Change Request
 
NHS Information Authority

NHS Data Model and Dictionary Service

Reference: Change Request 484
Version No: 1.20
Subject: Payment by Results
Type of Change: Changes to the content of the Commissioning Data Sets (CDS) to support Payment by Results in April 2005
Effective Date: 1 April 2005
Reason for Change: The Payment by Results (PbR) policy changes the way funds flow between commissioners and providers of health care services in England. Through the establishment of standard national tariffs for similar types of treatments, providers will be paid on the basis of the volume and complexity of the activity they actually deliver. Payment by Results has ministerial backing. This DSCN has been sponsored by the Head of the Payment by Results. The DSCN supports 'Implementing PbR Technical Guidance 2005/06', specifically paragraphs 3.16 to 3.18 and 6.12, which can be found on the DH website: http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/<br>PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4097993&chk=JSLwVc. For Foundation Trusts the scope of PbR includes non-elective admissions, out-patients and A&E in 2005/6. Although, for non-Foundation Trusts, these elements are outside the scope of the tariff in 2005/6, data are still required to flow to operate PbR in shadow form and so that new baselines can be established for 2006/7. Payment by Results also requires the implementation of DSCNs 26/2003 and 34/2003 Updated National Specialty List (introduction of new Treatment Function codes). The outpatient tariff is based on Treatment Function and certain Treatment Functions are also used to define the scope of the Admitted Patient Care tariff.

Background:

Mandation of data sets

Admitted Patient Care CDS types and Out-Patient Attendance CDS type are already mandated.

The Accident and Emergency Attendance CDS type is mandated for national transmission from April 2005.

Out-Patient Attendance CDS - Nurse and Midwife led clinics and Ward Attendances are transmitted as part of the Out-Patient Attendance CDS type from 1 April 2005.

The Ward Attendance CDS type is not required. The CDS will be withdrawn after the KH05 Summary of Ward Attenders has been discontinued.

Data Elements

No changes to the CDS message structure are allowable for April 2005. However, the value sets in two of the Out-Patient Attendance CDS data elements have been extended . 'Medical Staff Type Seeing Patient' now has to cover non-medical staff until changes to the CDS message are permitted; users are advised to use '03' for the lead Care Professional and '04' for a member of the lead Care Professional's team. Whether the lead Care Professional is a Consultant, Nurse or Midwife can be determined from the Consultant Code. 'First Attendance' has additional codes to cover telephone or telemedicine consultations. Reference costs for Telemedicine are expected to be collected for the first time in 2006/07.

Procedures in Out-Patients - where treatment has been transferred appropriately to an out-patient setting the funding is subject to local agreement. To facilitate this the Provider must record at least one ICD diagnosis code and either an OPCS4 procedure code or an out-patient HRG code (whichever best describes the procedure or investigation in question) in the Out-Patient Attendance CDS record.

Admitted Patient Care - it should be noted that the following data elements are essential for PbR: Hospital Provider Spell Number, Healthcare Resource Group Code, and Healthcare Resource Group Code - Version Number.

Accident and Emergency Attendances - it should be noted that the following data elements are essential for PbR: A&E Attendance Disposal, Accident and Emergency Investigation - First, Accident and Emergency Investigation - Second, Healthcare Resource Group Code, Organisation Code (PCT of Residence), Organisation Code (Code of Provider), Organisation Code (Code of Commissioner).

Rehabilitation and Critical Care exclusions from the PbR tariff

All discrete episodes taking place solely for Rehabilitation should be recorded with Treatment Function 314 so that they can be identified as eligible for funding at local prices rather than under the PbR tariff.

Adult Critical Care commissioning will be on a cost and volume basis until Critical Care HRGs have been developed. Critical Care finished Consultant Episodes (Hospital Provider) where the Treatment Function code is 192 Critical Care Medicine, are excluded from the PbR tariff. NB: 192 should only be used where the consultant responsible specialises in Critical Care Medicine and where the level of care for the whole of the episode is high dependency and/or intensive care. The existing Augmented Care Period in the CDS should still be collected as elements of it feature in the PbR algorithm on Secondary Uses Service (SUS).

No changes to data standards are required.

Sub-contracting

The commissioner [Organisation Code (Code of Commissioner)] is the organisation, usually the PCT, with the original allocated resource to commission activity. The commissioned provider [Organisation Code (Code of Provider)] is the organisation that receives the PbR tariff income and disburses it to sub-contractors if used. The organisation treating the patient (whether commissioned provider or sub-contractor) is derived from the Site Code of Treatment. This guidance supersedes that given in DSCN 47/2002.

The commissioned provider is responsible for identifying which organisation will be sending the CDS for the sub-contracted activity and for ensuring that the activity sent is not duplicated.


Summary of changes:

Class Definitions
CLINIC ATTENDANCE MIDWIFE    Change to Attributes
CLINIC ATTENDANCE NURSE    Change to Attributes
OUT-PATIENT ATTENDANCE CONSULTANT    Change to Description
OUT-PATIENT ATTENDANCE CONSULTANT    Change to Attributes
 
Attribute Definitions
CONSULTATION MEDIA USED    New Attribute
FIRST ATTENDANCE    Change to Description
MEDICAL STAFF TYPE SEEING PATIENT    Change to Aliases
 
Data Elements
FIRST ATTENDANCE    Change to Description
MEDICAL STAFF TYPE SEEING PATIENT    Change to Aliases
ORGANISATION CODE (CODE OF COMMISSIONER)    Change to Description
ORGANISATION CODE (CODE OF PROVIDER)    Change to Description
SITE CODE (OF TREATMENT)    Change to Description
 
Dataset
OUT-PATIENT ATTENDANCE CDS TYPE    Change to Table
WARD ATTENDANCE CDS TYPE    Change to Table
 
Supporting Information
CDS INTRO    Change to Supporting Information
 

Name: Michelle Cambridge
Date: 13 April 2005
Sponsor: DH Payment by Results Programme

Note: Additions shown in highlighted with a blue background. Deletions are shown using strikeout. Within the Diagrams deleted classes and relationships are shown as red in colour, blue is used for changed items and green is used for created items.

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CLINIC ATTENDANCE MIDWIFE

Change to Class: Change to Attributes
Attributes of this Class are:
ANTENATAL OR POSTNATAL INDICATOR
CONSULTATION MEDIA USED
FIRST ATTENDANCE

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CLINIC ATTENDANCE NURSE

Change to Class: Change to Attributes
Attributes of this Class are:
COLPOSCOPY PRIME PROCEDURE TYPE
   colposcopy only
CONSULTATION MEDIA USED
FIRST ATTENDANCE

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OUT-PATIENT ATTENDANCE CONSULTANT

Change to Class: Change to Description

An attendance at which a PATIENT is seen by a CONSULTANT, in respect of one referral, that is not a visit to the home of a PATIENT for which a fee is payable under paragraph 140 of the Terms and Conditions of Service. An attendance at which a PATIENT is seen (face to face or via telephone/telemedicine) by a CONSULTANT, in respect of one referral, that is not a visit to the home of a PATIENT for which a fee is payable under paragraph 140 of the Terms and Conditions of Service. For the purposes of this definition 'CONSULTANT' includes a member of the CONSULTANT's firm or locum for such a member.

If a PATIENT is seen by a CONSULTANT at a CONSULTANT CLINIC then this will be a CLINIC ATTENDANCE CONSULTANT. An attendance may involve more than one person (e.g. a family). The number of attendances to be recorded should be the number of PATIENTS for whom the particular CONSULTANT has identifiable individual records and which will be maintained as a result of the attendance.

A visit to the home of a PATIENT made at the instance of a hospital or specialist to review the urgency of a proposed admission to hospital, or to continue to supervise treatment initiated or prescribed at a hospital or clinic is covered by this definition.

OUT-PATIENT ATTENDANCE CONSULTANT also includes a PATIENT being seen by a CONSULTANT from a different MAIN SPECIALTY during a CONSULTANT EPISODE (HOSPITAL PROVIDER) in circumstances where there is no transfer of responsibility for the care of the PATIENT.

If the PATIENT is currently subject to a MENTAL HEALTH CARE SPELL and the consultant they are in contact with during attendance is their allocated Care Programme Approach care coordinator then a FACE TO FACE CONTACT CPA CARE COORDINATOR should also be recorded.

This class is also known by these names:

Context Alias
plural OUT-PATIENT ATTENDANCES CONSULTANT


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OUT-PATIENT ATTENDANCE CONSULTANT

Change to Class: Change to Attributes
Attributes of this Class are:
K ATTENDANCE DATE
K ATTENDANCE IDENTIFIER
CONSULTATION MEDIA USED
FIRST ATTENDANCE
LOCATION TYPE
O MEDICAL STAFF TYPE SEEING PATIENT
OUTCOME OF ATTENDANCE

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CONSULTATION MEDIA USED

Change to Attribute: New Attribute

CONSULTATION MEDIA USED

Identifies the communication mechanism used to relay information between the CARE PROFESSIONAL and the PERSON who is the subject of the consultation, during a Care Activity.

The telephone or telemedicine consultation should directly support diagnosis and care planning and must replace a face to face OUT-PATIENT ATTENDANCE CONSULTANT, CLINIC ATTENDANCE NURSE or CLINIC ATTENDANCE MIDWIFE, types of Care Activity. A record of the telephone or telemedicine consultation must be retained in the patient's records.

Telephone contacts solely for informing PATIENTS of results are excluded.

National Codes:

01 Face to face communication
02 Telephone
03 Telemedicine web camera
04 Talk type for a person unable to speak
 

This attribute is also known by these names:

Context Alias
plural CONSULTATION MEDIA USED


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FIRST ATTENDANCE

Change to Attribute: Change to Description

This indicates whether a patient is making a first or follow-up attendance. For DAY CARE ATTENDANCES, FIRST ATTENDANCES is the first of a series, or only attendance, within one DAY CARE FUNCTIONS at DAY CARE FACILITIES of an ORGANISATION by either a PATIENT using a hospital bed or a regular day attender. For DAY CARE ATTENDANCES, FIRST ATTENDANCE is the first of a series, or only attendance, within one DAY CARE FUNCTION at DAY CARE FACILITIES of an ORGANISATION by either a PATIENT using a hospital bed or a regular day attender. A re-attendance is any subsequent attendance at a DAY CARE SESSION of the same DAY CARE FUNCTIONS and same HEALTH CARE PROVIDER by a PATIENT whose attender status has not changed since the previous attendance. 

It should be noted that:

a. If a PATIENT attends a DAY CARE SESSION of the same DAY CARE FUNCTIONS at another site of the ORGANISATION, the initial attendance at the second facility is a re-attendance
b. If a PATIENT attends a DAY CARE SESSION which is not of the same DAY CARE FUNCTIONSas one previously attended within the ORGANISATION, the initial attendance at the second facility is a FIRST ATTENDANCES
b. If a PATIENT attends a DAY CARE SESSION which is not of the same DAY CARE FUNCTIONS as one previously attended within the ORGANISATION, the initial attendance at the second facility is a FIRST ATTENDANCES
c. If a PATIENT changes attender status from hospital bed to regular attender or vice-versa, the initial attendance after the change is a FIRST ATTENDANCES

For OUT-PATIENT ATTENDANCE CONSULTANT the first attendance is the start of the CONSULTANT OUT-PATIENT EPISODE and is the first attendance in a series with the same CONSULTANT following a referral. For OUT-PATIENT ATTENDANCE CONSULTANT the first attendance (face to face or telephone/telemedicine) is the start of the CONSULTANT OUT-PATIENT EPISODE and is the first attendance in a series with the same CONSULTANT following a referral.

For CLINIC ATTENDANCES NURSE a FIRST ATTENDANCE is the first in a series, or the only attendance, at a NURSE CLINIC by a PATIENT. For CLINIC ATTENDANCES MIDWIFE a FIRST ATTENDANCE is the first in a series, or the only attendance, at a MIDWIFE CLINIC by a PATIENT. For WARD ATTENDANCES a FIRST ATTENDANCE is the first in a series, or the only attendance by a PATIENT at a WARD. For GENITOURINARY CLINIC ATTENDANCES a FIRST ATTENDANCE is the first in a series, or the only attendance by a PERSON at a CONSULTANT CLINIC. For CLINIC ATTENDANCES NURSE a FIRST ATTENDANCE is the first in a series, or the only attendance (face to face or telephone/telemedicine), at a NURSE CLINIC by a PATIENT.

National Codes:

1 First attendance
2 Follow-up attendance
For CLINIC ATTENDANCES MIDWIFE a FIRST ATTENDANCE is the first in a series, or the only attendance (face to face or telephone/telemedicine), at a MIDWIFE CLINIC by a PATIENT.   For WARD ATTENDANCES a FIRST ATTENDANCE is the first in a series, or the only attendance by a PATIENT at a WARD.

For GENITOURINARY CLINIC ATTENDANCES a FIRST ATTENDANCE is the first in a series, or the only attendance by a PERSON at a CONSULTANT CLINIC. 

This attribute is also known by these names:

Context Alias
plural FIRST ATTENDANCES


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MEDICAL STAFF TYPE SEEING PATIENT

Change to Attribute: Change to Aliases

A classification of the type of medical staff seeing the PATIENT during an OUT-PATIENT ATTENDANCE CONSULTANT. A classification of the type of care professional staff dealing with the PATIENT during an OUT-PATIENT ATTENDANCE CONSULTANT or NURSE OR MIDWIFE CONTACT.

National Codes:

01 Consultant
01 Consultant (Retired 2005-04-01)
02 Member of Consultant firm (Retired 2005-04-01)
03 Lead Care Professional (Effective 2005-04-01)
02 Member of Consultant firm
04 Member of Care Professional team (Effective 2005-04-01)
 

This attribute is also known by these names:

Context Alias
plural MEDICAL STAFF TYPE SEEING PATIENTS
plural MEDICAL STAFF TYPES SEEING PATIENT


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FIRST ATTENDANCE

Change to Data Element: Change to Description
Format/length: n1
HES item:
National Codes:
Default Codes:
  National Codes:
1 First attendance face to face
2 Follow-up attendance face to face
3 First telephone or telemedicine consultation
4 Follow-up telephone or telemedicine consultation

This indicates whether a patient is making a FIRST ATTENDANCE or follow-up attendance and whether the CONSULTATION MEDIA USED was a face to face contact or telephone/telemedicine consultation. 

This data element is also known by these names:

Context Alias
plural FIRST ATTENDANCES


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MEDICAL STAFF TYPE SEEING PATIENT

Change to Data Element: Change to Aliases
Format/length: an2
HES item:
National Codes: Press Definition button for the National Codes
Default Codes:
 

This data element is also known by these names:

Context Alias
plural MEDICAL STAFF TYPE SEEING PATIENTS
plural MEDICAL STAFF TYPES SEEING PATIENT


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ORGANISATION CODE (CODE OF COMMISSIONER)

Change to Data Element: Change to Description
Format/length: an5
HES item: PURCODE
National Codes:
Default Codes:

Notes:
This is the ORGANISATION CODE of the ORGANISATION commissioning health care. The organisation code of the PRIMARY CARE TRUST should be recorded in the ORGANISATION CODE (CODE OF COMMISSIONER) field. This should always be the ORGANISATION CODE of the original commissioner for Commissioning Data Sets to support Payment by Results.

The ORGANISATION CODE of the PRIMARY CARE TRUST which is the NHS Trust's main commissioner (normally the PRIMARY CARE TRUST with the highest value of Service Agreements with the NHS Trust) is recorded for OUT OF AREA TREATMENTS. For Specialised Services, the ORGANISATION CODE required would be that of the commissioning consortium. The code may be the ORGANISATION CODE of the 'lead' commissioner.

Commissioning responsibility for individual patients rests with the Primary Care Trust (PCT) with whom the patient is registered. This means that patients registered with a GP in one PCT area may reside in a neighbouring or other area but remain the responsibility of the PCT with whom their GP of registration is associated. PCTs are also responsible for non-registered patients who are resident within their boundaries.

Where activity is commissioned by a Welsh Local Health Board the ORGANISATION CODE required is that of the Local Health Board. Where specialised services are commissioned by Health Commission Wales the code W01HC should be used.

See NHS Administrative Codes  for a description of ORGANISATION CODES. 

This data element is also known by these names:

Context Alias
plural ORGANISATION CODES (CODE OF COMMISSIONER)


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ORGANISATION CODE (CODE OF PROVIDER)

Change to Data Element: Change to Description
Format/length: an5
HES item: PROCODE
National Codes:
Default Codes:
89997 - UK provider where no organisation code has been issued
89999 - Non-NHS UK provider where no organisation code has been issued


Notes:
This is the ORGANISATION CODE of the ORGANISATION acting as a HEALTH CARE PROVIDER. This should always be the ORGANISATION CODE of the provider receiving the Payment by Results tariff income for the Commissioning Data Sets.

Where NHS patient care is sub-commissioned to independent or overseas providers, the NHS SERVICE AGREEMENT should specify that the non-NHS provider has requested an identifying organisation code from the National Administrative Codes Service (NACS). Where NHS patient care is sub-commissioned to independent or overseas providers, the NHS SERVICE AGREEMENT should specify that the non-NHS provider has requested an identifying organisation code from the Organisation Codes Service.

See NHS Administrative Codes for a description of ORGANISATION CODES.

For the NACS contact details, see Publication Information Contact Details.

 

This data element is also known by these names:

Context Alias
plural ORGANISATION CODES (CODE OF PROVIDER)


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SITE CODE (OF TREATMENT)

Change to Data Element: Change to Description
Format/length: an5
HES item: SITETRET
National Codes:
Default Codes: 89999 - non-NHS UK provider where no organisation site code has been issued
89997 - Not applicable: non-UK provider

Notes:
SITE CODE (OF TREATMENT) is the ORGANISATION SITE CODE of ORGANISATION SITE of the provider ORGANISATION. SITE CODE (OF TREATMENT) is the ORGANISATION SITE CODE for the ORGANISATION SITE where the patient was treated. Note that the SITE CODE (OF TREATMENT) should always identify an ORGANISATION SITE where activity managed by the treating organisation takes place ie it should enable the treating organisation to be identified.

This identifies the site within the ORGANISATION on which the PATIENT was treated, since facilities may vary on different hospital sites. The code recorded should always be the national code; if the treatment is sub-commissioned to another provider, the site code used should be that of the provider actually carrying out the work.

Each ORGANISATION has a unique ORGANISATION CODE, see NHS Administrative Codes for a description and format of ORGANISATION CODES. However, where an ORGANISATION has more than one site from which it provides services then each site is uniquely identified. These sites are ORGANISATION SITES and are uniquely identified by ORGANISATION SITE CODE. The ORGANISATION SITE CODE contains the first 3 digits of the ORGANISATION CODE with the last two digits being the site identifier.

Example:

RA700 ORGANISATION CODE of the ORGANISATION
RA701 ORGANISATION SITE CODE of the first identified ORGANISATION SITE within the ORGANISATION
RA702 ORGANISATION SITE CODE of the second identified ORGANISATION SITE within the ORGANISATION

Where treatment for an NHS patient is sub-commissioned to an independent UK provider the appropriate ORGANISATION SITE CODE should be used. Where treatment is sub-commissioned to an overseas provider the default code 89997 is applicable.

For out-patients, activity may take place outside the hospital, such as in the PATIENT'S home; in such cases, raising a site code is impractical. LOCATION CLASS is used in the CDS message to indicate the classification of the physical location within which the activity occurred. 

This data element is also known by these names:

Context Alias
plural SITE CODE (OF TREATMENT)


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OUT-PATIENT ATTENDANCE CDS TYPE

Change to Dataset: Change to Table
COMMISSIONING DATA SET (CDS)
 
Diagram
OUT-PATIENT ATTENDANCE CDS TYPE
The Out-Patient Attendance Commissioning Data Set Type carries the data for an Out-Patient Attendance or a missed appointment. The data set only applies for Consultant attendances and appointments.

The column headed Opt (Optionality) shows whether the Data Element is Mandatory M, Optional O or Must Not Be Used *.

The Out-Patient Attendance Commissioning Data Set Type carries the data for an Out-Patient Attendance or a missed appointment. The data set applies to Consultant, Nurse and Midwife attendances and appointments including Ward Attendances for nursing care.

The column headed Opt (Optionality) shows whether the Data Element is Mandatory M, Optional O or Must Not Be Used *.

Opt CDS Data Element U/A
Person Group (Patient):
To carry the personal details of the Patient. One occurrence of this Group is permitted.
M LOCAL PATIENT IDENTIFIER  
M ORGANISATION CODE (LOCAL PATIENT IDENTIFIER)  
M ORGANISATION CODE TYPE  
M NHS NUMBER  
M BIRTH DATE  
O CARER SUPPORT INDICATOR  
* ETHNIC CATEGORY  
* MARITAL STATUS
(psychiatric patients only)
 
M NHS NUMBER STATUS INDICATOR  
M SEX  
O NAME FORMAT CODE  
O PATIENT NAME  
O ADDRESS FORMAT CODE  
O PATIENT USUAL ADDRESS  
M POSTCODE OF USUAL ADDRESS  
M ORGANISATION CODE (PCT OF RESIDENCE)  
M ORGANISATION CODE TYPE  
  Note:
For reasons of confidentiality, the patient's preferred name and address (not including POSTCODE OF USUAL ADDRESS) must not be carried where a valid NHS Number is present.
 
(HCA) Consultant Out-Patient Episode - Person Group (Consultant):
To carry the details of the responsible Consultant. One occurrence of this Group is permitted.
M CONSULTANT CODE  
M MAIN SPECIALTY CODE  
M TREATMENT FUNCTION CODE  
(HCA) Consultant Out-Patient Episode - Clinical Information Group (ICD):
To carry the details of the ICD Diagnosis Scheme and the Diagnoses. Up to 2 occurrences of this Group are permitted.
O DIAGNOSIS SCHEME IN USE  
O PRIMARY DIAGNOSIS (ICD)  
O SECONDARY DIAGNOSIS (ICD)
(1st Secondary)
 
(HCA) Consultant Out-Patient Episode - Clinical Information Group (READ):
To carry the details of the READ Diagnosis Scheme and the Diagnoses. Up to 2 occurrences of this Group are permitted.
O DIAGNOSIS SCHEME IN USE  
O PRIMARY DIAGNOSIS (READ)  
O SECONDARY DIAGNOSIS (READ)
(1st Secondary)
 
(HCA) Attendance Occurrence Activity Characteristics:
To carry the details of the Out-Patient Attendance or missed appointment.
M ATTENDANCE IDENTIFIER  
M ADMINISTRATIVE CATEGORY  
M ATTENDED OR DID NOT ATTEND  
M FIRST ATTENDANCE  
M MEDICAL STAFF TYPE SEEING PATIENT  
M OPERATION STATUS
(per attendance)
 
M OUTCOME OF ATTENDANCE  
M APPOINTMENT DATE  
(HCA) Attendance Occurrence - Service Agreement Details:
To carry the details of the Service Agreement for the Out-Patient Attendance.
M COMMISSIONING SERIAL NUMBER  
O NHS SERVICE AGREEMENT LINE NUMBER  
O PROVIDER REFERENCE NUMBER  
M COMMISSIONER REFERENCE NUMBER  
M ORGANISATION CODE (CODE OF PROVIDER)  
M ORGANISATION CODE TYPE  
M ORGANISATION CODE (CODE OF COMMISSIONER)  
M ORGANISATION CODE TYPE  
(HCA) Attendance Occurrence - Clinical Activity Group (OPCS):
To carry the details of the OPCS coded Clinical Activities undertaken. Up to 12 occurrences of this Group are permitted.
O PROCEDURE SCHEME IN USE  
O PRIMARY PROCEDURE (OPCS)  
O PROCEDURE (OPCS)
(2nd to 12th, there may be up to 11 repetitions)
 
(HCA) Attendance Occurrence - Clinical Activity Group (READ):
To carry the details of the READ coded Clinical Activities undertaken. Up to 12 occurrences of this Group are permitted.
O PROCEDURE SCHEME IN USE  
O PRIMARY PROCEDURE (READ)  
O PROCEDURE (READ)
(2nd to 12th, there may be up to 11 repetitions)
 
(HCA) Attendance Occurrence - Location Group - Out-Patient Attendance:
To carry the details of the location for the Out-Patient Attendance - Site Code of Treatment. One occurrence of this Group is permitted. One occurrence of this Group is permitted.
M LOCATION CLASS  
M SITE CODE (OF TREATMENT)  
M ORGANISATION CODE TYPE  
(HCA) GP Registration:
To carry the details of the Patient's Registered GMP. One occurrence of this Group is permitted.
M GMP (CODE OF REGISTERED OR REFERRING GMP)  
O CODE OF GP PRACTICE (REGISTERED GMP)  
O ORGANISATION CODE TYPE  
(HCA) Referral Activity Characteristics:
To carry the details of the referral. One occurrence of this Group is permitted.
M PRIORITY TYPE
 
M SERVICE TYPE REQUESTED  
M SOURCE OF REFERRAL FOR OUT-PATIENTS  
M REFERRAL REQUEST RECEIVED DATE  
(HCA) Referral Person Group:
To carry the details of the referrer. One occurrence of this Group is permitted.
M REFERRER CODE  
M REFERRING ORGANISATION CODE  
M ORGANISATION CODE TYPE  
(HCA) Missed Appointment Occurrence:
To carry the details of the missed appointment. One occurrence of this Group is permitted.
M LAST DNA OR PATIENT CANCELLED DATE  
(HCA) Healthcare Resource Group Activity - Activity Characteristics:
To carry the details of the Healthcare Resource Group from 01/10/2001. Each CDS may contain only a single occurrence of this Group.
O HEALTHCARE RESOURCE GROUP CODE  
O HEALTHCARE RESOURCE GROUP CODE-VERSION NUMBER  
  Note:
If there is no HRG agreed for the Specialty, or samples only are required for the specialty which does not include this particular out-patient attendance, the segments relating to HRGs need not be sent. HRG Dominant Grouping Variable does not apply to out-patient attendances.
 

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WARD ATTENDANCE CDS TYPE

Change to Dataset: Change to Table
COMMISSIONING DATA SET (CDS)
 
Diagram
WARD ATTENDANCE CDS TYPE
The Ward Attender Commissioning Data Set Type carries the data for a Ward Attender.

The column headed Opt (Optionality) shows whether the Data Element is Mandatory M, Optional O or Must Not Be Used *.

The Ward Attender Commissioning Data Set Type carries the data for a Ward Attender.

The Ward Attender CDS Type should not be used on or after 1 April 2005. Attendances by patients for nursing care on a ward should be transmitted using the Out-Patient Attendance CDS Type.

The column headed Opt (Optionality) shows whether the Data Element is Mandatory M, Optional O or Must Not Be Used *.

Opt CDS Data Element U/A
Person Group (Patient):
To carry the personal details of the Patient. One occurrence of this Group is permitted.
M LOCAL PATIENT IDENTIFIER  
M ORGANISATION CODE (LOCAL PATIENT IDENTIFIER)  
M ORGANISATION CODE TYPE  
M NHS NUMBER  
M BIRTH DATE  
O CARER SUPPORT INDICATOR  
M NHS NUMBER STATUS INDICATOR  
M SEX  
O NAME FORMAT CODE  
O PATIENT NAME  
O ADDRESS FORMAT CODE  
O PATIENT USUAL ADDRESS  
M POSTCODE OF USUAL ADDRESS  
M ORGANISATION CODE (PCT OF RESIDENCE)  
M ORGANISATION CODE TYPE  
  Note:
For reasons of confidentiality, the patient's preferred name and address (not including POSTCODE OF USUAL ADDRESS) must not be carried where a valid NHS Number is present.
 
(HCA) Ward Attendance Occurrence Activity Characteristics:
To carry the details of the Ward Attender.
M ATTENDANCE IDENTIFIER  
M ADMINISTRATIVE CATEGORY  
* MEDICAL STAFF TYPE SEEING PATIENT  
M OPERATION STATUS
(per attendance)
 
M ATTENDANCE DATE  
(HCA) Ward Attendance Occurrence - Service Agreement Details:
To carry the details of the Service Agreement for the Ward Attender.
M COMMISSIONING SERIAL NUMBER  
O NHS SERVICE AGREEMENT LINE NUMBER  
O PROVIDER REFERENCE NUMBER  
* COMMISSIONER REFERENCE NUMBER  
M ORGANISATION CODE (CODE OF PROVIDER)  
M ORGANISATION CODE TYPE  
M ORGANISATION CODE (CODE OF COMMISSIONER)  
M ORGANISATION CODE TYPE  
(HCA) Ward Attendance Occurrence - Clinical Information Group (ICD):
To carry the details of the ICD Diagnosis Scheme and the Diagnoses. Up to 2 occurrences of this Group are permitted.
O DIAGNOSIS SCHEME IN USE  
O PRIMARY DIAGNOSIS (ICD)  
O SECONDARY DIAGNOSIS (ICD)
(1st Secondary)
 
(HCA) Ward Attendance Occurrence - Clinical Information Group (READ):
To carry the details of the READ Diagnosis Scheme and the Diagnoses. Up to 2 occurrences of this Group are permitted.
O DIAGNOSIS SCHEME IN USE  
O PRIMARY DIAGNOSIS (READ)  
O SECONDARY DIAGNOSIS (READ)
(1st Secondary)
 
(HCA) Ward Attendance Occurrence - Clinical Activity Group (OPCS):
To carry the details of the OPCS coded Clinical Activities undertaken. Up to 12 occurrences of this Group are permitted.
O PROCEDURE SCHEME IN USE  
O PRIMARY PROCEDURE (OPCS)  
O PROCEDURE (OPCS)
(2nd to 12th, there may be up to 11 repetitions)
 
(HCA) Ward Attendance Occurrence - Clinical Activity Group (READ):
To carry the details of the READ coded Clinical Activities undertaken. Up to 12 occurrences of this Group are permitted.
O PROCEDURE SCHEME IN USE  
O PRIMARY PROCEDURE (READ)  
O PROCEDURE (READ)
(2nd to 12th, there may be up to 11 repetitions)
 
(HCA) Attendance Occurrence - Location Group - Ward Attendance:
To carry the details of the location for the Out-Patient Attendance - Site Code of Treatment. One occurrence of this Group is permitted. One occurrence of this Group is permitted.
M LOCATION CLASS  
M SITE CODE (OF TREATMENT)  
M ORGANISATION CODE TYPE  
M INTENDED CLINICAL CARE INTENSITY  
M AGE GROUP INTENDED  
M SEX OF PATIENTS  
(HCA) GP Registration:
To carry the details of the Patient's Registered GMP. One occurrence of this Group is permitted.
M GMP (CODE OF REGISTERED OR REFERRING GMP)  
O CODE OF GP PRACTICE (REGISTERED GMP)  
O ORGANISATION CODE TYPE  

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CDS INTRO

Change to Supporting Information: Change to Supporting Information
COMMISSIONING DATA SETS (CDS)
 

COMMISSIONING DATA SETS (CDS)

Introduction

Although EDIFACT messages had previously been developed for Commissioning Minimum Data Sets (CMDS), the NHS-wide Clearing Service (NWCS) implementation required a single EDIFACT message capable of carrying all local variations of all CMDSs.

Before such an EDIFACT message could be produced it was necessary to remodel all CMDSs to conform to a single structure. In addition, it was necessary to include flow control information required by the NWCS processes.

The resultant, extended CMDSs, are referred to as the Commissioning Data Sets (CDS), for further information please refer to the current version of The NHS CDS Manual.

CDS Types

The CDS is the basic structure used for the exchange of commissioning data between Providers and Commissioners (and other users) via the NWCS. The CDS design is capable of individually conveying many different CDS structures encompassing Accident and Emergency Attendances, Out-Patient Attendances, Admitted Patient Care and Elective Admission List data. CDS Messages have been defined in component parts known as CDS Type. Each CDS Type as configured into the CDS Message carries only one CDS, examples being one finished General Consultant Episode CDS Type etc.

The CDS also allows the transfer of additional, locally defined information in what are termed 'Very General Purpose Data Segments' (VGPs), please refer to the current version of The NHS CDS Manual for the rules and constraints when using VGPs.

How CDS Types are transmitted

Many CDS Messages may be physically transmitted together as an EDI Interchange. The inclusion of particular CDS Messages in any one EDI Interchange is subject to grouping rules.

The NHS-wide Clearing Service

The NHS-wide Clearing Service (NWCS) was established to accept CDS Messages from Providers for onward transmission to Commissioners and to be copied to other recipients.

In order to meet the Hospital Episode Statistics (HES) requirements and to provide Value Added Services for its users, the NWCS maintains a central database of all valid CDS Messages received.

The adoption and use of the NWCS for the exchange of Admitted Patient Care CDS data was mandated for all NHS Organisations in an Executive Letter, EL/95/139 issued in December 1995 and is a component of the 'Information for Health' strategy.

The Mandated CDS Flows

The NWCS supports all CDS Types but only a subset are mandated to flow via the NWCS, the minimum CDS data flow requirement to enable HES extracts to be created by NWCS is: The NWCS supports all CDS Types but only a subset are mandated to flow via the NWCS, the minimum CDS data flow requirement to enable HES and Payment by Results to be supported by NWCS is:

- All Admitted Patient Care Finished Episodes are to be passed via the NWCS. This includes Out of Area Treatments, Home Birth and Home Delivery Episodes
- As at midnight on 31 March each year, all Unfinished Consultant Episodes which are not included in the Detained and/or Long-Term Psychiatric Census, must be sent to the NWCS
- All Unfinished Episodes qualifying for inclusion in the Detained and/or Long-Term Psychiatric Census as at midnight 31 March each year must be sent to the NWCS
- Out-Patient Attendance Commissioning Data Sets were mandated to flow via the NWCS from 1st October 2001, see DSCN 05/2001.
- Out-Patient Attendance Commissioning Data Sets were mandated to flow via the NWCS from 1st October 2001, see DSCN 05/2001. Nurse and Midwife attendances and Ward Attendances for nursing care were mandated to be carried on the Out-Patient Attendance CDS from 1 April 2005, see DSCN 32/2004.
- Accident and Emergency Attendance Commissioning Data Sets were mandated to flow nationally from 1st April 2005, see DSCN 32/2004.

For further information please refer to the current version of The NHS CDS Manual.


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Barbara Fogarty