPCS) or if the CDS field SECONDARY PROCEDURE (OPCS) includes any of the following OPCS4 intervention codes:

N34.1-6, Q13.1-9, Q21.1, Q21.8, Q21.9, Q38.2-3, Q48.1-4, Q48.8, Q48.9, Q56.1-2, Y96.1-6, Y96.8-9

Then the answer to this question is ‘Yes’ else the answer is ‘No’

Armed Forces

The commissioning arrangements for infertility care are complex for the armed forces population where special rules exist for serving members, their partners and veterans, for cases where the infertility is a consequence of service. However the number of patients falling into this category are very low (<10 per annum). It is not possible to unequivocally identify using CDS fields alone whether a CDS record describing infertility care or treatment should be paid for under the

45

Assignment Process


special rules applying to armed forces health.

As a consequence the Responsible CCG will pay for infertility treatment in the vast majority of cases and providers should use this by default unless otherwise advised. The Responsible CCG is based on the CCG which a patient’s registered GP belongs to, or for patients who are not registered with any GP, the CCG within which the patient is usually resident.

NHS England Armed Forces health leads operate a process to determine whether a patient’s infertility treatment needs to be paid for under the special rules applying to armed forces health (see Appendix E). Where this is found to be the case providers will be contacted by NHS England before the patient attends for care. Providers will then need to manually modify the commissioner code within the relevant CDS submission records from the default responsible CCG code to the agreed code for NHS England Armed Forces Health Commissioning Hub– ‘13Q’ .

I This question checks whether the patient’s GP Practice Code is a Defence Medical Services practice.

‘Who Pays?’ guidance states that NHS England is responsible for commissioning secondary and community health services for members of the armed forces who are registered with an English Defence

Yes:- NHSE Armed Forces Commissioning Hub

46

Assignment Process


Medical Services (DMS) GP Practice, for the members’ families where they are registered with an English DMS practice, and also for reservists whilst mobilised, irrespective of their registration status. Patients who fall within this commissioning responsibility are registered with or referred from English GP practices, which have the code ‘13Q’ as their parent commissioning organisation in the national GP practice reference file ‘epraccur’.

Where GENERAL MEDICAL PRACTICE CODE (PATIENT REGISTRATION) in the CDS record is populated with an organisation code that has the code ’13Q’ listed as the Commissioner organisation in column 15 of the national GP practice reference file ‘epraccur’, AND where the postcode of the practice address (column 10 of the national GP practice reference file ‘epraccur’) has the value E92000001 in the ‘Country’ field in the ONS NHS Postcode Directory then the answer to this question is ‘Yes’ else the answer is ‘No’

No:- J

J The ‘Who Pays?’ guidance and the ‘Securing Excellence for Commissioning in Offender Health’ state that NHS England is responsible for commissioning

NHS England only commissions admitted patient care and outpatient care for these patients. It does not commission accident and emergency care.

Note that NHS England is not responsible for paying for

Yes:- Responsible NHSE Regional Geography for Health and Justice

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Assignment Process


admitted and outpatient care provided by secondary care health services for persons who are detained in English Prisons, Secure Training Centres, Secure Children’s Homes, Young Offender Institutes and Immigration Removal Centres. This includes people who have been convicted and people held on remand. This question is designed to identify whether patients fall into this category.

secondary care for persons detained in and referred from police custody suites, other places of temporary secure accommodation such as courts, or people held on remand in the community whilst on bail.

The use of prison practice codes to identify the eligible health and justice population is not recommended as offenders often remain with their usual NHS GP if their sentence is less than 2 years. Another reason is that the current prison primary care system is not connected to the Spine and therefore the registration details for patients registered with HMP practices will not flow from the Spine to Spine-connected Patient Administration Systems. Finally not all prisons use a dedicated HMP practice.

Providers should record the place of permanent detention as the place of usual residence for any patient referred for secondary care from a place of secure accommodation. This is in line with Connecting for Health Guidance from 201027. The specific institutions that are in-scope are described in Appendix 1 of Securing Excellence for Commissioning for Offender Health28. Just under 95% of these institutions have a

Commissioning

No:- Responsible CCG

27 http://nww.connectingforhealth.nhs.uk/offenderhealth/guidance/prisonreferrals.pdf 28 http://www.england.nhs.uk/wp-content/uploads/2013/03/offender-commissioning.pdf

48

Assignment Process


unique postcode, with the remaining institutions sharing a postcode with another address site.

Providers should also ensure that the CDS field SOURCE OF ADMISSION CODE (HOSPITAL PROVIDER SPELL) is populated with the value ‘39’ (penal establishment, court, or police station) for any patients who have been admitted from a prison. Any patient whose postcode of place of usual residence is one of these institutions listed in Appendix F and whose admission source is a prison, court or police station will be deemed to be part of the eligible health and justice population. It is acknowledged that for the ~ 5% of institutions that do not have a unique postcode then there is a small risk of incorrect allocation using this methodology. However since full address data does not flow in the CDS where there is a valid NHS Number there is currently no other unequivocal identification method.

For APC CDS records: If the CDS field: POSTCODE OF USUAL ADDRESS is populated with a postcode value contained within the list of organisations detailed in Appendix F (column D refers) AND if CDS field SOURCE OF ADMISSION CODE (HOSPITAL PROVIDER SPELL) is populated with the value ‘39’ then

49

Assignment Process


the answer to this question is ‘Yes’, else the answer is ‘No’.

For Outpatient CDS records: If the CDS field: POSTCODE OF USUAL ADDRESS is populated with a postcode value contained within the list of organisations detailed in Appendix F (column D refers) then the answer to this question is ‘Yes’, else the answer is ‘No’.

Ten NHS England Regional Geographies are responsible for health and justice commissioning (see Appendix A). These regional geography teams commission secondary care based on which prison or detention centre referred the patient. The responsible regional geography – detention centre mapping can be inferred from in Appendix 1 of ‘Securing Excellence in Commissioning for Offender Health’29 which lists the relationship between the old NHS England Area teams (which map on a 1:1 basis to the new NHS England Regional Geographies) and prison/detention centres. This has been used to construct a mapping table (Appendix F) which shows which of the 10 NHS England Regional Geographies are responsible for which prison/detention centre.

29 http://www.england.nhs.uk/wp-content/uploads/2013/03/offender-commissioning.pdf

50

Assignment Process


Take the postcode value from the CDS field: POSTCODE OF USUAL ADDRESS and look this up in column D of Appendix F.

The responsible Regional Geography commissioner can be obtained from Column E for the matching record.

Please note, in cases where prisoners are transferred from one hospital provider to another hospital provider, the SOURCE OF ADMISSION CODE (HOSPITAL PROVIDER SPELL) field will no longer be ‘39’ in the second provider. This creates a small risk that the method will not provide the correct commissioner in this case.

51

12 Appendix A - NHS England Direct Commissioning Framework Responsibilities Matrix 2015/16

NHS England Region Name NHS England Region (Geography) Name

ODS Region

(Geography)

Code

ODS Commissioning hub

Name

ODS

Commissioning

hub Code

Commissioning

Responsibility

Organisation Code

(Code of

Commissioner) for

CDS Submissions

and Provider

Invoices

Specialised

Commissioning Hub

Name

Commissioning

Responsibility

Organisation

Code (Code of

Commissioner)

for CDS

Submissions

Invoicing

Arrangements

Commissioning

Responsibility

Organisation

Code (Code of

Commissioner)

for CDS

Submissions

and Provider

Invoices

Commissioning

Responsibility

Organisation

Code (Code of

Commissioner)

for CDS

Submissions

and Provider

Invoices

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

NHS England North (Yorkshire and Humber) Q72Yorkshire and Humber

Commissioning hub13V � 13V

Yorkshire and Humber

Specialised

Commissioning Hub

� 13Q � Q72 � Q72 � �

NHS England North (Lancashire and Greater Manchester) Q73Lancashire and Greater

Manchester Commissioning hub13W � Q73 � Q73 � �

NHS England North (Cumbria and North East) Q74Cumbria and North East

Commissioning hub13X � 13X

North East Specialised

Commissioning Hub� Q74 � Q74 � �

NHS England North (Cheshire and Merseyside) Q75Cheshire and Merseyside

Commissioning hub13Y � 13Y

North West Specialised

Commissioning Hub� Q75 � �

NHS England Midlands and East (North Midlands) Q76North Midlands Commissioning

hub14A � 13Q � Q76 � Q76 � �

NHS England Midlands and East (West Midlands) Q77West Midlands Commissioning

hub14C � 14C

West Midlands

Specialised

Commissioning Hub

� Q77 � �

NHS England Midlands and East (Central Midlands) Q78Central Midlands Commissioning

hub14D � 14D

Central Midlands

Specialised

Commissioning Hub

� Q78 � �

NHS England Midlands and East (East) Q79 East Commissioning hub 14E � 14EEast Specialised


NHS England South (South West) Q80 South West Commissioning hub 14F � 14FSouth West Specialised


NHS England South (South East) Q81 South East Commissioning hub 14G � 14GSouth East Specialised


NHS England South (South Central) Q82South Central Commissioning

hub14H � * 13Q � Q82 � Q82 � �

NHS England South (Wessex) Q70 Wessex Commissioning hub 13N � 13NWessex Specialised

Commissioning Hub� Q70 � �

London NHS England London Q71 London Commissioning hub 13R � 13RLondon Specialised

Commissioning Hub

Providers in this

Region should send

invoices pertaining to

Armed Forces activity

to NHS England -

South (South Central)

and codify them with

'Q82'

� Q71 � Q71 � �

National Commissioning hub 1 13Q* Denotes Lead Commissioning Team

Providers in this

Region should send



to NHS England -

North (Yorkshire &

Humber) and codify

them with 'Q72'

Providers in this

Region should send



to NHS England -

Midlands and East

(North Midlands) and

codify them with

'Q76'

Providers in this

Region should send



to NHS England -

South (South Central)

and codify them with

'Q82'

North

Midlands & East

South

Direct Commissioning Responsibilities

Specialised Armed Forces Health and Justice Secondary Dental

Public

Health

Primary

Care

52

Structure of the Matrix

Each row of the matrix describes one of the 13 NHS England regional teams. The matrix columns then provide further information for each as follows:

• Column 1 – Region Name • Column 2 – Region (Geography) Name • Column 3 – Region (Geography) ODS Code • Column 4 – Commissioning hub Name • Column 5 – Commissioning hub ODS Code

Columns 6-18 describe the direct commissioning responsibilities of each of the 13 NHS England regional teams, which organisation codes should be used in commissioning data sets to differentiate these responsibilities and, where relevant, what the invoicing arrangements are for directly-commissioned services. This information is broken down by the different service types commissioned by NHS England as follows:

• Columns 6-8 - Specialised Services • Columns 9-11 - Armed Forces Health • Columns 12-13 - Health and Justice • Columns 14-17 - Secondary Dental, Public Health and Primary Care.

Matrix Columns 6-8: Specialised Services

Ten NHS England regional teams are designated as Specialised Commissioning Hubs responsible for commissioning specialised services and these are designated by a corresponding tick in column 6. Column 8 describes the names of the Specialised Commissioning Hubs. Data processors and providers should use the relevant regional Commissioning hub code stated in column 7 (format nnA, e.g. ‘13X’) to designate this responsibility in commissioning data sets for both contracted and non-contracted activity. The same code and naming convention should also be used on provider invoices for specialised care in line with the NHS England SBS letter (Gateway Reference 03227).

The organisation code of the NHS England Region (Geography) (format Qnn) should not be used to designate specialised commissioning responsibility in commissioning data sets and on invoices.

The 10 NHS England regional teams responsible for specialised commissioning do so on a named provider basis, with each regional team having contracts with designated specialised service providers within the UK. It is possible that the application of the identification rules for specialised services30 by some providers might indicate that specialised care has been provided by a hospital that does not have a contract with one of the 10 Specialised Commissioning Hubs.

In these scenarios the responsible CCG for the relevant patient will be responsible for paying for the care as NHS England does not recognise specialised care if it has been delivered by a non-contracted provider, i.e. there is no such thing as non-contracted specialised activity. The responsible CCG is the CCG that the patient’s registered GP belongs to or, for patients who are not registered with any GP, the CCG within which the patient is usually resident.

30 http://www.england.nhs.uk/wp-content/uploads/2012/11/pss-ir.pdf

53

Matrix Columns 9-11: Armed Forces

Three NHS England regional teams are responsible for commissioning healthcare services for the eligible armed forces population and these regional teams are designated by a corresponding tick in column 10. The three regional teams act as a single commissioner and do not need their individual organisational identities to be recorded in commissioning data sets. Column 11 states that Providers should use the code for the National Commissioning hub 1 (‘13Q’) to designate this responsibility in any commissioning data set record describing armed forces health activity.

The ‘13Q’ code should not be recorded on any provider invoices for NHS England armed forces health activity, as the 3 regional teams responsible for armed forces health still hold individual financial allocations. The letter from NHS England Shared Business Services ‘Important changes to invoicing and payment arrangements for NHS England’ (Gateway Reference 03227) requires providers to use the NHS England Region (Geography) codes (format Qnn) on any invoices pertaining to non-specialised NHS England-commissioned activity.

Column 12 in the matrix describes the invoicing arrangements for armed forces health activity. Providers located within NHS England – North should codify armed forces health invoices with the NHS England North (Yorkshire and Humber) Region (Geography) code ‘Q72’; Providers located within NHS England Midlands and East should codify armed forces health invoices with the NHS England Midlands and East (North Midlands) Region (Geography) code ‘Q76’ and Providers located within either NHS England South or NHS England London should codify armed forces health invoices with the NHS England South (South Central) Region (Geography) code ‘Q82’.

Matrix Columns 12-13: Health and Justice

Ten NHS England regional teams are responsible for commissioning healthcare services for the eligible health and justice population and these regional teams are designated by a corresponding tick in column 13. Data processors and providers should use the relevant NHS England Region (Geography) code (format Qnn) stated in column 14 to designate this responsibility in commissioning data sets.

The same code should also be used on provider invoices for Health and Justice activity in line with the letter from NHS England Shared Business Services ‘Important changes to invoicing and payment arrangements for NHS England’ (Gateway Reference 03227) which asks providers to use the NHS England Region (Geography) codes (format Qnn) on any invoices pertaining to non-specialised NHS England-commissioned activity.

Matrix Columns 14-15: Secondary Dental

All 13 NHS England regional teams are responsible for commissioning secondary dental healthcare services. Data processors and providers should use the relevant NHS England Region (Geography) code (format Qnn) stated in column 16 to designate this responsibility in commissioning data sets.

The same code should also be used on provider invoices for Health in Justice activity in line with the letter from NHS England Shared Business Services ‘Important changes to invoicing and payment arrangements for NHS England’ (Gateway Reference 03227) which asks providers to use the NHS England Region (Geography) codes on any invoices pertaining to non-specialised NHS England-commissioned activity.

54

Matrix Columns 16-17: Public Health and Primary Care

All 13 NHS England regional teams are responsible for commissioning Public Health (section 7a) and Primary Care services. Data processors and providers should use the relevant NHS England Region (Geography) code stated in column 3 to designate this responsibility in commissioning data sets.

The same code should also be used on provider invoices for public health and primary activity in line with the letter from NHS England Shared Business Services ‘Important changes to invoicing and payment arrangements for NHS England’ (Gateway Reference 03227) which asks providers to use the NHS England Region (Geography) codes on any invoices pertaining to non-specialised NHS England-commissioned activity.

55

13 Appendix B – Specialised and Highly-Specialised Service Line Codes

Number Specialised Service Line Code

Service Highly Specialised?

Identified by PS 2014/15?

1 NCBPS11C ACCESS FOR DIALYSIS YES - IN PS 2014/15

2 NCBPS20A ALKAPTONURIA YES NO

3 NCBPS17Z ALLERGY YES - IN PS 2014/15

4 NCBPSH23 ALSTRÖM SYNDROME YES NO

5 NCBPS01J ANAL CANCER NO

6 NCBPS23G ATAXIA TELANGIECTASIA SERVICE (ADULTS) YES NO

7 NCBPS23J ATAXIA TELANGIECTASIA SERVICE (CHILDREN) YES NO

8 NCBPS16A AUTOIMMUNE PAEDIATRIC GUT SYNDROMES YES NO

9 NCBPS12A AUTOLOGOUS INTESTINAL RECONSTRUCTION YES NO

10 NCBPS20B BARDET-BIEDL SYNDROME YES NO

11 NCBPS36A BARTH SYNDROME YES NO

12 NCBPS36B BECKWITH-WIEDEMANN SYNDROME WITH MACROGLOSSIA YES NO

13 NCBPS16B BEHCET’S SYNDROME YES NO

56




14 NCBPSD23 BLADDER EXSTROPHY YES NO

15 NCBPS02Z BLOOD AND MARROW TRANSPLANTATION YES - IN PS 2014/15

16 NCBPS32B BONE ANCHORED HEARING AIDS YES - IN PS 2014/15

17 NCBPS01O BONE SARCOMA NO

18 NCBPS07Z BRAIN INJURY AND COMPLEX REHABILITATION NO

19 NCBPS01A BREAST RADIOTHERAPY INJURY REHABILITATION YES NO

20 NCBPS13K CARDIAC - OTHER YES - IN PS 2014/15

21 NCBPS13B CARDIAC ELECTROPHYSIOLOGY YES - IN PS 2014/15

22 NCBPS13E CARDIAC SURGERY YES - IN PS 2014/15

23 NCBPS13H CARDIOVASCULAR MAGNETIC RESONANCE IMAGING

YES - IN PS 2014/15 (Admitted Patient Care ONLY)

24 NCBPS01C CHEMOTHERAPY


25 NCBPS22C CHILD AND ADOLESCENT MENTAL HEALTH SERVICES YES NO

57




26 NCBPS23A CHILDRENS SERVICES - CANCER YES - IN PS 2014/15

27 NCBPS23B CHILDRENS SERVICES - CARDIAC YES - IN PS 2014/15

28 NCBPS23E CHILDRENS SERVICES - ENDOCRINOLOGY YES - IN PS 2014/15

29 NCBPS23D CHILDRENS SERVICES - ENT NO

30 NCBPS23F CHILDRENS SERVICES - GASTROENTEROLOGY YES - IN PS 2014/15

31 NCBPS23H CHILDRENS SERVICES - HAEMATOLOGY YES - IN PS 2014/15

32 NCBPS23M CHILDRENS SERVICES - NEUROSCIENCES YES - IN PS 2014/15

33 NCBPS23N OPHTHALMOLOGY (CHILDREN) YES - IN PS 2014/15

34 NCBPS23C CHILDRENS SERVICES - PAEDIATRIC DENTISTRY NO

36 NCBPS23P CHILDRENS SERVICES - PAEDIATRIC ORAL / MAXILLOFACIAL SURGERY NO

37 NCBPS23Y CHILDRENS SERVICES - PAIN MANAGEMENT YES - IN PS 2014/15

38 NCBPS23R CHILDRENS SERVICES - PLASTIC SURGERY NO

39 NCBPS23S CHILDRENS SERVICES - RENAL YES - IN PS 2014/15

40 NCBPS23T CHILDRENS SERVICES - RESPIRATORY YES - IN PS 2014/15

58




41 NCBPS23W CHILDRENS SERVICES - RHEUMATOLOGY YES - IN PS 2014/15

42 NCBPS23X CHILDRENS SERVICES - SURGERY YES - IN PS 2014/15

43 NCBPS23Q CHILDRENS SERVICES - TRAUMA AND ORTHOPAEDICS NO

44 NCBPS23Z CHILDRENS SERVICES - UROLOGY NO

45 NCBPS01I CHORIOCARCINOMA SERVICE YES NO

46 NCBPS29Q CHRONIC PULMONARY ASPERGILLOSIS YES NO

47 NCBPS15Z CLEFT LIP AND PALATE YES - IN PS 2014/15

48 NCBPS32A COCHLEAR IMPLANTS YES - IN PS 2014/15

49 NCBPS05C COMMUNICATION AIDS NO

50 NCBPSK23 COMPLEX CHILDHOOD OSTEOGENESIS IMPERFECTA YES NO

51 NCBPSM23 COMPLEX EHLERS-DANLOS SYNDROME YES NO

52 NCBPS29V COMPLEX HOME VENTILATION NO

53 NCBPS33B COMPLEX INFLAMMATORY BOWEL DISEASE YES - IN PS 2014/15

54 NCBPS04A COMPLEX MINIMAL ACCESS GYNAECOLOGY SURGERY YES - IN PS 2014/15

55 NCBPS08A COMPLEX NEUROFIBROMATOSIS TYPE 1 YES NO

59




56 NCBPS08C COMPLEX NEUROFIBROMATOSIS TYPE 2 YES NO

57 NCBPS06Z COMPLEX SPINAL SURGERY YES - IN PS 2014/15

58 NCBPS33A COMPLEX SURGERY FOR INCONTINENCE YES - IN PS 2014/15

59 NCBPS29B COMPLEX THORACIC SURGERY YES - IN PS 2014/15

60 NCBPSB23 COMPLEX TRACHEAL DISEASE YES NO

61 NCBPS04D COMPLEX URINARY AND FAECAL INCONTINENCE AND GENITAL PROLAPSE YES - IN PS 2014/15

62 NCBPS13X CONGENITAL HEART DISEASE (ADULTS) YES - IN PS 2014/15

63 NCBPSN23 CONGENITAL HYPERINSULINISM YES NO

64 NCBPS15A CRANIAL FACIAL SERVICE YES NO

65 NCBPS02A CRYOPYRIN ASSOCIATED PERIODIC SYNDROME YES NO

66 NCBPS10Z CYSTIC FIBROSIS YES - IN PS 2014/15

67 NCBPS33E

CYTOREDUCTIVE SURGERY AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY FOR COLORECTAL CANCER NO

68 NCBPS24Z DERMATOLOGY YES - IN PS 2014/15 (NAC

60




ONLY)

69 NCBPS02B DIAGNOSTIC SERVICE FOR AMYLOIDOSIS YES NO

70 NCBPS29D DIAGNOSTIC SERVICE FOR PRIMARY CILIARY DYSKINESIA YES NO

71 NCBPS08B DIAGNOSTIC SERVICE FOR RARE NEUROMUSCULAR DISEASE YES NO

72 NCBPS33D DISTAL SACRECTOMY FOR ADVANCED AND RECURRENT RECTAL CANCER NO

73 NCBPS22E EATING DISORDERS NO

74 NCBPS11D ENCAPSULATING SCLEROSING PERITONEAL SURGERY YES NO

75 NCBPS27Z ENDOCRINOLOGY YES - IN PS 2014/15

76 NCBPS05E ENVIRONMENTAL CONTROLS NO

77 NCBPS24A EPIDERMOLYSIS BULLOSA YES NO

78 NCBPS29F EXTRA CORPOREAL MEMBRANE OXYGENATION (ADULTS) YES NO

79 NCBPSR23 EXTRA CORPOREAL MEMBRANE OXYGENATION (CHILDREN) YES NO

80 NCBPS01D EX-VIVO PARTIAL NEPHRECTOMY YES NO

81 NCBPS04C FETAL MEDICINE YES - IN PS 2014/15

61




82 NCBPS22S FORENSIC AND SECURE INPATIENTS NO

83 NCBPS22Z GENDER DYSPHORIA YES - IN PS 2014/15

84 NCBPS03Z HAEMOPHILIA YES - IN PS 2014/15

85 NCBPS01M HEAD AND NECK CANCER NO

86 NCBPS13N HEART AND LUNG TRANSPLANTATION YES NO

87 NCBPS19Z HEPATOBILIARY YES - IN PS 2014/15

88 NCBPSE23 HIGHLY SPECIALIST PALLIATIVE CARE SERVICES FOR CHILDREN AND YOUNG PEOPLE NO

89 NCBPS14Z HUMAN IMMUNODEFICIENCY VIRUS YES - IN PS 2014/15

90 NCBPS28Z HYPERBARIC OXYGEN TREATMENT YES - IN PS 2014/15

91 NCBPS16Z IMMUNOLOGY YES - IN PS 2014/15

92 NCBPS13A IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS (ICD) AND CARDIAC RESYNCHRONISATION THERAPY (CRT) NO

93 NCBPS18A INFECTIOUS DISEASES (ADULTS) YES - IN PS 2014/15

94 NCBPS18C INFECTIOUS DISEASES (CHILDREN) YES - IN PS 2014/15

95 NCBPS18U INFECTIOUS DISEASES ISOLATION UNIT NO

62




96 NCBPS13C INHERITED HEART DISORDERS YES - IN PS 2014/15

97 NCBPS27A INSULIN-RESISTANT DIABETES YES NO

98 NCBPS29M INTERSTITIAL LUNG DISEASE YES - IN PS 2014/15

99 NCBPS12Z INTESTINAL FAILURE NO

100 NCBPS27B ISLET CELL TRANSPLANT YES NO

101 NCBPS19T LIVER TRANSPLANTATION YES NO

102 NCBPS29C LYMPHANGIOLEIOMYOMATOSIS YES NO

103 NCBPS36C LYSOSOMAL STORAGE DISORDER YES NO

104 NCBPS34T MAJOR TRAUMA NO

105 NCBPS29E MANAGEMENT OF CENTRAL AIRWAY OBSTRUCTION YES - IN PS 2014/15

106 NCBPS04E MATERNAL MEDICINE COMPLICATIONS OF PREGNANCY YES - IN PS 2014/15

107 NCBPS26A MCARDLE’S DISEASE YES NO

108 NCBPS20Z MEDICAL GENETICS YES - IN PS 2014/15

109 NCBPS01K MALIGNANT MESOTHELIOMA NO

110 NCBPS22D MENTAL HEALTH SERVICES FOR THE DEAF (ADULTS) NO

63




111 NCBPS22B MENTAL HEALTH SERVICES FOR THE DEAF (CHILDREN AND ADOLESCENTS) YES NO

112 NCBPS36Z METABOLIC DISORDERS YES - IN PS 2014/15

113 NCBPS32D MIDDLE EAR IMPLANTS YES - IN PS 2014/15

114 NCBPS35Z MORBID OBESITY SURGERY YES - IN PS 2014/15

115 NCBPSNIC NEONATAL INTENSIVE CARE NO

116 NCBPS08O NEUROLOGY YES - IN PS 2014/15

117 NCBPS08D NEUROMYELITIS OPTICA YES NO

118 NCBPS08P NEUROPHYSIOLOGY YES - IN PS 2014/15

119 NCBPS08Y NEUROPSYCHIATRY NO

120 NCBPS08R NEURORADIOLOGY YES - IN PS 2014/15

121 NCBPS08S NEUROSURGERY YES - IN PS 2014/15

122 NCBPS01H OCULAR ONCOLOGY YES NO

123 NCBPS22O OFFENDER PERSONALITY DISORDER NO

124 NCBPS37A OPHTHALMIC PATHOLOGY YES NO

64




125 NCBPS37Z OPHTHALMOLOGY (ADULTS) YES - IN PS 2014/15

126 NCBPS34A ORTHOPAEDIC SURGERY YES - IN PS 2014/15

127 NCBPS34R ORTHOPAEDIC SURGERY - REVISIONS YES - IN PS 2014/15

128 NCBPS37B OSTEO-ODONTO-KERATOPROSTHESIS FOR CORNEAL BLINDNESS YES NO

129 NCBPSF23 PAEDIATRIC AND PERINATAL POST MORTEM NO

130 NCBPSPIC PAEDIATRIC INTENSIVE CARE NO

131 NCBPS12B PAEDIATRIC INTESTINAL PSEUDO-OBSTRUCTIVE DISORDERS YES NO

132 NCBPS31Z PAIN MANAGEMENT YES - IN PS 2014/15

133 NCBPS27C PANCREAS TRANSPLANTATION YES NO

134 NCBPS03A PAROXYSMAL NOCTURNAL HAEMOGLOBINURIA YES NO

135 NCBPS22P PERINATAL MENTAL HEALTH SERVICES NO

136 NCBPS01P PET-CT


65




137 NCBPS13F PPCI AND STRUCTURAL HEART DISEASE COMPLEX INVASIVE CARDIOLOGY YES - IN PS 2014/15

138 NCBPS29P PRIMARY CILIARY DYSKINESIA YES NO

139 NCBPS01E PRIMARY MALIGNANT BONE TUMOURS YES NO

140 NCBPS05P PROSTHETICS AND ORTHOTICS NO

141 NCBPS01B PROTON BEAM THERAPY YES NO

142 NCBPS01F PSEUDOMYXOMA PERITONEI YES NO

143 NCBPS13G PULMONARY HYPERTENSION (ADULTS)


144 NCBPS13J PULMONARY HYPERTENSION (CHILDREN) YES NO

145 NCBPS13M PULMONARY THROMBOENDARTERECTOMY (PTE) YES NO

146 NCBPS29A PULMONARY VASCULAR SERVICES YES - IN PS 2014/15

147 NCBPS01R RADIOTHERAPY YES - IN PS 2014/15

148 NCBPS01Y RARE CANCERS (ADULTS) YES - IN PS 2014/15

149 NCBPS36D RARE MITOCHONDRIAL DISORDERS YES NO

66




150 NCBPS04B

RECONSTRUCTIVE SURGERY FOR ADOLESCENTS WITH CONGENITAL MALFORMATION OF THE FEMALE GENITAL TRACT YES NO

151 NCBPS11B RENAL DIALYSIS NO

152 NCBPS11T RENAL TRANSPLANTATION


153 NCBPS29R RESPIRATORY - OTHER YES - IN PS 2014/15

154 NCBPS01G RETINOBLASTOMA YES NO

155 NCBPS26Z RHEUMATOLOGY YES - IN PS 2014/15

157 NCBPS27D SEVERE ACUTE PORPHYRIA YES NO

158 NCBPS29S SEVERE AND DIFFICULT TO CONTROL ASTHMA NO

159 NCBPS16C SEVERE COMBINED IMMUNODEFICIENCY AND RELATED DISORDERS YES NO

160 NCBPS12C SEVERE INTESTINAL FAILURE (ADULTS) YES NO

161 NCBPS22F SEVERE OBSESSIVE COMPULSIVE DISORDER AND BODY DYSMORPHIC DISORDER YES NO

67




162 NCBPS38S SICKLE CELL YES - IN PS 2014/15

163 NCBPS12D SMALL BOWEL TRANSPLANTATION YES NO

164 NCBPS01L SOFT CELL SARCOMA NO

165 NCBPS09Z SPECIALISED BURNS CARE YES - IN PS 2014/15

166 NCBPS13Z SPECIALISED CARDIOLOGY AND CARDIAC SURGERY OUTPATIENTS YES - IN PS 2014/15

167 NCBPSC23 SPECIALIST PAEDIATRIC LIVER DISEASE YES NO

168 NCBPS05W SPECIALIST WHEELCHAIRS NO

169 NCBPS06A SPINAL CORD INJURY YES - IN PS 2014/15 (NAC ONLY)

170 NCBPSP23

STEM CELL TRANSPLANTATION SERVICE FOR JUVENILE IDIOPATHIC ARTHRITIS AND RELATED CONNECTIVE TISSUE DISORDERS YES NO

171 NCBPS01S STEREOTACTIC RADIOSURGERY YES - IN PS 2014/15

172 NCBPS20C STICKLER SYNDROME DIAGNOSTIC SERVICE YES NO

173 NCBPS01T TEENAGE AND YOUNG ADULTS CANCER YES - IN PS 2014/15

68




174 NCBPS38T THALASSAEMIA YES - IN PS 2014/15

175 NCBPS29Z THORACIC SURGERY YES - IN PS 2014/15

176 NCBPS22T TIER 4 PERSONALITY DISORDERS NO

177 NCBPS33C TRANSANAL ENDOSCOPIC MICROSURGERY YES - IN PS 2014/15

178 NCBPS01U UPPER GI SURGERY - OESOPHAGEAL AND GASTRIC CANCER NO

179 NCBPS30Z VASCULAR SERVICES YES - IN PS 2014/15

180 NCBPSA23 VEIN OF GALEN MALFORMATION YES NO

181 NCBPS22G VETERANS’ POST TRAUMATIC STRESS DISORDER PROGRAMMES YES NO

182 NCBPSQ23 WOLFRAM SYNDROME YES NO

183 NCBPS24B XERODERMA PIGMENTOSUM YES NO

998 NCBPSXXX NONE OF THE ABOVE (SPECIALISED SERVICE BUT NOT ATTRIBUTABLE)

999 99999999 NONE OF THE ABOVE (NON-SPECIALISED SERVICE)

69

14 Appendix C - Specialised Services Cross Border Flows within the UK

Whilst NHS England predominantly commissions specialised care from English providers for English-resident patients it also commissions some specialist services from providers within devolved administrations, for both English and non-English UK residents and it also pays for some specialised care delivered to non-English UK residents by English specialised services providers. These exceptions are described in more detail below.

Highly Specialised Service

Pre-1991 Services Commissioned on Behalf of Welsh, Scottish and Northern Irish Residents

Part A: Services Commissioned on Behalf of Scottish Residents in Addition to Pre-1991 Services D. Notes

Part B: Services Commissioned on Behalf of Northern Irish Residents in Addition to Pre-1991 Services F. Notes

ALKAPTONURIA NCBPS20a

ALSTRÖM SYNDROME NCBPSh23

AMYLOIDOSIS NCBPS02b

ATAXIA TELANGIECTASIA (CHILD) NCBPSj23

ATAXIA TELANGIECTASIS (ADULT) NCBPSg23

70





BARDET-BIEDL SYNDROME (CHILD) NCBPS20b

BARDET-BIEDL SYNDROME (ADULT) NCBPS20b

BARTH SYNDROME SERVICE NCBPS36a

BECKWITH-WIEDEMANN SYNDROME WITH MACROGLOSSIA SERVICE NCBPS36b

BLADDER EXSTROPHY NCBPSd23

CHORIOCARCINOMA NCBPS01k

CHRONIC PULMONARY ASPERGILLOSIS NCBPS29q

COMPLEX EHLERS DANLOS SYNDROME NCBPSm23

71





COMPLEX NEUROFIBROMATOSIS TYPE 2 NCBPS08c

COMPLEX TRACHEAL DISEASE NCBPSb23

CONGENITAL HYPERINSULINISM NCBPSn23

CRANIOFACIAL SURGERY NCBPS15a

CRYOPYRIN ASSOCIATED PERIODIC SYNDROME NCBPS02a

EXTRA CORPOREAL MEMBRANE OXYGENATION (ADULT) NCBPS29f

EXTRA CORPOREAL MEMBRANE OXYGENATION SERVICE (CHILDREN) NCBPSr23

EPIDERMOLYSIS BULLOSA NCBPS24a

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EX-VIVO PARTIAL NEPHRECTOMY (EPN)

GENDER DYSPHORIA (CHILD) NCBPS22a

HEART AND LUNG TRANSPLANTATION (ADULTS) NCBPS13n NCBPS13n

HEART AND LUNG TRANSPLANTATION (CHILDREN) NCBPS13n

Great Ormond Street Hospital only

LIVER TRANSPLANTATION (ADULTS) NCBPS19t

LIVER TRANSPLANTATION (CHILDREN) NCBPS19t

LYMPHANGIOLEIOMYOMATOSIS NCBPS29c

73





LYSOSOMAL STORAGE DISORDER (ADULT) NCBPS36c

Service only (not drugs) NCBPS36c

Service only (not drugs)

LYSOSOMAL STORAGE DISORDER (CHILD) NCBPS36c

Service only (not drugs) NCBPS36c


MCARDLE’S DISEASE NCBPS26a

NEUROMYELITIS OPTICA NCBPS08d

PAEDIATRIC INTESTINAL PSEUDO-OBSTRUCTIVE DISORDERS NCBPS12b

PAROXYSMAL NOCTURNAL HAEMOGLOBINURIA NCBPS03a


PRIMARY CILIARY DYSKINESIA NCBPS29p

PSEUDOMYXOMA PERITONEI NCBPS01f

74





PULMONARY HYPERTENSION (CHILD) NCBPS13j


PULMONARY THROMBOENDARTERECTOMY (PTE) NCBPS13m

RARE MITOCHONDRIAL DISORDERS SERVICE NCBPS36d

RARE NEUROMUSCULAR DISORDERS NCBPS08b

RETINOBLASTOMA NCBPS01g

SEVERE INTESTINAL FAILURE (ADULTS) NCBPS12c

SMALL BOWEL TRANSPLANTATION (CHILD) NCBPS12d

75





SPECIALIST PAEDIATRIC LIVER DISEASE NCBPSc23

STICKLER SYNDROME DIAGNOSTIC NCBPS20c

VEIN OF GALEN MALFORMATION NCBPSa23

WOLFRAM SYNDROME NCBPSq23

XERODERMA PIGMENTOSUM NCBPS24b

76

15 Appendix D – Mapping Table to Identify Secondary Dental Activity

Treatment Function Code Mapping of GDC definitions of dental specialties defined as being NHS England Commissioning Responsibility in Appendix A of ‘Securing Excellence in Commissioning NHS Dental Services’

The table below describes how secondary care dental activity can be identified in commissioning data sets predominantly via treatment function code mapping, as part of the wider Commissioner Assignment Method. It needs to be used as part of this process, as secondary dental activity needs to be identified in line with the agreed commissioning hierarchy for NHS England directly-commissioned services, as some activity in these treatment function codes will be specialised activity (via provider, patient age and clinical coding look-ups as per specialised services identification rules). Not all secondary dental activity can be currently identified by treatment function codes (specifically special care dentistry) and the dental element of oral maxillofacial surgery (and possibly paediatric maxillofacial surgery) will need to isolated from the non-dental element at some future date when pathways have been agreed by commissioners and providers (see notes below).

GDC Dental Specialty Name

Securing Excellence Speciality Description31

Treatment Function mapping for Commissioner Assignment Process

Treatment Function Code mapping for Commissioner Assignment Process

Special care dentistry1

This is concerned with the improvement of the oral health of individuals and groups in society who have a physical, sensory, intellectual, mental, medical, emotional or social impairment or disability or, more often, a combination of these factors. It pertains to adolescents and adults.

None1 None1

31 From Annex A, Scope of NHS Commissioning Board’s responsibilities, Securing Excellence in Commissioning NHS Dental Services, NHS England, February 2013

77





Oral surgery

This deals with the treatment and ongoing management of irregularities and pathology of the jaw and mouth that require surgical intervention. This includes the specialty previously called Surgical Dentistry.

Oral Surgery 140

Orthodontics

This is the development, prevention, and correction of irregularities of the teeth, bite and jaw.

Orthodontics 143

Paediatric dentistry

This is concerned with comprehensive therapeutic oral health care for children from birth through adolescence, including care for those who demonstrate intellectual, medical, physical, psychological and/or emotional problems.

Paediatric Dentistry,

Paediatric Maxillo-facial Surgery2

142, 217

Endodontics

This is concerned with the cause, diagnosis, prevention and treatment of diseases and injuries of the tooth root, dental pulp, and surrounding tissue.

Restorative Dentistry

141

Periodontics

The diagnosis, treatment and prevention of diseases and disorders (infections and inflammatory) of the gums and other structures around the teeth


141

78





Prosthodontics

The replacement of missing teeth and the associated soft and hard tissues by prostheses (crowns, bridges, dentures) which may be fixed or removable, or may be supported and retained by implants.


141

Restorative dentistry

This deals with the restoration of diseased, injured, or abnormal teeth to normal function. This includes all aspects of Endodontics, Periodontics and Prosthodontics.


141

Oral medicine

Concerned with the oral health care of patients with chronic recurrent and medically related disorders of the mouth and with their diagnosis and non-surgical management.

Dental Medicine Specialties

450

Oral microbiology3

Diagnosis and assessment of facial infection - typically bacterial and fungal disease. This is a clinical specialty undertaken by laboratory based personnel who provide reports and advice based on interpretation of microbiological samples.

None3 None3

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Oral and maxillofacial pathology4

Diagnosis and assessment made from tissue changes characteristic of disease of the oral cavity, jaws and salivary glands. This is a clinical specialty undertaken by laboratory based personnel.

None4 None4

Dental and maxillofacial radiology5

Involves all aspects of medical imaging which provide information about anatomy, function and diseased states of the teeth and jaws.

None5 None5

80





Oral and maxillofacial surgery

Involves the diagnosis and treatment of any disease affecting the mouth, jaws, face and neck. This includes surgical dentistry (impacted teeth, dental cysts, dental implants etc.), injuries to the face, salivary gland problems, cancers of the head and neck, facial deformity, oral medicine, (ulcers, red/white patches, mouth cancer), facial pain and temporo-mandibular joint disorders. Not considered a dental specialty, but encompasses significant oral surgery elements that would be considered NHS CB remit. NHS CB will work in collaboration with CCGs to commission these services from April 2013 aligned to oral surgery services, for a transitional period to enable ‘unravelling’ of procedures, coding and pathways, after which it will transfer to CCG6

Maxillo-Facial Surgery

144

Notes:

1 Special care dentistry does not have a treatment function code but is a main specialty code (451). An analysis of national SUS data has revealed that no SUS activity has been attributed to this main specialty code by providers. Further analysis has been carried out to identify whether this work is carried out in other (dental or other) specialties and whether non-primary diagnostic ICD-10 codes can differentiate it from other dental activity (if this is required for commissioning purposes). This work has indicated that secondary diagnosis codes could be used to differentiate the

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special care dentistry activity within other dental specialties at some future date, if required.

2 Whilst this specialty is not explicitly mentioned in the Securing Excellence document the inclusion of Oral and Maxillofacial Surgery (see below) suggests that Paediatric Maxillofacial Surgery needs to be added to the inclusion list as Paediatric Dentistry is within scope. If so the same medium to longer term follow-on work may be needed to separate out the dental element of Paediatric Maxillofacial Surgery.

3 Oral microbiology does not have a treatment function but this is a diagnostic service and Admitted Patient Care and Outpatient activity is extremely unlikely to have any activity attributed to this specialty

4 Oral and maxillofacial pathology does not have a treatment function but this is a diagnostic service and Admitted Patient Care and Outpatient activity is extremely unlikely to have any activity attributed to this specialty

5 Dental and maxillofacial radiology does not have a treatment function but this is a diagnostic service and Admitted Patient Care and Outpatient activity is extremely unlikely to have any activity attributed to this specialty

6 It will not be viable for TFC 144 to be associated entirely with secondary dental in perpetuity as the non-dental activity within 144 will need to be identified separately and allocated to a CCG commissioner code and not NHS England. This will need to be achieved via the use of ICD-10 and OPCS4 code combinations, which will be specified at a later date.

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16 Appendix E – Identification of Correct Commissioning Organisation for Infertility Care

A very small number of patients each year (<10) will receive infertility care funded by NHS England under the special rules governing members of the armed forces, their dependents and veterans.

NHS England uses the following algorithm to determine whether an infertility patient should be funded by this route (see diagram below).

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Providers will be contacted directly by NHS England before patients receive the treatment and advised whether NHS England will fund the care or whether the patient’s CCG will be responsible. For this reason it is not possible to provide a definitive and consistent means of identifying commissioner for this activity. Therefore providers are advised to use a default of the responsible CCG (as this will be true in the vast majority of cases), and only change this to NHS England if advised otherwise by direct communication before treatment commences.

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17 Appendix F – Mapping Table of Detention Centre Addresses and Regional Geography Commissioners Responsible for Paying for Treatment for Referrals from that Detention Centre

A - Justice Facility Code

B - Justice Facility Name

C - Justice Facility Type

D - Justice Facility Postcode

E - NHS England Regional Geography with Commissioning Responsibility Name

F - NHS England Regional Geography with Commissioning Responsibility Code

VFH HMP BELMARSH Prison SE28 0EB London Q71

VGX HARMONDSWORTH REMOVAL CENTRE

Immigration Removal Centre

UB7 0HB London Q71

VM4 HMP/ YOI HOLLOWAY Young Offender Institute

N7 0NU London Q71

VPR HMP WORMWOOD SCRUBS

Prison W12 0AE London Q71

VRN HMP BRIXTON Prison SW2 5XF London Q71

VXG HMP/YOI ISIS Young Offender Institute

SE28 0FG London Q71

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WAH HMP PENTONVILLE Prison N7 8TT London Q71

WL0 HMP LATCHMERE HOUSE

Prison TW10 5HH London Q71

WP5 HMP WANDSWORTH Prison SW18 3HS London Q71

WQC HMP THAMESIDE Prison SE28 0FJ London Q71

WQY COLNBROOK IMMIGRATION REMOVAL CENTRE


UB7 0FX London Q71

WTM HMP/YOI FELTHAM Young Offender Institute

TW13 4ND London Q71

VE4 HMP BEDFORD Prison MK40 1HG East Q79

VJC HMP THE MOUNT Prison HP3 0NZ East Q79

VPY HMP RYE HILL Prison CV23 8SZ East Q79

WD6 YARL'S WOOD Immigration MK44 1FD East Q79

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REMOVAL CENTRE Removal Centre

WHP HMP ONLEY Prison CV23 8AP East Q79

WMG HMP WELLINGBOROUGH

Prison NN8 2NH East Q79

WQP HMP WOODHILL Prison MK4 4DA East Q79

WT1 OAKHILL STC Secure Training Centre

MK5 6AJ East Q79

VH8 LINCOLNSHIRE SCH Secure Children's Home

NG34 7TY North Midlands Q76

VMW HMP STOCKEN Prison LE15 7RD North Midlands Q76

WGW HMP NORTH SEA CAMP

Prison PE22 0QX North Midlands Q76

WJA HMP/YOI/RC GLEN PARVA

Young Offender Institute

LE18 4TN North Midlands Q76

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WLV HMP LINCOLN Prison LN2 4BD North Midlands Q76

WMF RAINSBROOK STC Secure Training Centre

CV23 8SY North Midlands Q76

WMM HMP GARTREE Prison LE16 7RP North Midlands Q76

WQ2 MORTON HALL IMMIGRATION REMOVAL CENTRE


LN6 9PT North Midlands Q76

WR8 HMP LEICESTER Prison LE2 7AJ North Midlands Q76

VCC HMP/ YOI NORWICH Young Offender Institute

NR1 4LU East Q79

VEW HMP/ YOI HIGHPOINT SOUTH


CB8 9YG East Q79

VGC HMP WHITEMOOR Prison PE15 0PR East Q79

VKM HMP/ YOI CHELMSFORD


CM2 6LQ East Q79

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VLL HMP BURE Prison NR10 5GB East Q79

VQ4 HMP PETERBOROUGH

Prison PE3 7PD East Q79

VYJ CLARE LODGE SCH Secure Children's Home

PE6 7AW East Q79

WA5 HMP WAYLAND Prison IP25 6RL East Q79

WHV HMP HIGHPOINT NORTH

Prison CB8 9YN East Q79

WJL HMP/ YOI HOLLESLEY BAY


IP12 3JW East Q79

WX5 LEVERTON SCH Secure Children's Home

CM14 5LL East Q79

WXA HMP LITTLEHEY Prison PE28 0SR East Q79

VEV HMYOI BRINSFORD Young Offender Institute

WV10 7PY North Midlands Q76

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VJT HMYOI SWINFEN HALL


WS14 9QS North Midlands Q76

VK3 HMP FEATHERSTONE Prison WV10 7PU North Midlands Q76

VPW HMP LOWDHAM GRANGE

Prison NG14 7DA North Midlands Q76

VV6 HMP STAFFORD Prison ST16 3AW North Midlands Q76

VXL HMP FOSTON HALL Prison DE65 5DN North Midlands Q76

VY3 HMP OAKWOOD Prison WV10 7QD North Midlands Q76

VYG HMP NOTTINGHAM Prison NG5 3AG North Midlands Q76

WDC HMP/ YOI DRAKE HALL


ST21 6LQ North Midlands Q76

WFY HMP WHATTON Prison NG13 9FQ North Midlands Q76

WHY HMP DOVEGATE Prison ST14 8XR North Midlands Q76

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WVD HMP SUDBURY Prison DE6 5HW North Midlands Q76

WYF HMYOI WERRINGTON Young Offender Institute

ST9 0DX North Midlands Q76

WYP CLAYFIELDS SCH Secure Children's Home

NG9 8GU North Midlands Q76

VMY HMYOI STOKE HEATH Young Offender Institute

TF9 2JL North Midlands Q76

VG2 HMP HEWELL Prison B97 6QS North Midlands Q76

VJ0 HMP BIRMINGHAM Prison B18 4AS North Midlands Q76

WEC HMP LONG LARTIN Prison WR11 8TZ North Midlands Q76

VE1 ST CATHERINES SCH Secure Children's Home

WA11 9RJ Lancashire & Greater Manchester Q73

VT6 RED BANK SCH Secure Children's Home

WA12 8DU Lancashire & Greater Manchester Q73

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VWE HMP LIVERPOOL Prison L9 3DF Lancashire & Greater Manchester Q73

WFV HMP KENNET Prison L31 1HX Lancashire & Greater Manchester Q73

WPJ HMP ALTCOURSE Prison L9 7LH Lancashire & Greater Manchester Q73

WPT HMP RISLEY Prison WA3 6BP Lancashire & Greater Manchester Q73

WQL HMP / YOI STYAL Young Offender Institute

SK9 4HR Lancashire & Greater Manchester Q73

WY4 HMYOI THORN CROSS


WA4 4RL Lancashire & Greater Manchester Q73

VDA HMP ACKLINGTON Prison NE65 9XG Cumbria & North East Q74

VGW HMYOI DEERBOLT Young Offender Institute

DL12 9BG Cumbria & North East Q74

VK4 AYCLIFFE SCH Secure Children's Home

DL5 6JB Cumbria & North East Q74

VTD HMP HAVERIGG Prison LA18 4NA Cumbria & North East Q74

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VW3 KYLOE HOUSE SCH Secure Children's Home

NE61 6DE Cumbria & North East Q74

WD7 HASSOCKFIELD STC Secure Training Centre

DH8 6QY Cumbria & North East Q74

WFF HMP LOW NEWTON Prison DH1 5YA Cumbria & North East Q74

WJ8 HMP NORTHUMBERLAND

Prison NE65 9XG Cumbria & North East Q74

WMX HMP FRANKLAND Prison DH1 5YD Cumbria & North East Q74

WP3 HMP DURHAM Prison DH1 3HU Cumbria & North East Q74

WQW HMP HOLME HOUSE Prison TS18 2QU Cumbria & North East Q74

VDJ HMP/ YOI FOREST BANK


M27 8FB Lancashire & Greater Manchester Q73

VG3 PENNINE HOUSE IMMIGRATION REMOVAL CENTRE


M90 4AG Lancashire & Greater Manchester Q73

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VGY BARTON MOSS SCH Secure Children's Home

M30 7RL Lancashire & Greater Manchester Q73

VN2 HMP GARTH Prison PR26 8NE Lancashire & Greater Manchester Q73

VN4 HMP PRESTON Prison PR1 5AB Lancashire & Greater Manchester Q73

VPE HMP / YOI LANCASTER FARMS


LA1 3QZ Lancashire & Greater Manchester Q73

VQL HMYOI HINDLEY Young Offender Institute

WN2 5TH Lancashire & Greater Manchester Q73

VT7 HMP KIRKLEVINGTON GRANGE

Prison TS15 9PA Lancashire & Greater Manchester Q73

WCC HMP KIRKHAM Prison PR4 2RN Lancashire & Greater Manchester Q73

WJ9 HMP WYMOTT Prison PR26 8LW Lancashire & Greater Manchester Q73

WM6 HMP MANCHESTER Prison M60 9AH Lancashire & Greater Manchester Q73

WNV HMP BUCKLEY HALL Prison OL12 9DP Lancashire & Greater Manchester Q73

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VD8 HMP HULL Prison HU9 5LS Yorkshire & Humber Q72

VF7 HMP RANBY Prison DN22 8EU Yorkshire & Humber Q72

VGT HMP FULL SUTTON Prison YO41 1PS Yorkshire & Humber Q72

VH7 HMP LINDHOLME Prison DN7 6EE Yorkshire & Humber Q72

VPP HMP/ YOI ASKHAM GRANGE


YO23 3FT Yorkshire & Humber Q72

VRD HMP WAKEFIELD Prison WF2 9AG Yorkshire & Humber Q72

VRV HMYOI WETHERBY Young Offender Institute

LS22 5ED Yorkshire & Humber Q72

VX3 LINDHOLME IMMIGRATION REMOVAL CENTRE


DN7 6EE Yorkshire & Humber Q72

WGM HMP/ YOI DONCASTER


DN5 8UX Yorkshire & Humber Q72

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WK9 HMYOI HATFIELD Young Offender Institute

DN7 6EL Yorkshire & Humber Q72

WMJ ALDINE SCH Secure Children's Home

S17 3ES Yorkshire & Humber Q72

WRF HMP WEALSTUN Prison LS23 7AZ Yorkshire & Humber Q72

WVX HMP LEEDS Prison LS12 2TJ Yorkshire & Humber Q72

WW0 HMP HUMBER Prison HU15 1RB Yorkshire & Humber Q72

WWA HMP/ YOI NEW HALL Young Offender Institute

WF4 4XX Yorkshire & Humber Q72

WWD HMP/YOI MOORLAND Young Offender Institute

DN7 6EL Yorkshire & Humber Q72

WYN EAST MOOR SCH Secure Children's Home

LS16 8EB Yorkshire & Humber Q72

VC5 HMYOI HUNTERCOMBE


RG9 5SB South Central Q82

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VJV CAMPSFIELD HOUSE IMMIGRATION REMOVAL CENTRE


OX5 1RE South Central Q82

VKJ HMYOI HUNTERCOMBE


RG9 5SB South Central Q82

VN7 HMP ERLESTOKE Prison SN10 5TU South Central Q82

VVR HMP SPRING HILL Prison HP18 0TL South Central Q82

VXC HMP BULLINGDON Prison OX25 1PZ South Central Q82

WC4 HMYOI & RC READING Young Offender Institute

RG1 3HY South Central Q82

WT3 HMP GRENDON Prison HP18 0TL South Central Q82

WTH HMYOI AYLESBURY Young Offender Institute

HP20 1EH South Central Q82

WW1 HMP HIGH DOWN Prison SM2 5PJ South Central Q82

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VD1 HMP/ YOI EAST SUTTON PARK


ME17 3DF South East Q81

VDN HMP ELMLEY Prison ME12 4DZ South East Q81

VDW BEECHFIELD SCH Secure Children's Home

RH10 3HZ South East Q81

VF2 HMP SEND Prison GU23 7LJ South East Q81

VFL LANSDOWNE SCH Secure Children's Home

BN27 1NP South East Q81

VJG TINSLEY HOUSE REMOVAL CENTRE


RH6 0PQ South East Q81

VP9 HMP STANDFORD HILL

Prison ME12 4AA South East Q81

VQF HMP BLANTYRE HOUSE

Prison TN17 2NH South East Q81

VQY HMP MAIDSTONE Prison ME14 1UZ South East Q81

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VR8 HMP LEWES Prison BN7 1EA South East Q81

VRH HMP COOKHAM WOOD

Prison ME1 3LU South East Q81

VT2 BROOK HOUSE IMMIGRATION REMOVAL CENTRE


RH6 0PQ South East Q81

VYQ HMP CANTERBURY Prison CT1 1PJ South East Q81

WAJ MEDWAY STC Secure Training Centre

ME1 3YB South East Q81

WG3 HMP BRONZEFIELD Prison TW15 3JZ South East Q81

WG4 HMP ROCHESTER Prison ME1 3QS South East Q81

WG6 HMP COLDINGLEY Prison GU24 9EX South East Q81

WGC HMP DOWNVIEW Prison SM2 5PD South East Q81

WKX DOVER IMMIGRATION Immigration CT17 9DR South East Q81

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WL4 HMP SWALESIDE Prison ME12 4AX South East Q81

WTX HMP FORD Prison BN18 0BX South East Q81

VQE HMP LEYHILL Prison GL12 8BT South West Q80

VGD HMP/ YOI EXETER Young Offender Institute

EX4 4EX South West Q80

VTH HMP DARTMOOR Prison PL20 6RR South West Q80

VX7 HMP BRISTOL Prison BS7 8PS South West Q80

WLL ATKINSON UNIT SCH Secure Children's Home

EX4 8NA South West Q80

WRC HMP/ YOI EASTWOOD PARK


GL12 8DB South West Q80

WV9 HMP ASHFIELD Prison BS16 9QJ South West Q80

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WXX HMP CHANNINGS WOOD

Prison TQ12 6DW South West Q80

WYL VINNEY GREEN SCH Secure Children's Home

BS16 7AA South West Q80

VGN HMP ISLE OF WIGHT Prison PO30 5RS South Central Q82

VJ1 HMP DORCHESTER Prison DT1 1JD South Central Q82

VJK HMP PARKHURST Prison PO30 5RS South Central Q82

VLR IRC HASLAR (IMMIGRATION REMOVAL CENTRE)


PO12 2AW South Central Q82

VPC HMYOI PORTLAND Young Offender Institute

DT5 1DL South Central Q82

VR3 HMP/ YOI GUYS MARSH


SP7 0AH South Central Q82

WC5 THE VERNE IMMIGRATION

Immigration DT5 1EQ South Central Q82

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WEN SWANWICK LODGE SCH

Secure Children's Home

SO31 7HD South Central Q82

WVP HMP WINCHESTER Prison SO22 5DF South Central Q82

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18 Appendix G – Glossary

Abbreviation Description

A&E Accident and Emergency

CCG Clinical Commissioning Group

CDS Commissioning Data Set

DMICP Defence Medical Information Capability Programme

DMS Defence Medical Services

DSCRO Data Services for Commissioners, Regional Offices

EHIC European Health Insurance Card

GDC General Dental Council

GP General Practitioner

HSCIC Health and Social Care Information Centre

HRG Healthcare Resource Group

ICD-10 International Classification of Diseases (10th edition)

IR Identification Rules for Prescribed Specialised Services

IRC Immigration Removal Centre

MHL&D Mental Health Liaison and Diversion

NHAIS National Health Applications & Infrastructure Services

NHSE NHS England

ODS Organisation Data Service

OPCS4 Office of Population Census and Statistics Classification of Interventions and Procedures (version four)

PAS Patient Administration System

PDS Personal Demographic Service

SARC Sexual Assault Referral Centre

SUS Secondary Uses Service

UK United Kingdom

YOI Youth Offender Institution

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19 Appendix H – Pseudo Postcodes for EU Member States and Other States with Similar Arrangements (starred)

Country Pseudo Postcode Austria ZZ99 4MZ Belgium ZZ99 2DZ Bulgaria ZZ99 4UZ Croatia ZZ99 5VZ Cyprus (Southern) ZZ99 6AZ Czech Republic ZZ99 5XZ Denmark ZZ99 4FZ Estonia ZZ99 7LZ Finland ZZ99 4BZ France ZZ99 4GZ Germany ZZ99 4QZ Greece ZZ99 4RZ Hungary ZZ99 4XZ Iceland* ZZ99 4CZ Italy ZZ99 4LZ Latvia ZZ99 7RZ Liechtenstein* ZZ99 2PZ Lithuania ZZ99 7SZ Luxembourg ZZ99 2EZ Malta ZZ99 5BZ Netherlands ZZ99 4EZ Norway* ZZ99 2AZ Poland ZZ99 4YZ Portugal ZZ99 4JZ Republic of Ireland ZZ99 3AZ Romania ZZ99 4ZZ Slovakia ZZ99 5YZ Slovenia ZZ99 5UZ Spain ZZ99 4HZ Sweden ZZ99 2CZ Switzerland* ZZ99 4PZ

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20 Appendix I – CAM Flow Chart

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