Commissioner Assignment Method Flow Chart:
Accompanying Guidance
Document Control
Version / Date / Notes2.1 / 30/05/2014 / Minor changes prior to consultation with Providers/CSUs
03/06/2014 / Significant changes incorporating extra section to deal with cross-UK border and overseas aspects for specialised services’ commissioning
4 / 04/06/2014 / Addition of appendices
4.1 / 05/06/2014 / Typos fixed and Action Plan table added
4.2 / 07/07/2014 / AMT review comments enacted, action plan updated
9.0 / Started 09/07/2014 Completed 18/07/2014 / Version number aligned to flow chart version number, document amended to reflect consultation responses received as at 17/07/2014. Determining usual place of residence section expanded.
9.1 / 29/07/2014 / Final version of PSS Provider – AT relationship table provided by Ceri Townley and used to replace version in Appendix D
9.2 / 22/08/2014 / Amendment to flowchart following conversation with Alison Treadgold regarding new agreement reached concerning the division of MoD and NHS commissioning responsibilities for DMS-registered patients receiving operational care
9.3 / 11/09/14 / Minor changes to text in 01, 36 & 51 re OSV
9.4 / 22/09/2014 / Changes to the section on non-contracted specialist services commissioning and also further elaboration on the use of Y36 ICD-10 codes to define ‘operational care’. Various typos fixed.
Action Plan to Complete for Next Version
Action / Responsible / StatusProvide updated version of Appendix D / Ceri Townley / Requested – still outstanding
29/07/2014 – new version provided and Appendix D updated
Provide content for Appendix G / Alison Treadgold / Requested (via Nicola Troup)
Requirement removed and text written by BW
Send version 7 and this document to a small number of providers and CSUs and seek informal feedback/sense check/burden implications / Brent Walker,
Martin Hart,
Nicola Troup / Started 05/06/2014 – feedback requested by 13/06/2014
Feedback chased 03/07/2014
Deadline of 18/07/2014 given – no further comments received
Send version 7 and this document to Andrew Thompson and Jill Mitchell to get informal feedback from the 10 ATs with commissioning responsibility for Health & Justice / Brent Walker / Sent 05/06/2014
Feedback received 03/07/2014
Send version 7 and this document to Fiona Marley to get feedback on specialised services section / Brent Walker / Sent 05/06/2014
Feedback received 25/06/2014
Final meeting held with FM on 17/04/2014 to resolve final areas requiring clarification
Send version 7 and this document to members of the ‘Who Pays?...’ Task Force / Brent Walker / Requested by Sarah Smith 05/06/2014
Circulated 16/06/2014
Create presentation for ARPOG/SMT meetings w/c 09/06/2014 / Brent Walker & Martin Hart / First draft required for Helen Brown to review by noon 06/06/2014
Presentation given to SMT 16/06/2014
Develop presentation for sense check group review / Brent Walker / Sense check review carried out on 02/07/2014
Write paper for ARPOG Meeting on 09/07/2014 / Brent Walker & Martin Hart / Paper written and circulated to ARPOG 01/07/2014
Write minutes from Sense Check Group to inform debate at ARPOG on 09/07/2014 / Brent Walker / Minutes written and circulated 03/07/2014
Create v9 Flow Chart and update guidance and align version numbers for both documents / Brent Walker / Completed 18/07/2014
Provide v9 Flow Chart and v9 Guidance to Gerry Firkins at HSCIC who has agreed to redraft diagram to make it more efficient / Brent Walker / Version 9 sent to GF 23/07/2014
Provide v9 Flow Chart and v9 Guidance to NHS E analyst to develop SQL version of the flow chart / Brent Walker / Version 9.1 sent to RKH 30/07/2014
Provide v9.4 Flow Chart and v9 Guidance to NHS E analyst to develop SQL version of the flow chart for impact assessment / Brent Walker / Version 9.4 sent to RKH 26/09/2014
Document Purpose
This document provides further clarification and supporting information for the commissioner assignment method flow chart.
Commissioner Assignment Method Objective
The commissioner assignment method 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 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 (e.g. Ministry of Defence).It embodies the explicit commissioning hierarchy for CCG and NHS England commissioned services as described inthe Gateway Reference Letter to NHS England Area Teams – Secondary Dental Care (Gateway Reference No. 00781), dated 20 November 2013[1].
This shows the order of precedence for the different NHS England commissioned services, where more than one apply for a particular patient (e.g. armed forces member receiving specialised care).
CDS Scope
The following CDS typesare within the scope of the commissioner assignment process flow chart:
CDS / Name010 / 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
Guidance for other services not covered by these CDS flows will be issued at a later date.
CDS Activity Dates
The commissioner assignment process should be applied, based on CDS data content, at the following activity dates for the described CDS types:
CDS Type / Activity Date010 (Accident & Emergency Attendances) / Arrival Date At Accident and Emergency Department
020 (Outpatients) / Appointment Date
120 (Admitted Patient Care Finished Birth Episodes) / START DATE (HOSPITAL PROVIDER SPELL)
130 (Admitted Patient Care Finished General Episodes) / START DATE (HOSPITAL PROVIDER SPELL)
140 (Admitted Patient Care Finished Delivery Episodes / START DATE (HOSPITAL PROVIDER SPELL)
150 (Admitted Patient Care Other Birth Events) / DELIVERY DATE
160 (Admitted Patient Care Other Delivery Events) / DELIVERY DATE
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 identifya usual place of residence based upon the address of the main site of the provider delivering the careand use this address when determining commissioning payment responsibilities.
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 and can be found at the following HSCIC website:
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 MoD’s health information system ‘DMICP’ (Defence Medical Information Capability Programme). DMICP is integrated to the Patient Demographic Service on the Spine and the Spine’sdemographic 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.
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. Providers need to write the correct Organisation Data Services organisation code for this organisation in the ORGANISATION CODE (CODE OF COMMISSIONER)[2] field in the CDS.
For the sake of clarity the commissioner assignment process flowchart includes an annotations for each process step which link to further detail in the table below. The flow chart 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 and may become national files in due course.
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Draft Version 9.4 22/09/2014
Commissioner Assignment Process Flowchart Annotations
Annotation Number / Annotation Detail / Further Comments / OutstandingIssues/Questions/Actions01 / ‘Who Pays?’ guidance states that NHS England is responsible for commissioning secondary and community health services for members of the armed forces, for their families, where they are registered with aDMS practice, and for reservists whilst mobilised.
This population will be defined by the presence of an eligible Defence Medical Services (DMS) practice code (starting with A91…) in either the General Medical Practice Code (Patient Registration) (for serving members and their DMS-registered dependents) code or Referring Organisation Code (for mobilised reservists) within the CDS. / Providers must ensure they record a valid DMS practice code in their PAS when they register a patient who is part of the eligible armed forces population, or record a referral from a DMS practice if the patient is a mobilised reservist who is not registered with a DMS practice[3].
DMS practice codes are listed in the ‘epraccur’ file maintained by the Organisation Data Services (ODS). This list is currently being assured by the MoD as it may contain erroneous entries. The file also contains DMS practices sited outside England (Scotland, Wales, overseas etc.).
Once the final list of DMS practices are agreed providers will need to ensure that their patient administration systems (PAS) are able to populate the required CDS fields with DMS practice codes. Spine PDS-connected PASs should do this automatically for practice codes because of the DMICP[4]-Spine NHAIS link.
There will be a need to measure and manage provider compliance regarding use of REFERRING ORGANISATION CODE, This field is marked as ‘Required’ in the NHS Data Model and Dictionary and therefore may not be fully populated in CDS flows / Agreement is neededon the range ofDMS codes which will be used to define the eligible armed forces population.
Kate Harrison and Ian Boyd at the MoD are working with the HSCIC and/or ODS to agree a final definitive list of validDMS practice codes to include within a revised version of the ‘epraccur’ ODS reference file. There is a need for a status update on this work and an estimate for the completion date. In the interim Appendix A of this guidance contains an interim list of DMS practice codes based on preliminary data from the MoD.
02 / Entitlement to free NHS hospital treatment is based on ‘ordinary residence’ in the UK (or exemptions from charges under the Charging Regulations). Section 3.4 -3.18 of the current Overseas Visitors Guidance[5] relates. / This question is included at this stage to accommodate the eligible armed forces population who return to the UK and receive care in an Accident and Emergency department and is meant to distinguish those based overseas (and therefore usually resident there) and those based in the UK. For DMS-registered armed forces personnel the place of ordinary residence is ‘civilianised’ via the DMICP-PDS link which lists the (civilianised) DMS practice address as the patient’s place of residence. If this DMS practice address is not in the UK, then the patient will be deemed to be not usually resident in the UK.
For mobilised reservists their General Medical Practice will be their normal GP so providers will need to use the DMS practice code in the REFERRING ORGANISATION CODE to derive place of residence. The interim list of DMS practices in Appendix A identifies explicitly overseas DMS practices.
03 / Where armed forces personnel usually resident outside the UK require care in a UK A&E department then the Host CCG (the CCG within which the address of theprovider main site is located) will be responsible for paying for the care / This is in line with the current Overseas Visitors Guidance[6].
04 / This question checks whether the member of the armed forces is usually resident in a non-English home country / Members of the armed forces registered with a non-English UK DMS practice will be deemed to be usually resident in the relevant home country.The interim list of DMS practices in Appendix A explicitly identifies Home Country DMS practices.
05 / The Who Pays? guidance[7] states that for residents of Scotland, Wales and Northern Ireland attending A&E departments, the cost is covered by the ‘host CCG’ (the CCG within which the A&E provider’s main site is located), not the patient’s responsible health board
06 / NHS England is responsible for paying for care in an accident and emergency department for the eligible armed forces population when these patients are usually resident in the UK.[8] / Three NHS England Area teams have commissioning responsibility for armed forces (see Appendix B) and all have agreed that commissioner code subdivision to this level of organisational detail is not required.
Providers should use the ‘Parent Organisation Code’ for the A91* practices in the epraccur 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. The HSCIC have indicated that there are no issues in using this code for this purpose.
07 / This question checks whether the patient is not usually resident within the UK – this will be assessed on the presence of a non-UK postcode in the patient’s address of place of usual residence / This question is required as the commissioner for A&E activity for non-armed forces patients varies according to country of residence. Providers should record a pseudo postcode for the relevant country of residence in the CDS record
08 / Patients from overseas are not liable for NHS charges for emergency care and the payment commissioner is the ‘host CCG’ (the CCG within which the A&E provider’s main site is located). / This is in line with paragraph 9 (second bullet point) of Annex A in the Who Pays? guidance
09 / This question checks whether the patient is not usually resident in England but is usually resident in one of the UK home countries
10 / The ‘host CCG’ (the CCG within which the A&E provider is sited) pays for emergency care for residents of Scotland, Wales and Northern Ireland / This is in line with paragraph 5, second bullet point, of the Who Pays? guidance / The Who Pays? guidance uses the 2013/14 PbR Guidance to justify this. This document has been superseded by the 2014/15 PbR Guidance which now references Who Pays?
11 / The responsible CCG commissioner (based on the patient’s registered GP, or place of ordinary residence if not registered) pays for emergency care for non-armed forces patients usually resident in England / As per paragraph 5, bullet point one in the Who Pays? guidance
12 / 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 and ADMINISTRATIVE CATEGORY fields of the CDS in order to further demonstrate the answer this question
13 / The commissioner for self-funded care will continue to be the ODS default code ‘VPP00’. / This is in line with existing NHS data standards for ORGANISATION CODE (CODE OF COMMISSIONER).
14 / Specialised and highly-specialised services are identified via the correct and complete application of the Identification Rules for Prescribed Specialised Services[9] / The identification rules software tool is not, of itself, sufficient means to identify specialised activity in CDS flows asfull application of the IR requires the use ofadditional non-SUS datasets and logic. Providers should apply the rules in full using these other resources as required.