1. First or Follow-up?
Please can you provide clarification on first and follow-up attendances with a nurse?
From an NHS Data Model and Dictionary perspective, a First Attendance has always been the first time a Patient has been seen by a Care Professional for a series of appointments. This principle originates from the definitions of a Consultant Out-Patient Episode, where the First Attendance is the first time the Patient has been seen by the Consultant in a series of attendances. Should the Consultant refer the Patient to another Consultant this will generate a new Consultant Out-Patient Episode for the new Consultant and therefore a new First Attendance recorded for the first time where the Patient is seen by the new Consultant.
While this definition applies to Consultant activity only, we would expect this understanding also applies to Nurse, Midwife, and Allied Health Professional activity.
However, should you require a definition of a First Attendance with respect to Payment by Results please refer to our Frequently Asked Questions page for Payment by Results.
2. Main Specialty
We undertake a lot of nurse led clinics within our services- and currently have the nurses set up under the Main Specialty of the service they work in. I believe the Main Specialty should be changed to 950 Nursing Episode, can you confirm?
You are correct the Main Specialty is recorded using the default value '950 NURSING EPISODE'.
The Consultant Code should be recorded using the default code 'N9999998 - Nurse'.
3. Clinical Nurse specialist activity
The definition for Out Patient Attendance Consultant also includes a Patient being seen by a Consultant from a different Main Speciality during a Consultant Episode (Hospital Provider) in circumstances where there is no transfer of responsibility for the care of the Patient".
If a "Clinical Nurse Specialist" from a different Main Specialty sees the Patient during a Consultant Episode (Hospital Provider) in circumstances where there is no transfer of responsibility, how would we class/record it?
The same rules apply to Out-Patient Attendances for non-Consultant Activity. This assumes that the treatment that the nurse is providing is not already included in the standard care provided to the Patient as part of their Hospital Provider Spell, however. For example, a physiotherapist might see an orthopaedic Patient as part of their recovery from a hip replacement, however, this activity would not be chargeable (or recorded) separately under Physiotherapy treatment function, as it would be part of the usual package of orthopaedic care.
A clinical nurse specialist attendance would be recorded with a MAIN SPECIALTY of '950 NURSING EPISODE', and the appropriate TREATMENT FUNCTION relating to the care they provide.
The Consultant Code should be recorded using the default code 'N9999998 – Nurse'.
4. Group Nursing and Midwifery Sessions
Can you advise whether there is any national standard care type/contact for collecting attendances at group nursing/midwifery sessions?
I do not believe that it is appropriate to record multiple Patient attendances at group sessions as 'Out Patient Attendances' - please confirm on this.
The sort of session we are thinking about are:
Active Birth Workshops
Group specialist nursing/advice sessions for post heart attack Patients etc.
You are correct the activity is not recorded as Out-Patient Attendances.
This activity is recorded as a Professional Staff Group Contact, where 'one or more members of the professional staff group discipline may be in contact with one or more PATIENTS at the same time'. The NHS Data Model and Dictionary definition also gives guidance on how to record contacts for such a scenario:
'a. If one or more staff of the same discipline are in contact with one Patient at the same time, this should be recorded as one face to face contact
b. If staff see a Patient with staff of other disciplines, this should be recorded as one face to face contact for each discipline involved
c. If one or more staff of one discipline are in contact with a group of Patients at the same time, each Patient should be recorded as one face to face contact
d. If staff from different disciplines are in contact with a group of Patients at the same time, each Patient should be recorded as one face to face contact for each discipline involved'
5. Recording Nurse Consultant activity for admissions
We have been asked to add a Nurse Consultant to our PAS in order for her to admit Patients alongside her Medical Consultant colleague. What impact does this have on the APC-CDS?
Where a Nurse is responsible for a Patient during their admitted Patient care, this is recorded with the Main Specialty as '950 Nursing Episode'. This will correctly recognise a Nurse is responsible for the Patient during a Hospital Provider Spell, for the Admitted Patient Care Commissioning Data Sets.
6. Nurse acting on behalf of a Consultant
In the circumstance that:
- a nurse sees a patient as part of a consultant-led service
- the nurse is acting on behalf of the consultant (i.e. not in their own right); and
- the consultant retains clinical responsibility for the patient
I would suggest that the lead clinician for the nurse appointment should be the Consultant, and the Main Specialty reflect that of the Consultant. Please can you confirm?
I can confirm that you are correct in saying that if a Nurse sees a Patient as part of a Consultant-led service or a Nurse is acting on behalf of a Consultant (i.e. not in their own right); and the Consultant retains clinical responsibility for the Patient, then the Consultant and Main Specialty codes in the Commissioning Data Sets should be the codes of the Consultant responsible for the Patient.