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

Data Services for Commissioners - Commissioner Assignment Method Flow Chart 2015/16: Accompanying Guidance and Reference Tables 1

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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. 3

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 4

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 2013 1. 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 group 2. 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 2013 3. Secondarydentalcare AFHJ11November2013 (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-jg7rftqtejdbtygzdlpa5h9pmjniqwhogwbfcujwxvn5rx54wnkxgofyyg51ytynid7gfxojd9m7m3hqyqr*d2sg--v/secondarydentalcareafhj11november2013.pdf 5

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 010 (Accident & Emergency Attendances) Date Arrival Date At Accident and Emergency Department 020 (Outpatients) Appointment Date 120 (Admitted Patient Care Finished Birth Episodes) 130 (Admitted Patient Care Finished General Episodes) DISCHARGE DATE (HOSPITAL PROVIDER SPELL) DISCHARGE DATE (HOSPITAL PROVIDER SPELL) 140 (Admitted Patient Care Finished DISCHARGE DATE (HOSPITAL 6

CDS Type 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 Date PROVIDER SPELL) DISCHARGE DATE (HOSPITAL PROVIDER SPELL) DISCHARGE DATE (HOSPITAL PROVIDER SPELL) START DATE (HOSPITAL PROVIDER SPELL) START DATE (HOSPITAL PROVIDER SPELL) START DATE (HOSPITAL PROVIDER SPELL) 7

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. 8

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 9

9 Flowchart Key 10 Definitions of Assigned Commissioners Assigned Commissioners Commissioner Host CCG Comments / Logic 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 10

Assigned Commissioners Commissioner Comments / Logic 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 11

Assigned Commissioners Commissioner Comments / Logic 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 12

Assigned Commissioners Commissioner Comments / Logic 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 highlyspecialised 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) 13

Assigned Commissioners Commissioner Comments / Logic 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 area 6. 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 14

Assigned Commissioners Commissioner Comments / Logic 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 population 7, 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 15

Assigned Commissioners Commissioner Comments / Logic 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 Services 8. 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 resident 10. 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 16

Assigned Commissioners Commissioner Comments / Logic 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 ringfenced 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 17

Assigned Commissioners Commissioner Comments / Logic 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) If there is no match to a record in epraccur then revert to the postcode methodology.. 18

Assigned Commissioners Commissioner Responsible NHSE Regional Geography for Health and Justice Commissioning Comments / Logic 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 19

11 Flow Chart Annotations Assignment Process Code Description Comments / Logic 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 residence 12 ) 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. Assigned Commissioner Yes:- Responsible CCG No:- Host CCG 12 Note usual residence does not mean the same as ordinary residence see Comments/Logic regarding question (C) 20

Assignment Process Code Description Comments / Logic Assigned Commissioner 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 21

Assignment Process Code Description Comments / Logic Assigned Commissioner answer to question 2 is Yes, else the answer is No 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. 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. Yes:- A-1 No:- C 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 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). 22

Assignment Process Code Description Comments / Logic Assigned Commissioner 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 HSCIC 14, 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. 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 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 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 23

Assignment Process Code Description Comments / Logic 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_fi eld_notes/c/co/commissioning_serial_number_de.asp?s hownav=0 for more information). Assigned Commissioner No:- Box F. 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 15 www.england.nhs.uk/wp-content/uploads/2012/11/pss-ir-managers.pdf 24

Assignment Process Code Description Comments / Logic Assigned Commissioner 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 25

Assignment Process Code Description Comments / Logic Assigned Commissioner 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, 26

Assignment Process Code Description Comments / Logic Assigned Commissioner 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. 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 logic 16. 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. 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 27

Assignment Process Code Description Comments / Logic else the answer is No. Assigned Commissioner 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 28

Assignment Process Code Description Comments / Logic Assigned Commissioner B-3 Checks whether the care provided is highly specialised. 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. question is Yes else the answer is No 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) 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:- B-4 No:- Residential Population Check (RPop) Yes:- NHSE Specialised Commissioning Hub (based on Provider Mapping Table) No:- Residential Population Check (RPop) 29

Assignment Process Code Description Comments / Logic Assigned Commissioner residents have right of access to English highlyspecialised services (relevant pseudo postcode values are listed in appendix H), then the answer to this question is Yes, else the answer is No 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. 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 2015 17 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 crossborder protocol) No: - Is activity highlyspecialised? (B-3) 17 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/418634/implementing_overseas_charging_regulations_2015.pdf 30

Assignment Process Code Description Comments / Logic Assigned Commissioner 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 agreement 18 between Wales and England, for those patients usually resident in a defined set of Welsh administrative areas and English counties 19 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 31

Assignment Process Code Description Comments / Logic Assigned Commissioner 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 32

Assignment Process Code Description Comments / Logic Assigned Commissioner 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 33

Assignment Process Code Description Comments / Logic Assigned Commissioner 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 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. 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 area 20 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 34

Assignment Process Code Description Comments / Logic Assigned Commissioner 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 inhospital 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 resident 22. 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 35

Assignment Process Code Description Comments / Logic Assigned Commissioner 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 36

Assignment Process Code Description Comments / Logic Assigned Commissioner 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. 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. 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 37

Assignment Process Code Description Comments / Logic Assigned Commissioner are providing services covered by the NHS England Section 7a agreement 24 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 38

Assignment Process Code Description Comments / Logic Assigned Commissioner F-1 This question checks whether the patient is resident within England F-2 This question checks whether activity data represents a public health service covered by the Section 7a agreement answer is No. 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 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. In England certain public health services are commissioned by NHS England under the Section 7a agreement 25. 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 No responsible Welsh Local Health Board commissioner If Yes go to F-2 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 39

Assignment Process Code Description Comments / Logic Assigned Commissioner 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 40

Assignment Process Code Description Comments / Logic Assigned Commissioner from epraccur field 4 ( High Level Health Geography) If there is no match to a record in epraccur then revert to the postcode methodology. 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 GDCrecognised 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 41

Assignment Process Code Description Comments / Logic Assigned Commissioner 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 42

Assignment Process Code Description Comments / Logic Assigned Commissioner (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 SUS 26 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-susv10/pdf/submitting_sensitive_or_anonymous_records_to_sus_v1.0.pdf 43

Assignment Process Code Description Comments / Logic Assigned Commissioner 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 44

Assignment Process Code Description Comments / Logic Assigned Commissioner 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 45

Assignment Process Code Description Comments / Logic 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. Assigned Commissioner No:- J 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 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 46

Assignment Process Code Description Comments / Logic Assigned Commissioner 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 2010 27. The specific institutions that are in-scope are described in Appendix 1 of Securing Excellence for Commissioning for Offender Health 28. 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 47

Assignment Process Code Description Comments / Logic Assigned Commissioner 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 48

Assignment Process Code Description Comments / Logic Assigned Commissioner 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 49

Assignment Process Code Description Comments / Logic Assigned Commissioner 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. 50

12 Appendix A - NHS England Direct Commissioning Framework Responsibilities Matrix 2015/16 Direct Commissioning Responsibilities Specialised Armed Forces Health and Justice Secondary Dental 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 Commissioning Hub Responsibility Name 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 Public Health Primary Care 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 North Midlands & East South NHS England North (Yorkshire and Humber) NHS England North (Lancashire and Greater Manchester) NHS England North (Cumbria and North East) NHS England North (Cheshire and Merseyside) NHS England Midlands and East (North Midlands) NHS England Midlands and East (West Midlands) NHS England Midlands and East (Central Midlands) Q72 Q73 Q74 Q75 Q76 Q77 Q78 Yorkshire and Humber Commissioning hub Lancashire and Greater Manchester Commissioning hub Cumbria and North East Commissioning hub Cheshire and Merseyside Commissioning hub North Midlands Commissioning hub West Midlands Commissioning hub Central Midlands Commissioning hub NHS England Midlands and East (East) Q79 East Commissioning hub 14E 14E London NHS England London Q71 London Commissioning hub 13R 13R 13V 13V Yorkshire and Humber Specialised 13Q Q72 Q72 Commissioning Hub Providers in this Region should send 13W invoices pertaining to Q73 Q73 Armed Forces activity to NHS England - 13X 13X North East Specialised North (Yorkshire & Commissioning Hub Humber) and codify Q74 Q74 them with 'Q72' North West Specialised 13Y 13Y Commissioning Hub Q75 14A 13Q Providers in this Q76 Q76 West Midlands Region should send 14C 14C Specialised invoices pertaining to Q77 Commissioning Hub Armed Forces activity Central Midlands to NHS England - 14D 14D Specialised Midlands and East Q78 Commissioning Hub (North Midlands) and codify them with East Specialised Commissioning Hub 'Q76' Q79 Q79 NHS England South (South West) Q80 South West Commissioning hub 14F 14F South West Specialised Providers in this Commissioning Hub Region should send Q80 Q80 NHS England South (South East) Q81 South East Commissioning hub 14G 14G South East Specialised invoices pertaining to Commissioning Hub Armed Forces activity Q81 Q81 NHS England South (South Central) Q82 South Central Commissioning to NHS England - 14H * 13Q hub South (South Central) Q82 Q82 NHS England South (Wessex) Q70 Wessex Commissioning hub 13N 13N Wessex Specialised and codify them with Commissioning Hub 'Q82' Q70 London 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 51

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 services 30 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 noncontracted 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 52

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 nonspecialised 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. 53

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. 54

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 55

Number Specialised Service Line Code Service Highly Specialised? Identified by PS 2014/15? 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 24 NCBPS01C CHEMOTHERAPY YES - IN PS 2014/15 (Admitted Patient Care ONLY) YES - IN PS 2014/15 (Admitted Patient Care ONLY) 25 NCBPS22C CHILD AND ADOLESCENT MENTAL HEALTH SERVICES YES NO 56

Number Specialised Service Line Code Service Highly Specialised? Identified by PS 2014/15? 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 57

Number Specialised Service Line Code Service Highly Specialised? Identified by PS 2014/15? 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 58

Number Specialised Service Line Code Service Highly Specialised? Identified by PS 2014/15? 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 59

Number Specialised Service Line Code Service Highly Specialised? Identified by PS 2014/15? ONLY) 69 NCBPS02B DIAGNOSTIC SERVICE FOR AMYLOIDOSIS YES NO 70 NCBPS29D DIAGNOSTIC SERVICE FOR PRIMARY CILIARY DYSKINESIA YES NO 71 NCBPS08B 72 NCBPS33D DIAGNOSTIC SERVICE FOR RARE NEUROMUSCULAR DISEASE YES NO 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 60

Number Specialised Service Line Code Service Highly Specialised? Identified by PS 2014/15? 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 61

Number Specialised Service Line Code Service Highly Specialised? Identified by PS 2014/15? 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 62

Number Specialised Service Line Code Service Highly Specialised? Identified by PS 2014/15? 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 63

Number Specialised Service Line Code Service Highly Specialised? Identified by PS 2014/15? 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 YES - IN PS 2014/15 (Admitted Patient Care ONLY) 64

Number Specialised Service Line Code Service Highly Specialised? Identified by PS 2014/15? 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) YES - IN PS 2014/15 (Admitted Patient Care ONLY) 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 65

Number Specialised Service Line Code Service Highly Specialised? Identified by PS 2014/15? 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 YES - IN PS 2014/15 (Admitted Patient Care ONLY) 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 66

Number Specialised Service Line Code Service Highly Specialised? Identified by PS 2014/15? 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 67

Number Specialised Service Line Code Service Highly Specialised? Identified by PS 2014/15? 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) 68

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 69

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 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 70

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 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 71

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 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 LYMPHANGIOLEIOMYOMATOSI S NCBPS29c 72

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 LYSOSOMAL STORAGE DISORDER (ADULT) NCBPS36c Service only (not drugs) NCBPS36c Service only (not drugs) LYSOSOMAL STORAGE DISORDER (CHILD) NCBPS36c Service only (not drugs) NCBPS36c Service only (not drugs) MCARDLE S DISEASE NCBPS26a NEUROMYELITIS OPTICA NCBPS08d PAEDIATRIC INTESTINAL PSEUDO-OBSTRUCTIVE DISORDERS NCBPS12b PAROXYSMAL NOCTURNAL HAEMOGLOBINURIA NCBPS03a Service only (not drugs) PRIMARY CILIARY DYSKINESIA NCBPS29p PSEUDOMYXOMA PERITONEI NCBPS01f 73

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 PULMONARY HYPERTENSION (CHILD) NCBPS13j Service only (not drugs) 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 74

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 SPECIALIST PAEDIATRIC LIVER DISEASE NCBPSc23 STICKLER SYNDROME DIAGNOSTIC NCBPS20c VEIN OF GALEN MALFORMATION NCBPSa23 WOLFRAM SYNDROME NCBPSq23 XERODERMA PIGMENTOSUM NCBPS24b 75

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 Description 31 Treatment Function mapping for Commissioner Assignment Process Treatment Function Code mapping for Commissioner Assignment Process Special care dentistry 1 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. None 1 None 1 31 From Annex A, Scope of NHS Commissioning Board s responsibilities, Securing Excellence in Commissioning NHS Dental Services, NHS England, February 2013 76

GDC Dental Specialty Name Securing Excellence Speciality Description 31 Treatment Function mapping for Commissioner Assignment Process Treatment Function Code mapping for Commissioner Assignment Process Oral surgery Orthodontics 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. This is the development, prevention, and correction of irregularities of the teeth, bite and jaw. Oral Surgery 140 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 Surgery 2 142, 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 Restorative Dentistry 141 77

GDC Dental Specialty Name Securing Excellence Speciality Description 31 Treatment Function mapping for Commissioner Assignment Process Treatment Function Code mapping for Commissioner Assignment Process 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. Restorative Dentistry 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. Restorative Dentistry 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 microbiology 3 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. None 3 None 3 78

GDC Dental Specialty Name Securing Excellence Speciality Description 31 Treatment Function mapping for Commissioner Assignment Process Treatment Function Code mapping for Commissioner Assignment Process Oral and maxillofacial pathology 4 Dental and maxillofacial radiology 5 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. Involves all aspects of medical imaging which provide information about anatomy, function and diseased states of the teeth and jaws. None 4 None 4 None 5 None 5 79

GDC Dental Specialty Name Securing Excellence Speciality Description 31 Treatment Function mapping for Commissioner Assignment Process Treatment Function Code mapping for Commissioner Assignment Process 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 CCG 6 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 80

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. 81

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). 82

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. 83

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 84

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 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 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 85

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 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 86

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 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 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 Young Offender Institute CB8 9YG East Q79 VGC HMP WHITEMOOR Prison PE15 0PR East Q79 VKM HMP/ YOI CHELMSFORD Young Offender Institute CM2 6LQ East Q79 87

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 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 Young Offender Institute 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 88

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 VJT HMYOI SWINFEN HALL Young Offender Institute 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 Young Offender Institute ST21 6LQ North Midlands Q76 WFY HMP WHATTON Prison NG13 9FQ North Midlands Q76 WHY HMP DOVEGATE Prison ST14 8XR North Midlands Q76 89

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 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 90

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 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 Young Offender Institute 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 91

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 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 Young Offender Institute M27 8FB Lancashire & Greater Manchester Q73 VG3 PENNINE HOUSE IMMIGRATION REMOVAL CENTRE Immigration Removal Centre M90 4AG Lancashire & Greater Manchester Q73 92

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 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 Young Offender Institute 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 93

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 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 Young Offender Institute 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 Immigration Removal Centre DN7 6EE Yorkshire & Humber Q72 WGM HMP/ YOI DONCASTER Young Offender Institute DN5 8UX Yorkshire & Humber Q72 94

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 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 Young Offender Institute RG9 5SB South Central Q82 95

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 VJV CAMPSFIELD HOUSE IMMIGRATION REMOVAL CENTRE Immigration Removal Centre OX5 1RE South Central Q82 VKJ HMYOI HUNTERCOMBE Young Offender Institute 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 96

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 VD1 HMP/ YOI EAST SUTTON PARK Young Offender Institute 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 Immigration Removal Centre RH6 0PQ South East Q81 VP9 VQF HMP STANDFORD HILL HMP BLANTYRE HOUSE Prison ME12 4AA South East Q81 Prison TN17 2NH South East Q81 VQY HMP MAIDSTONE Prison ME14 1UZ South East Q81 97

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 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 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 98

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 REMOVAL CENTRE Removal Centre 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 Young Offender Institute GL12 8DB South West Q80 WV9 HMP ASHFIELD Prison BS16 9QJ South West Q80 99

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 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) Immigration Removal Centre PO12 2AW South Central Q82 VPC HMYOI PORTLAND Young Offender Institute DT5 1DL South Central Q82 VR3 HMP/ YOI GUYS MARSH Young Offender Institute SP7 0AH South Central Q82 WC5 THE VERNE IMMIGRATION Immigration DT5 1EQ South Central Q82 100

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 REMOVAL CENTRE Removal Centre WEN SWANWICK LODGE SCH Secure Children's Home SO31 7HD South Central Q82 WVP HMP WINCHESTER Prison SO22 5DF South Central Q82 101

18 Appendix G Glossary Abbreviation A&E CCG CDS DMICP DMS DSCRO EHIC GDC GP HSCIC HRG ICD-10 IR IRC MHL&D NHAIS NHSE ODS OPCS4 PAS PDS SARC SUS UK YOI Description Accident and Emergency Clinical Commissioning Group Commissioning Data Set Defence Medical Information Capability Programme Defence Medical Services Data Services for Commissioners, Regional Offices European Health Insurance Card General Dental Council General Practitioner Health and Social Care Information Centre Healthcare Resource Group International Classification of Diseases (10 th edition) Identification Rules for Prescribed Specialised Services Immigration Removal Centre Mental Health Liaison and Diversion National Health Applications & Infrastructure Services NHS England Organisation Data Service Office of Population Census and Statistics Classification of Interventions and Procedures (version four) Patient Administration System Personal Demographic Service Sexual Assault Referral Centre Secondary Uses Service United Kingdom Youth Offender Institution 102

19 Appendix H Pseudo Postcodes for EU Member States and Other States with Similar Arrangements (starred) Country Austria Belgium Bulgaria Croatia Cyprus (Southern) Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland* Italy Latvia Liechtenstein* Lithuania Luxembourg Malta Netherlands Norway* Poland Portugal Republic of Ireland Romania Slovakia Slovenia Spain Sweden Switzerland* Pseudo Postcode ZZ99 4MZ ZZ99 2DZ ZZ99 4UZ ZZ99 5VZ ZZ99 6AZ ZZ99 5XZ ZZ99 4FZ ZZ99 7LZ ZZ99 4BZ ZZ99 4GZ ZZ99 4QZ ZZ99 4RZ ZZ99 4XZ ZZ99 4CZ ZZ99 4LZ ZZ99 7RZ ZZ99 2PZ ZZ99 7SZ ZZ99 2EZ ZZ99 5BZ ZZ99 4EZ ZZ99 2AZ ZZ99 4YZ ZZ99 4JZ ZZ99 3AZ ZZ99 4ZZ ZZ99 5YZ ZZ99 5UZ ZZ99 4HZ ZZ99 2CZ ZZ99 4PZ 103

20 Appendix I CAM Flow Chart 104