Using NHS Numbers for commissioning and contracting

Introduction

In April 2010, the NHS Operations Board agreed that the NHS number should normally form part of the datasets submitted for contractual payments under the NHS standard contract.

In addition to improving the correct identification of patients for commissioning and payment purposes, it is expected that tying contractual payments to the inclusion of a NHS Number will increase NHS Number use by organisations more generally. This in turn will contribute to improved patient safety, as required by the NHS Number Safer Practice Notice and will result in better communications with and about patients.

Many commissioners and providers already use NHS Numbers as part of the payment process to identify patients. The data used by commissioners may be provided locally or as part of a national data set submitted to the Secondary Uses Service (SUS).

The NHS Operating Framework 2011/12 stated that from 2012/13, use of the NHS number will be linked to contractual payments from commissioners in line with guidance. The NHS Operating Framework 2012/13 states;

3.29 No single technical change has greater power to improve the integration of services than the consistent use of the NHS number. NHS organisations are expected to use the NHS number consistently in 2012/13 and commissioners should link the use of the NHS number to contractual payments in line with the guidance. There will be punitive contract sanctions for any organisation not compliant by 31 March 2013.

Contractual provision for withholding payments

To reflect the change to the Operating Framework, the NHS Standard Contracts for Mental Health, Community and Acute services 2011/12 have been amended to require that providers, subject to Guidance, shall include the verified NHS Number in the Patient or Service User Health Record.

The current approach allows commissioners to determine locally how to implement the provisions to withhold payments for non-use of NHS Number. Further details are available in the contractual provision section.

Work in-progress to produce guidance

To help commissioners and providers in making these decisions, the NHS Number programme is running a project to analyse and report the reasons why organisations currently do not have patients' NHS Numbers, and to produce guidance - for April 2012 - to enable organisations to:

Increase the coverage of NHS Numbers on patient health records;
Identify circumstances in which it may not be possible or practical for organisations to obtain and use an NHS Number for a patient to whom services have been provided.

The project is split into three work streams – acute, community and mental health – in line with the amended NHS Standard contract. The analysis is using samples of patient demographic data for which the provider organisations have been unable to include NHS Numbers, and attempting to find (i.e. trace) the patient on the Personal Demographics Service (PDS) to determine if the patient's NHS Number is in fact available and traceable. Tracing is being performed using the demographic searching functionality in the Summary Care Record application (SCRa), the standard method of accessing PDS records via the Spine portal. Samples from a number of organisations from the three care settings will be analysed to get a representative view.

The analysis will document the improvements that organisations could make to increase NHS Number coverage and identify reasons why NHS Numbers are not available for some patients. The objective is to ensure that providers and commissioners:

have a common understanding of the issues related to NHS Number retrieval;
are clear on the circumstances when patients will have NHS Numbers;
recognise the circumstances when it may not be possible to find and use an NHS Number for a patient, or reasonable to expect other organisations to do so; and
understand how to increase the proportion of patient records which include NHS Number.

The project is not documenting or assessing commissioning processes (which may vary locally), nor attempting to increase the volume of commissioning based on patient identifiable information or commissioned under the NHS standard contract.

The Health Bill consultation suggests that all secondary uses for contracting and commissioning move to the Information Centre and the use of patient identifiable data for contracting and commissioning purposes through SUS is allowed. This has been raised as an issue as part of the consultation. Even if this proposal is accepted it is likely that local data flows to support commissioning will continue for the foreseeable future. As the details of future data flows for commissioning and contracting processes are not yet fully defined, this project will not recommend to commissioners and providers how they share information to prove NHS Number use, but assumes that commissioners will – as they already do – query and challenge absence of the NHS Number, on the basis that the payment requested cannot be confirmed as relating to a patient for whom they are responsible.

Current guidance

Until the project completes in April 2012 the following information has been collated to aid providers and commissioners using NHS Numbers.

NHS Number use

Many organisations within acute, community and mental health are already achieving NHS Number coverage figures of over 98%, even up to 99.8% including for A&E services. The contract expects providers to add NHS Numbers to patient health records so that the NHS Number is available to healthcare professionals treating patients.

It is important that staff with the correct skills identify patients and their NHS Numbers. Providers can provide the NHS Number to commissioners for the majority of patients but there will be cases when it is not possible to find the patients NHS Number.

Commissioners need to be aware of the cases when it may be difficult for a provider to find and use an NHS Number for a patient, please read Section 2 – Determine why the patient hasn't got an NHS Number.

Providers need to read all sections within Finding NHS Numbers.

Finding NHS Numbers

The following guidance is aimed at organisations providing NHS Numbers to commissioners. The processes to identify patients and their NHS Numbers will not be followed by commissioners.

Identifying patients and their NHS Numbers
Determine why the patient hasn't got an NHS Number
Create a patient record and NHS Number (allocation) on PDS (if organisation has the capability)

1 Identifying patients and their NHS Numbers

If being referred from a GP or another NHS Organisation the patient should already have an NHS number. If the NHS number is not included in the referral, request it from the referrer.

The Personal Demographics Service (PDS) can be used to identify the NHS Number for patients and to check that NHS Numbers are correct for the patient (i.e. verified).

Before giving a reason why a patient has not got an NHS Number, organisations must search for the patient (i.e. trace) on PDS to identify the patient and their NHS Number. The tracing guidance contains tracing tips identified following analysis of duplicate records on the PDS.

2 Determine why the patient hasn't got an NHS Number

In some circumstances it is difficult to identify a patient's PDS record and NHS Number, the reasons fall into four categories:

NHS Numbers cannot be used
NHS Numbers have changed
Individuals never registered with the NHS
At the time of the episode accurate demographics are either not available, or are not recorded.

Patients with these characteristics must still be traced on PDS as many will have a record. If not found at the time of the episode a trace some time after the episode may find a match.

2.1 NHS Numbers cannot be used

There are very few circumstances when it is not appropriate to use a patient's NHS Number. If there is an existing policy which requires that patients be treated anonymously then the NHS Number must not be used.

SUS already recognises cases when it is not appropriate to identify the patient and the SUS handling of Sensitive Records document outlines when use of the NHS Number is not expected.

The NHS Number coverage figures - based on episodes submitted to HES and excluding those for sensitive records - also exclude episodes with treatment function code 360 which covers sexual health treatment.

Episodes submitted with NHS Number Status field set to 07 which do not meet the SUS Sensitive Records rules or have a treatment code of 360 are not excluded from NHS Number coverage figures as these have not been identified nationally as requiring patient anonymity. Providers and commissioners would have to agree further rules locally in line with requirements for Information Governance and Clinical Safety.

2.2 NHS Numbers have changed

There are a number of circumstances when the PDS National Back Office (NBO) may have to remove an NHS Number from use:

Adopted children (some cases)
Gender reassignment
Identity Changes
Resolution of a particularly complex data quality issue (duplicate or confused records)

Once NBO has amended the patient record on the PDS, the current patient demographics, including NHS Number, will be available on the PDS. If an organisation has the current patient demographics they will be able to find (i.e. trace) the patient on the PDS. If a previously verified NHS Number is no longer available on PDS and the patient is receiving treatment, check with the patient or GP that you have correct patient demographics.

Further details can be found on the NBO webpage.

2.3 Individuals never registered with NHS

There will be patients treated by the NHS who have never registered with the NHS. Some of the patients within these groups will have a record on the PDS with NHS Number which can be traced. Organisations must trace before stating that a patient does not have an NHS Number. The circumstances when a patient may never have registered with the NHS are:

Overseas visitors
Private patients
Individuals never registered with the NHS for other reasons
Residents in Scotland and Northern Ireland (NHS commissioners will not pay for these patients)

2.4 When it may be difficult to identify a patient and their NHS Number

It can be difficult to find NHS Numbers for patients in certain groups, notably:

Armed Forces personnel and Service Dependants (MOD)
Patient demographics provided do not match PDS
Long term mental health patients
Patients with no fixed abode
Prisoners
Patients incapable of identifying themselves e.g. Unconscious patients

However, the great majority of such patients will have a record on the PDS and can be traced by organisations so tracing should always be attempted.

3 Creating patient records and NHS Numbers on PDS (allocations)

To provide NHS Numbers to commissioners organisations, with the capability to allocate NHS Numbers, may wish to create a patient record and NHS Number on PDS. To avoid creating duplicate records for patients it is important that organisations have completed comprehensive tracing before creating a record.

Guidance for Trusts Allocating NHS Numbers (PDF, 385kB) has been produced for NHS Trusts allocating NHS Numbers to patients, to help avoid the duplication of patient records on the Personal Demographics Service. This guidance applies to any organisation either currently allocating NHS Numbers to patients or in the process of implementing this capability.

Support

If you require any further information please review the support page or contact nhsnumber@nhs.net.

Using NHS Numbers for commissioning and contracting — NHS Connecting for Health