Commissioner Assignment Method

Closed 30 Sep 2015

Opened 7 Sep 2015

Feedback Updated 7 Dec 2015

We Asked

We asked you to comment on the proposals for a new data standard and process to assign the correct commissioner code in commissioning data sets. The flow chart and supporting guidance was developed to provide a consistent approach for identifying the correct commissioner. This was required for cases where there may be a conflict in which code is required first, or where the commissioner may be difficult to determine, such as in Specialised care, cross border care, and military and offender health settings.

You Said

47 responses were received on the proposed standard. 100% of responses felt there was a need for a consistent and accurate Commissioner Assignment Method, and there were some positive comments in the value of having a single agreed guidance for this process and local variations observed.

91% thought that the method should be expanded to other data sets (Maternity, Children, Community, Diagnostic and Mental Health) however some comments were made arguing against this saying that it would be difficult to implement these changes in clinical systems in other areas. It was noted that in some data flows such as the Diagnostic Imaging Data Set, the commissioner code is derived in SUS, so that for the diagnostic imaging data set this could be applied in the SUS data.

The guidance was seen as comprehensive, but perhaps not as clear as it could be in all areas. 87% of responses agreed with the logic, but some potential errors were identified, particularly regarding patients living in the England-Wales border area. You emphasised that there may be local mismatches between funding and the identified commissioner in some areas, due to legacy issues.

To implement the standard, it was suggested that it could take six months to interpret and check the compliance of local systems. There was mixed feedback about the need for a tool to implement the CAM; Sample SQL code or example implementations was highly valued by respondents, however it was noted there would be much variation in the way that the algorithm would be implemented. There were some requests for peer support and networking to support implementation.

We Did

NHS England has made changes to the guidance, and published it on its website as a guidance document.

To make the guidance available to all as soon as possible, NHS England has published the 15/16 work as guidance on its website - https://www.england.nhs.uk/ourwork/tsd/data-services/. The CAM will be proposed as part of the 16/17 standard contract for NHS England to support implementation.

Thanks to the thorough feedback, errors were identified in our interpretation of the Welsh Border protocol, which has been corrected in the process. An issue was identified where the headquarters postcode of a trust may not be ideal for identifying the host CCG, and a clarification was made in the guidance to account for this. Guidance was changed to use GP Practice not General Practitioner to derive CCG. It has been acknowledged that there may be discrepancies between local commissioning arrangements and the commissioner code in the short term.

We have attempted to improve the diagram, and make certain parts of the guidance easier to follow. Some of the dependencies on other documents and processes are unavoidable, for example there is a dependency on Organisational Data Service files and the Prescribed Specialised Services Tool, these are independent services and including them would be beyond the scope of this work, and including copies of these data in the CAM guidance will make version control difficult. We will take on the feedback and improve for future versions where possible, and include links to the resources on our website.

We are looking into developing an example SQL implementation. We will be happy to talk with all survey respondents and set up a virtual network.

Results Updated 7 Dec 2015

A link to the results, pubished on 7 December 2015, is provided below.

Files:

Overview

This consultation is now closed. Please see the results section below for a summary of the feedback and a full response document.

The Standardisation Committee for Care Information (SCCI) has received a proposal for a new information standard. As part of the development and assurance process, and as mandated under the Health and Social Care Act 2012, this consultation seeks feedback on the proposal.

The consultation runs from 07/09/2015 to 30/09/2015. Your responses will influence how the Commissioner Assignment Method is developed, released and scheduled for implementation.

Consultation feedback will be included in the submission to SCCI for its meeting on 25 November 2015. Publication of an Information Standards Notice will follow this meeting, with a view to the standard taking effect from 1 April 2016.

Before answering our questions, please take time to review:

  • the background text below explaining the aims and objectives of the information standard

and the two documents provided at the bottom of this page:

  • the CAM algorithm
  • the CAM algorithm guidance.

 

Why We Are Consulting

Background

NHS England has developed an algorithm and associated guidance/reference documents (the Commissioner Assignment Method) which together describe how the Commissioning Data Sets (CDS) field ORGANISATION CODE (CODE OF COMMISSIONER) should be correctly populated by providers of healthcare and other organisations that generate CDS data. This field - ORGANISATION CODE (CODE OF COMMISSIONER) - must be populated with a valid organisation code which describes which organisation is responsible for paying for the healthcare activity described by the CDS record.

Commissioner Assignment Method

Ensuring the delivery of healthcare activity data to the correct commissioning organisation is essential.  The data is used by commissioners for various purposes including establishing healthcare needs, planning delivery of appropriate services, carrying out service reviews and supporting changes in patient pathways, resource allocation, providing assurance and performance management.

Commissioning Data Sets (CDS) are flowing but commissioner code is not being attributed correctly in national data flows. This in turn means that any analysis performed on national data that uses the commissioner organisation code as a reporting item has the potential to be incorrect. Analysis of national SUS data by NHS England has revealed inconsistent and inaccurate allocation of commissioner codes by some providers and also the use of incorrect organisation codes, including the use of defunct codes for legacy organisations and invalid default codes.

The use of incorrect codes means  that in some cases CDS records cannot flow routinely to the correct recipients as national data access solutions are not configured to release data extracts for these organisation codes. Data can also flow to incorrect recipients as Organisation Code (Code of Commissioner) is one of the ‘Reasons for Access’ used within the Secondary Uses Service (SUS) online extract service. It is also used to create managed service extracts.

The commissioning environment is using aggregate contract monitoring reports submitted by healthcare providers to commissioners  to secure payment. However it is difficult for commissioners to reconcile the aggregate contract monitoring reports with patient-level data and also to use these data to support the invoice validation and challenge process. As a consequence it is difficult for commissioners to prove the validity of provider-reported variations in contract performance.

In order to address these issues, this new information standard is proposed to ensure consistent commissioner assignment application and CDS copy recipient addressing across England. The Commissioner Assignment Method (CAM) is an algorithm designed to enable secondary healthcare providers and other processors of commissioning activity data to allocate the correct Organisation Code (Code of Commissioner) in Commissioning Data Sets (CDS) - as defined in the NHS Data Model and Dictionary. This standard is intended to be implemented as a mandatory information standard on 1 April 2016. 

The objective of this standard is to give secondary care providers the standard process logic and reference data they need to consistently and accurately identify the commissioning organisation responsible for paying for the healthcare activity described by a CDS record and then assigning the correct national organisation code denoting this responsibility within the CDS field Organisation Code (Code of Commissioner) within the CDS transaction record.

The Commissioner Assignment Method will:

  • provide clarity about which organisation codes should be used to support the effective commissioning of healthcare services in the current commissioning environment
  • provide clarity about the population (i.e. based on patient registration, patient residence or total provider provision) to be served by the different commissioning processes
  • provide clarity on the order of precedence for the various directly-commissioned services that NHS England is responsible for
  • provide details of logical rules / tests to be performed by provider organisations in order to establish the responsible commissioner.

As a consequence the following positive business outcomes can be achieved:

  • more accurate identification of commissioning responsibility in any national analyses of commissioning data sets leading to improved decision-making by commissioners
  • data extracts from SUS will contain only those records that valid data recipients have a legal basis to receive for their stated commissioning activities
  • more efficient and effective contract management processes, such as reconciliation of aggregate contract monitoring report and commissioning data set data, invoice validation and data challenge processes.

It is not anticipated that use of CAM will increase the burden on secondary care providers, as commissioner code allocation is an existing business as usual activity. The standard will be enacted as part of the providers’ contract monitoring system set-up at the start of the financial year and all that the proposed standard will do is ensure that this set-up is consistent across all impacted providers.

Feedback is sought on the feasibility of this proposal. Specifically we would be  interested in receiving feedback on the logic and reference data used within the algorithm and whether the derivation is in line with local implementation and if not why not. We would also be interested in understanding if there will be any issues in the implementation of this information standard.

 

What Happens Next

Your feedback will help us assess whether the algorithm can (a) do the job it needs to do and (b) be easily implemented.

Feedback will be consolidated into a report for SCCI and is a critical part of the evidence needed for independent appraisal of the proposed information standard.

Areas

  • All Areas

Audiences

  • Commissioners
  • Health IT System Suppliers
  • Heads of Information
  • Clinical Commissioning Groups (CCGs)
  • Commissioning Support Units (CSU)
  • NHS England
  • All Secondary Healthcare Providers
  • NHS England Commissioning Teams
  • All Users of the Commissioning Data Sets

Interests

  • Commissioning
  • Commissioning Data Sets