Document purpose

This document provides further clarification and supporting information for the Commissioner Assignment Method (CAM) flow chart.

The objective of the Commissioner Assignment Method is to provide a clear interpretation of the NHS England and Department of Health and Social Care guidance documents regarding the application of commissioning rules for payment to national NHS data sets in England.

This document should be read alongside the Who Pays? guidance published by NHS England.

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 2024/25 financial year.

Changes from 23/24 Commissioner Assignment Method flow chart and guidance document

The following items describe the changes from the previous guidance and diagram:

1. updated dates throughout to refer to 2024/25

2. updated references to overseas

3. updated references for specialised services to reflect service

4. some minor typographical type

5. updated armed forces section to remove reference to community services.

Document audience

This document is designed to support those organisations (hereafter referred to as ‘data providers’) that derive and provide commissioner code data within commissioning datasets and other activity-based data sets. These organisations may be:

• healthcare providers, e.g. acute or mental health trusts and independent sector hospitals
• NHS England
• commissioning support organisations, e.g. commissioning support units (CSUs), data services for commissioners regional offices (DSCROs)
• local health boards
• integrated care boards (ICBs)
• integrated care services
• organisations listed within the NHS England lead provider framework for commissioning support services or commissioners running their own contract data processing facility, such as a stage 1 accredited safe haven.

Commissioner Assignment Method objective

This document is designed to support those organisations (hereafter referred to as ‘data providers’) that derive and provide commissioner code data within commissioning datasets and other activity-based data sets.

The objective of the Commissioner Assignment Method is to provide a clear interpretation of the NHS England and Department of Health and Social Care guidance documents regarding the application of commissioning rules for payment to national NHS data sets in England.

This guidance has been developed in conjunction with the NHS England ‘Who Pays?’ team and incorporates several clarifications and revisions as Commissioner Assignment Method is subject to periodic review. Who Pays? sets out a framework for the NHS in England for establishing which NHS organisation has responsibility for commissioning an individual’s care and which has responsibility for paying for that care.

The Commissioner Assignment Method flow chart is designed to assist providers to allocate the correct commissioner code within specified commissioning data set (CDS) records 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.

The commissioner code describes which commissioning organisation has payment responsibility, differentiating activity paid for by NHS England (including subdivisions thereof), ICB commissioners, other commissioners and local health boards as appropriate. It should be noted that there are circumstances in which responsibility for commissioning and responsibility for payment will differ, and where responsibility will not be determined on the basis of GP registration. These are explained in detail in Who Pays?

It embodies the explicit commissioning hierarchy for ICB and NHS England commissioned services, originally as described in the Letter to NHS England Area Teams – Secondary Dental Care (Gateway Reference No. 00781), dated 20 November 2013, and expands this to ensure assignment of commissioner is appropriately aligned to allocations and budgets.

This shows the order of precedence for the different NHS England commissioned services, where more than one can apply for a patient, e.g. member of the armed forces receiving specialised care. After this letter, NHS England commissioning and finance teams have clarified that Health and Justice commissioning should take precedence over Armed Forces commissioning in the commissioning hierarchy, and that public health commissioning for CDS data should be positioned between Armed Forces and Health and Justice.

From April 2023 secondary dental services are no longer commissioned by NHS England and instead are commissioned by sub-integrated care board locations (sub-ICB locations).

From April 2024 a process of service delegation has been established to pass the responsibility for commissioning some specialised services to ICBs. This only relates to specialised services, other directly commissioning services (health and justice, public health and armed forces) are not subject to delegation.

The Commissioner Assignment Method is intended to provide an interpretation of the most likely organisation that will be responsible for care, based on routinely collected data. It does not alone create eligibility or payment responsibility. Other rules may apply, such as local commissioning rules, and eligibility criteria, and use of local data may create situations where the Commissioner Assignment Method cannot derive a correct commissioner. This guidance tries to be comprehensive, but it cannot cover all scenarios. In these cases, where further guidance is required, NHS England commissioning hubs can provide additional advice.

This guidance does not provide for every eventuality or case study covered in Who Pays? In the event of any inconsistency between this guidance and Who Pays?, the provisions of Who Pays? should be followed. In situations where disputes between NHS commissioners within England arise which cannot be resolved locally, a formal dispute resolution process, managed by NHS England’s national team, will apply to determine which commissioner should pay. This process is set out in full in Appendix 1 of Who Pays?

A sub-Integrated Care Board (sub-ICB) location is a sub-division of an Integrated Care Board’s total geographic area, used for data disaggregation purposes. It is expected that providers will continue to use sub-ICB codes through 2024/25, when recording a commissioner code in the Commissioning Data Sets.

CDS scope

The following Commissioning Data Set v6.3 types are within the scope of the Commissioner Assignment Method flow chart:

• CDS 011 Emergency Care Data Set
• CDS 020 Outpatient Appointments
• CDS 120 Admitted Patient Care Finished Birth Episodes
• CDS 130 Admitted Patient Care Finished General Episodes
• CDS 140 Admitted Patient Care Finished Delivery Episodes
• CDS 150 Admitted Patient Care Other Birth Events
• CDS 160 Admitted Patient Care Other Delivery Events
• CDS 180 Admitted Patient Care Unfinished Birth Episodes
• CDS 190 Admitted Patient Care Unfinished General Episodes
• CDS 200 Admitted Patient Care Unfinished Delivery Episodes

When to assign commissioner code

The Commissioner Assignment Method should be applied at the following dates for the described CDS types:

1. The Commissioner Assignment Method should be applied to completed Admitted Patient Care spells in line with the NHS Payment Scheme/National Tariff/PbR timetable (i.e. during the period between actual discharge date and the published reconciliation and post reconciliation dates).
2. The registered GP practice and postcode of usual address data that were valid at a spell’s admission date should be used when applying the Commissioner Assignment Method to Admitted Patient Care spell data (for either finished or unfinished spells).
3. If registered GP practice and/or postcode of usual address data changed between admission date and discharge date in completed Admitted Patient Care spells, and if this causes a different commissioner to be derived, then the sub-ICB location responsible for payment is to be determined on the basis of GP registration (or, failing that, usual address), applied at the point of admission for that inpatient hospital spell. The sub-ICB location identified on this basis is responsible for payment for the whole of that hospital spell, even if the patient’s GP or address changes during the spell.

Determining and recording usual place of residence

This document assumes the same rules for deciding usual place of residence of a patient, as described in Appendix 2 in ‘Who Pays?’. The guidance 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/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) or ZZ99 3GZ – ‘Wales’; ZZ99 1WZ – ‘Scotland’; ZZ99 2WZ ‘Northern Ireland’, 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. The default country of residence for these postcodes should be ‘England’ (on the rationale that only English providers submit CDS records to SUS).

Country code, where required in this document from the ONS NHS Postcode Directory, should be identified by using the ‘gridall.csv’ file4 from the NHS England ODS service.

Providers should not 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 segment this population group when undertaking analysis of health inequalities.

Providers should 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 postcode list is maintained by the Office of National Statistics (ONS) as part of the ONS NHS Postcode Directory and can be found at the NHS England Organisation Data Services 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 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 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 British Forces Post Office (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.

Commissioner Assignment Method 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 which identifies the commissioning organisation or organisation type with payment responsibility for the activity 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) field in the CDS. The correct codes to denote commissioning responsibilities for the 2024/25 financial year are described in the NHS England Direct Commissioning Framework Responsibilities Matrix 2024/25 (Appendix A). These organisations are also described in more detail in section 10 below. This matrix/appendix also includes additional information regarding the potential uses of organisation code 13Q in relation to the production of contract monitoring data sets, when recorded alongside the specific Commissioned Service Category Codes (see Appendix J).

The Commissioner Assignment Method flow chart 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 several reference files and look-up tables. These are either references to national files or a provided look-up file. 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 or Blank 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 Null or Blank records, would be answered ‘No.’ This approach should ensure that a commissioner code can be assigned to all CDS records.

Flow chart key

Assigned commissioners and commissioner code logic

The below describes the main commissioner types (known as the ‘Assigned Commissioner’), which are derived from following the Commissioner Assignment Method flow chart, and provides guidance for providers to determine which specific commissioner code to apply in CDS records. For example, the Commissioner Assignment Method may suggest a ‘Host sub-ICB location’ is the responsible commissioner type and this table will then help identify which specific sub-ICB location organisation code is appropriate.

Host sub-ICB location

The host sub-ICB location of a healthcare provider is the sub-ICB location within which the address of the provider’s main site is located.

‘Host sub-ICB location’ is derived as follows:

1. Establish main site of the healthcare provider from the CDS field: ORGANISATION CODE (CODE OF PROVIDER).

2. Derive postcode of the address of the provider’s main site by looking up the provider code in the ODS reference file ‘etr.csv’ and extracting the provider’s postcode.

3. Look up the extracted provider postcode in the ONS NHS Postcode Directory and derive the responsible sub-ICB location from the Postcode Directory for the matching record.

4. Local interpretation of these rules may be required for cases where the host sub-ICB location is not identified via this logic – this may occur in cases where providers have merged, resulting in a change to the main site of the trust HQ of a provider. In this case, local logic may be applied in the short term so that the host sub-ICB location is derived appropriately to meet local financial allocations*.

*Commissioners and providers should be encouraged to use the definition for host sub-ICB location suggested by this document. Where this would result in a shift of activity between sub-ICB locations, 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 sub-ICB location immediately.

Responsible sub-ICB location

The responsible sub-ICB location is based on the sub-ICB location which a patient’s registered GP belongs to. For patients who are not registered with any GP, the responsible sub-ICB location is the sub-ICB location within which the patient is usually resident.

Responsible sub-ICB location is typically derived as follows:

If the value of the CDS field GENERAL MEDICAL PRACTICE CODE (PATIENT REGISTRATION) is either Null or Blank, or V81999 (registered GP Practice Code not known) or V81998 (registered GP Practice code not applicable) or V81997 (No registered GP Practice), or if the patient (adult or child) is part of the health and justice population (POSTCODE OF USUAL

ADDRESS is populated with a postcode value contained within the list of organisations detailed in Appendix F), or if the patient is registered with an English Defence Medical Services (DMS) GP Practice then utilise a postcode-methodology; take the value from the CDS field POSTCODE OF USUAL ADDRESS** and look up this postcode value in the ONS NHS Postcode Directory and derive the responsible sub-ICB location commissioner from the value in the Directory’s sub-ICB location field for the matching record;

ELSE look up the value of GENERAL MEDICAL PRACTICE CODE (PATIENT REGISTRATION) in the ODS ‘epraccur’ file where the record has a ‘National Grouping’ value NOT equal to ‘W00’ AND if the record has a Status Code in the national GP file ‘epraccur’ of either A (active) or P (proposed) on the assignment date (as defined in section 5) and derive the responsible sub-ICB location commissioner from ‘epraccur’ (‘Code for the Commissioning Organisation’).

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), ‘England UK – not specified’ (Z99 3CZ), or ZZ99 3GZ – ‘Wales’; ZZ99 1WZ – ‘Scotland’; ZZ99 2WZ ‘Northern Ireland’, or is missing, 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. For the purposes of clarity, the pseudo postcode stored in the CDS record should not be replaced.

It is important to note that for looked after children, aged under 18, who are placed outside of their original sub-ICB location (Who Pays? Paragraph 15), the commissioning and payment responsibility will remain with the original sub-ICB location, and be different to which is defined by this process. This cannot be identified from CDS records, but relies on local validation and data. This is described in more detail in the Who Pays? guidance.

** The Spine is assumed to be the definitive record of a patient’s demographic and GP registration details. There are occasions where there might be a discrepancy between the patient postcode supplied by the National Spine Patient Demographic Service (PDS) and the patient postcode provided by the patient and recorded in the Provider CDS submission at the time of care. This may be since PDS can take some time to be updated after a change of address or GP details. If there is evidence that the demographic data on PDS was incorrect when the patient presents for care at a provider, then there may be a valid case to use patient-supplied data and submit this in the CDS submission.

Private Patient/Chargeable Overseas Visitor (COV)

If a patient is a private patient, or a Chargeable Overseas Visitor (COV), the default ODS code of VPP00 should be used as the commissioner code for these patients.

NHS England Armed Forces Commissioning Hub

Who Pays? guidance states that NHS England is responsible for commissioning secondary health services for members of the armed forces who are registered with an English Defence Medical Services (DMS) GP Practice and for the members’ families where they are registered with an English DMS practice.

Providers should use the ‘Parent Organisation Code’ for the English DMS 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. The use of this value together with the location of the DMS Practice (i.e. England, Scotland, Wales, Northern Ireland or Overseas) will unambiguously identify the correct commissioning organisation for the eligible armed forces population in commissioning data sets.

If the member of the armed forces, or their families, are not registered with an English DMS practice then their commissioner will be a non-armed forces commissioner.

NHS England Specialised Commissioning Hub

From 2024/25 some specialised services are being delegated from NHS England to ICBs. The different services and their ‘status’ are available from the ‘Delegated NHS England Functions – Supporting Resources’ Future NHS page.

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 described by the CDS record.

NHS England regional geographies with commissioning responsibility for specialised services (‘Specialised Commissioning Hubs’) agree contracts for specialised services with specified UK NHS and independent providers. The Specialised Commissioning Hubs are described in the NHS England Direct Commissioning Framework Responsibilities Matrix 2024/25 (Appendix A).

Providers MUST NOT use the redundant organisation code ‘YDD82’ as a commissioner code within the CDS.

The relevant responsible NHS England Regional Geography is derived in two different ways. Services that are not delegated (e.g. nationally retained “red services”) use the provider method (as in previous years) and others use the GP practice of the patient.

Provider method:

Take the value from the CDS field ORGANISATION CODE (CODE OF PROVIDER), 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 Provider to Commissioning Hub Mapping, which is available from ODS, and then use this to derive the corresponding NHS England Specialised Commissioning Hub code.GP practice method:

Look up the value of GENERAL MEDICAL PRACTICE CODE (PATIENT REGISTRATION) in the ODS ‘epraccur’ file where the record has a ‘National Grouping’ value NOT equal to ‘W00’ AND if the record has a Status Code in the national GP file ‘epraccur’ of either A (active) or P (proposed) on the assignment date (as defined in section 5) and get the National Grouping (NHS England Region), then lookup this value in Appendix A to derive the corresponding NHS England Specialised Commissioning Hub code.

If there is no match to a record in ‘epraccur’, then revert to the provider method.

Where a specific element of specialised service has been agreed to be funded nationally, and therefore given a commissioner code of 13Q, the associated commissioned service category code must be that for a specialised service. A list of the commissioned service category codes can be found at Appendix J.

NHS Scotland National Services Division

The Scottish devolved administration is responsible for paying for all specialised care at English providers for Scottish residents, not covered by pre-existing legacy agreements with NHS England.

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.

Providers should use the ODS code ‘SD002’ for the NHS Scotland Health National Services Division, as defined in the ODS ‘scotorg’ 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. 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 within Scottish Defence Medical Services Practices. There is no mapping between Scottish DMS practices and Scottish Health Boards, so 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 range SA9 to SZ9, as defined in the ODS ‘scotorg’ 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 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, therefore the responsible LCG is derived from the patient’s postcode of place of usual residence.

Welsh Local Health Board

The Welsh devolved administration is responsible for paying for care, which is not covered by existing legacy agreements with NHS England for its residents receiving highly-specialised care at English providers. It is also responsible for paying for care provided to patients registered within Welsh Defence Medical Services Practices. It holds payment responsibility for patients residing on both sides of the English/Welsh Border as defined within the Protocol for Cross-Border Healthcare Services. It also holds payment responsibility for services from English providers provided to patients residing in the rest of Wales.

NHS Wales discharges its specialised services commissioning responsibility through the Welsh Health Specialised Services Committee (Wales). Other commissioning responsibilities are covered by the various Welsh Local Health Boards (LHB) 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 because of the LHB area where the person is usually resident16. Therefore, the responsible LHB is derived from the patient’s postcode of place of usual residence.

However, because of the Welsh Cross-Border protocol, it is possible for an LHB to be the responsible commissioner for patients who are resident in England, specifically for those patients who are resident on the English side of the border who are registered with a Welsh border GP practice.

There is no mapping between Welsh DMS practices and Welsh Local Health Boards, so the 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.

For patients that are resident in Wales: 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 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.

For patients resident on the English side of the Wales-England border and who are registered with a Welsh GP: take the value from CDS field GENERAL MEDICAL PRACTICE CODE (PATIENT REGISTRATION) and look this up in the ODS ‘epraccur’ file and extract the postcode of the relevant GP Practice. Look this derived postcode up in the ONS NHS Postcode Directory where the relevant Welsh Local Health Board organisation code is listed for the matching record.

Welsh Health Specialised Service Committee

NHS Wales discharges its specialised services commissioning responsibility through the Welsh Health Specialised Services Committee (Wales).

The Welsh Health Specialised Service Committee (WHSCC) are hosted by the CWM TAF UNIVERSITY Local Health Board, with a site code 7A5HC. This code should be used as the commissioner code for CDS records where Wales is responsible for paying for specialised care activity.

The Referral Assessment Service (RAS) system has been introduced for when referring English resident cross border patients (who are registered with Welsh border GP practices who have opted into the service) for consultant led secondary care (community services, mental health and urgent suspected cancer referrals are not included). This is summarised below:

Patient’s residency: England
GP registration: Wales
Patient referred by: GP via RAS
Legally responsible body: NHSE
Body which will pay for patient’s care: LHB via WHSSC
English provider: NHS England Constitution
Welsh provider: NHS Wales standards

Patient’s residency: England
GP registration: Wales
Patient referred by: GP referral other than via RAS (Note: Only a specified list of GPs use RAS)
Legally responsible body: NHSE
Body which will pay for patient’s care: NHSE
English provider: NHS England constitution
Welsh provider: NHS Wales standards

Responsible Local Authority

Local Authorities have a duty to improve the health of the people in their areas, funded by a ring-fenced grant. Local Authorities fulfil this duty by commissioning a range of services from providers (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 data set will need to be the relevant Local Authority organisation.

The default assumption used in this guidance is that each local authority will be responsible for commissioning relevant services for their resident population, specifically those people whose ordinary 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 for the matching record.

Responsible NHS England Regional Geography for Public Health Services

All NHS England Regional Geographies have commissioning and payment responsibility for certain public health services (see Appendix A), therefore the correct Regional Geography code should be used to populate the commissioner code within the CDS for activity records pertaining to these services.

Each NHS England Regional Geography commissioning team commissions public health services for their responsible population which is defined as anyone registered with a GP practice located within the regional geography’s boundary or anyone, not registered with any GP, who lives within the regional geography’s boundary.

Take the value from the 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 Region from the value in the Directory’s ’NHSE Regional’ field for the matching record;

ELSE if this value relates to a non-BFPO DMS practice (i.e. those practices, active or proposed (‘epraccur’ status code equal to ‘A’ or ‘P’) on the assignment date (as defined in section 5), where the value in the ODS ‘epraccur’ file of the practice’s ‘Commissioning Organisation’ code = ‘13Q’ AND the postcode of the practice address does not correspond to the form ‘BFn nAA’), then take the postcode of the organisation from ‘epraccur’, look this postcode value up in the ONS NHS Postcode Directory and derive the responsible NHS England commissioner from the value in the Directory’s region field for the matching record. It should not be necessary to accommodate CDS records relating to BFPO practice registrants when assessing commissioning responsibility for public health section 7a activity as these records will be deemed to be relating to patients who are charge-exempt overseas visitors and will have been filtered out at a preceding part of the flow chart.

ELSE look up the value in the ODS ‘epraccur’ file and derive the code for the responsible Regional Geography from ‘epraccur’.

If there is no match to a record in ‘epraccur’ then revert to the postcode methodology: 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 NHS commissioner from the value in the Directory’s region field for the matching record.

Secondary Care Dental (SCD) Services

NHS England previously had commissioning and payment responsibilities for secondary dental care, this has now been transferred to sub-Integrated Care Board locations. This will be based on responsible sub-ICB location, as described above.

Commissioning hub for Health and Justice Commissioning

NHS England Regional Geographies are responsible for health and justice commissioning (see Appendix A). The NHS England Regional Geography teams commission secondary care based on which prison, Immigration Removal Centre (IRC), children and young people secure estate setting (Young Offender Institution holding under 18s, Secure Children’s Home, Secure Training Centre).

The responsible Health and Justice Commissioning Hub code to site relationship is given in Appendix F, which shows which of the Health and Justice commissioning hubs are responsible for which prison/children and young people secure estate setting/detention centre.

To find the commissioning hub code: take the postcode value from the CDS field: POSTCODE OF USUAL ADDRESS and look this up in Appendix F.

The responsible commissioner can be obtained for the matching record.

The ODS has implemented new Health and Justice Commissioning Hub codes for this activity to facilitate easier identification of health and justice activity within CDS records. It is anticipated that the further ODS reference data release changes will permit derivation of commissioning hub without the need for Appendix F in future versions of the Commissioner Assignment Method.

See Overseas Visitor Guidance

Detailed interpretation of the overseas visitors’ guidance is beyond the scope of the Commissioner Assignment Method documentation. Specific guidance to determine whether a patient is an overseas visitor and whether an overseas visitor is exempt from charges, in whole or part, (referred to as Charge Exempt Overseas Visitors (CEOV)) is detailed within the various Department of Health and Social Care (DHSC) documents on overseas visitor charging and the additional NHS England guidance for recovering costs for overseas visitors. As detailed in the NHS England Who Pays? guidance, the commissioner for CEOV is:

• the sub-ICB location, for a CEOV who is currently registered with a GP in England – or who is not currently registered with a GP in England, but who gives a UK address and can be considered part of the UK resident population

• the ICB in which the organisation providing the relevant health services is physically located, for a CEOV who is not registered with a GP in England and who is resident outside the UK.

However, it is noted from the DHSC guidance that there are many types of International Healthcare Agreements, and there may be occasions where local agreements exist with providers and non-UK commissioners that may need a different commissioner code to be applied. Local understanding is required to interpret the rules and regulations for these cases.

Flow chart annotations

The table below annotates the steps of the Commissioner Assignment Method process, giving guidance to assign the commissioner for CDS records.

Appendix A – NHS England direct commissioning framework responsibilities matrix 2024/25

Please see separate Commissioner assignment method supporting tables spreadsheet 2024/25, for full list.

Updated to include a table to show that sometimes it is valid for the code of 13Q to be used for services other than Armed Forces. This code may also be used in instances where a service is funded on a national basis. The matrix shows the instances of where the use of this code is valid in the production of contract monitoring data sets when recorded alongside specific Commissioned Service Category Codes (see Appendix J).

Appendix B – Specialised and highly-specialised service line codes

This appendix is no longer published as a part of the Commissioner Assignment Method, instead this is available within any one of the four information standards for contract monitoring for all directly commissioned services.

Appendix C – Specialised services cross border flows within the UK

Please see separate Commissioner assignment method supporting tables spreadsheet 2024/25, for full list.

Appendix D – Mapping Table to Identify Secondary Dental Activity

Please see separate Commissioner assignment method supporting tables spreadsheet 2024/25, for full list.

Appendix E – Identification of correct commissioning organisation for infertility care

NHS England is the commissioner of infertility treatment for Defence Medical Service patients and their partners, as described in the NHS England Clinical Commissioning Policy: Assisted Conception to ensure that Armed Forces members receive treatment in line with NICE guidance, regardless of where they live. In addition, 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).

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 sub-ICB location will be responsible. For this reason, it is not possible to provide a definitive and consistent means of identifying commissioner for this activity.

Where a patient is not ordinarily resident in the UK, assisted conception services must be paid for by the patient (in advance of receiving treatment) unless the patient meets an exemption from NHS charges (it is the duty of the relevant provider, and not the commissioner, to determine whether a patient is an overseas visitor to whom NHS charges for assisted conception apply). This applies most commonly where the patient is in the UK on a visa that is subject to the Immigration Health Surcharge (IHS) as identified by the CDS field OVERSEAS VISITOR CHARGING CATEGORY where the value is B. Where one person in a couple is not ordinarily resident in the UK and their partner is ordinarily resident, the partner who is ordinarily resident is entitled to receive assisted conception services without charge and cannot be denied access.

Appendix F – Mapping table of detention centre addresses and regional geography commissioners responsible for paying for treatment for referrals from that detention centre

Please see separate Commissioner assignment method supporting tables spreadsheet 2024/25, for full list.

Appendix G – Glossary

• A&E: Accident and Emergency
• Accident and Emergency attendance: An Accident and Emergency Attendance is an individual visit by one patient to an Accident and Emergency Department to receive treatment from the accident and emergency service
• BFPO: British Forces Post Office
• CCG: Clinical Commissioning Groups (CCGs) were created following the Health and Social Care Act in 2012, and replaced Primary Care Trusts on 1 April 2013. They are clinically-led statutory NHS bodies responsible for the planning and commissioning of health care services for their local area. From 1 July 2022, CCGs will be replaced as commissioner organisations by Integrated Care Boards (see ICBs). CCG boundaries have been (broadly) maintained and referred to as ‘sub ICB locations’
• CDS: Commissioning Data Sets form the basis of data on activity carried out by Organisations reported centrally for monitoring and payment purposes. They support the current Healthcare Resource Group (HRG) version for calculation of payment to trusts and monitoring of other initiatives
• CEOV: charge exempt overseas visitor is when a charge cannot be made or recovered from an overseas visitor
• COV: when a patient is a chargeable overseas visitor
• DHSC (formerly DH): Department of Health and Social Care (DHSC) is a ministerial department, supported by 15 arm’s length bodies and a number of other agencies and public bodies. The department employs 2,160 staff, who work in locations across the country
• DMICP: Defence Medical Information Capability Programme
• DMS: the primary role of the Defence Medical Service (DMS) is to promote, protect and restore the health of service personnel to ensure that they are ready and medically fit to go where they are required in the UK and throughout the world; generally referred to as being ‘fit for task’
• DSCRO: The law says commissioners are not allowed to access Personal Confidential Data (PCD) because they are not providing direct patient care. they need an intermediary service called Data Services for Commissioners Regional Office (DSRCO), that specialise in processing, analysing and packaging patient information within a secure environment into a format various commissioner can legally use; anonymised patient level data
• EEA Resident: A resident of the European Economic Area, a free-trade zone created in 1994, composed of the states of the European Union together with Iceland, Norway, and Liechtenstein
• ECDS: Emergency Care Data Set (a replacement for the A&E dataset)
• EHIC: European Health Insurance Card
• GDC: General Dental Council
• GP: General Practitioner
• HRG: Healthcare Resource Group
• ICD-10: International Classification of Diseases (10th edition)
• ICB: Each integrated care system (ICS) will have an integrated care board (ICB), a statutory organisation bringing the NHS together locally to improve population health and establish shared strategic priorities within the NHS. ICBs have replaced clinical commissioning groups (CCGs)
• ICS: Integrated Care Systems (ICSs) are partnerships of organisations that come together to plan and deliver joined up health and care services, and to improve the lives of people who live and work in their area
• IR: Identification Rules for Prescribed Specialised Services
• IRC: Immigration Removal Centre
• LHB: Established and hosted by local authorities, health and wellbeing boards bring together the NHS, public health, adult social care and children’s services, including elected representatives and Local Healthwatch, to plan how best to meet the needs of their local population and tackle local inequalities in health
• Local Health Board (Wales): A Local Health Board (Wales) (formerly known as Welsh Local Health Board) is an Organisation. Local Health Boards (Wales) are bodies corporate established by the Welsh Ministers under s.11 of the National Health Service (Wales) Act 2006
• MHL&D: Mental Health Liaison and Diversion
• NECS: The North East Commissioning Support Unit works across the UK to support health and social care customers in meeting strategic and operational challenges, to improve outcomes and increase efficiency
• NHAIS: National Health Applications & Infrastructure Services
• NHS Digital: NHS Digital, and their responsibilities, have merged with NHS England. NHS Digital were able to disseminate data to commissioners under the Health and Social Care Act (2012). The act provided the powers for NHS Digital to collect, analyse and disseminate national data and statistical information. To access this data organisations must submit an application and demonstrate that they meet the appropriate governance and security requirements
• NHS England: NHS England leads the National Health Service (NHS) in England
• NIHSCB: The National Health Service Commissioning Board is a statutory organisation. They arrange or ‘commission’ health and social care services for the population of Northern Ireland
• ODS: The Organisation Data Service (ODS) is responsible for publishing organisation and practitioner codes, along with related national policies and standards
• ONS: The UK’s largest independent producer of official statistics and its recognised national statistical institute. The ONS responsible for collecting and publishing statistics related to the economy, population and society at national, regional and local levels. They also conduct the census in England and Wales every 10 years
• OPCS4: Office of Population Census and Surveys, Classification of Interventions and Procedures (version four)
• Outpatient attendance: An attendance to enable a patient to see a consultant (or a GP acting as a consultant employed by the trust as a hospital practitioner) or clinical assistant, in respect of one referral
• PAS: Patient Administration System
• PbR: Payment by Results (PbR) was a system of paying NHS healthcare providers a standard national price or tariff for each patient seen or treated. This was replaced by the National Tariff Payment System, and latterly with the NHS Payment Scheme
• PDS: Personal Demographic Service
• RAS: The NHS e-Referral Service (e-RS) programme has introduced Referral Assessment Services (RAS), which now allow providers to:
  • assess the Clinical Referral Information from the GP/referrer
  • decide on the most appropriate onward clinical pathway
  • contact the patient to discuss choice (if an elective referral)
  • arrange an appointment, where needed
  • return the triage request to the original referrer with advice, if an onward referral isn’t needed
• SARC: Sexual Assault Referral Centre
• SHB: Scottish Health Board is a regional authority in Scotland with responsibility for the delivery of health services
• Specialised commissioning team: There are over 130 specialised services that are commissioned by 10 specialised commissioning teams that are part of NHS England. The specialised commissioning teams (or hubs) are grouped by the NHS England regions – North, Midlands and East, London and South. The South region is split into South West, South East and Wessex
• SUS+: Secondary Uses Service
• WHSSC: The Welsh Health Specialised Services Committee (WHSSC) is responsible for the joint planning of Specialised and Tertiary Services on behalf of Local Health Boards in Wales
• YOI: Youth Offender Institution

Appendix H – Pseudo postcodes for EU member states and other states with similar arrangements (starred)

The following pseudo postcodes are for EU member states and other states with similar arrangements.

• Austria: ZZ99 4MZ
• Belgium: ZZ99 2DZ
• Bulgaria: ZZ99 4UZ
• Croatia: ZZ99 5VZ
• Cyprus (Southern): ZZ99 6AZ
• Czech Republic: ZZ99 5XZ
• Denmark: ZZ99 4FZ
• Estonia: ZZ99 7LZ
• Finland: ZZ99 4BZ
• France: ZZ99 4GZ
• Germany: ZZ99 4QZ
• Greece: ZZ99 4RZ
• Hungary: ZZ99 4XZ
• Italy: ZZ99 4LZ
• Latvia: ZZ99 7RZ
• Lithuania: ZZ99 7SZ
• Luxembourg: ZZ99 2EZ
• Malta: ZZ99 5BZ
• Netherlands: ZZ99 4EZ
• Norway*: ZZ99 2AZ
• Poland: ZZ99 4YZ
• Portugal: ZZ99 4JZ
• Republic of Ireland: ZZ99 3AZ
• Romania: ZZ99 4ZZ
• Slovakia: ZZ99 5YZ
• Slovenia: ZZ99 5UZ
• Spain: ZZ99 4HZ
• Sweden: ZZ99 2CZ
• Switzerland*: ZZ99 4PZ

Notes on EU arrangements

• France includes the departments of Guadeloupe, Martinique, Guyane (French Guiana) and Réunion.
• Spain includes the Balearic Islands, the Canary Islands, Ceuta and Melilla
• Portugal includes the Azores and Madeira.
• The territory of Denmark excludes the Faroe Islands and Greenland, although Faroese residents are covered by a separate healthcare arrangement
• Andorra, Monaco, San Marino and Vatican City are not part of the EU or EEA.

Non-EEA reciprocal arrangement countries as listed in DHSC/NHS guidance and pseudo postcodes from ONS.

• Anguilla: ZZ99 6RZ
• Ascension: ZZ99 6UZ
• Australia: ZZ99 6GZ
• Bermuda: ZZ99 6RZ
• Bosnia and Herzegovina: ZZ99 5NZ
• British Virgin Islands: ZZ99 6RZ
• Cayman Islands: ZZ99 6RZ
• Falkland Islands: ZZ99 6UZ
• Faroe Islands: ZZ99 4WZ
• Gibraltar: ZZ99 5AZ
• Guernsey: ZZ99 3EZ
• Isle of Man: ZZ99 3BZ
• Israel: ZZ99 9AZ
• Jersey: ZZ99 3FZ
• Kosovo: ZZ99 9SZ
• Montenegro: ZZ99 9SZ
• Montserrat: ZZ99 6RZ
• New Zealand: ZZ99 6HZ
• North Macedonia: ZZ99 5QZ
• Pitcairn Islands (including Henderson, Ducie and Oeno Islands: ZZ99 6JZ
• Serbia: ZZ99 9SZ
• St Helena: ZZ99 6UZ
• Tristan da Cunha: ZZ99 6UZ
• Turks and Caicos Islands: ZZ99 6RZ

Further codes are available in the Country names and pseudo country postcodes file, available from the ODS ONS file section.

Appendix I – Commissioner Assignment Method Flow Chart

Commissioner assignment method 2024/25.

Appendix J – Commissioned Service Category Codes

Please see separate Commissioner assignment method supporting tables spreadsheet 2024/25, for the list of commissioned service category codes.