1. NHS England High Cost Drug Minimum Dataset (MDS)
Digital Medicines and Hospital Pharmacy Transformation Plans Events
October/ November 2016
Malcolm Qualie/Suzy Heafield

2. High Cost Drug Data Improvement Why is this a priority?
“NHS England does not have the information it needs to drive service improvements in specialised services.”
“For services, including high-cost drugs and devices, there are no consistent national data available.”
“NHS England does not have the information—on costs, access and outcomes —necessary to assess how to improve services.”
“The lack of consistent data means NHS England does not know whether it is meeting its objectives in improving patient outcomes and reducing inequalities across geographic areas”.

3. Carter Review – HPTP Plans
Recommendation 3d)
“Each Trust’s Finance Director, working with their Chief Pharmacist, ensuring that coding of medicines, particularly high cost drugs, is accurately recorded within NHS Reference Costs.”
From a Trust perspective one of the highest priorities is to implement the recommendations made by the Carter Review with NHS Improvement having a mandate to ensure the review is fully implemented across all Trusts
The recommendations include:
working closely with neighbouring Trusts to improve efficiency and reduce costs
Pharmacy and medicines optimisation has been identified as the area with the 2nd highest potential for efficiency savings with an estimated minimum opportunity of £0.8b over 3 years. To reflect this each Trust must develop a hospital pharmacy transformation programme (HPTP) plan which need to be in place by April 2017

4. NHS England Specialised Services Commissioning Intentions 2017-2019
“Provision of nationally defined datasets is a condition of reimbursement and accurate, patient-level itemised high cost drug expenditure is an immediate priority”
“Trusts will be required to provide dm+d drug codes as part of the MDS which aligns with the requirement for Trusts and system suppliers to implement the dm+d information standard by June 2017”
“Dashboards will be developed to monitor MDS data quality from each provider and these will be published on the NHS Improvement Model Hospital portal”

5. Current MDS
Highlighted are all Key fields to conduct basic drug validation

6. MDS Compliance at Month 5
Provider Outcome is based on the 10 critical fields
Provider Outcome
Definition of Outcome
Number of Trusts
Pass
9 or more fields ≥ 90% accuracy 54
Borderline
8 fields >90% accuracy with 1 field achieving between 80% and 89% 23
Fail
Criteria for Pass or Borderline has not been achieved. 71

7. How Is Poor Compliance Being Addressed?

8. Contractual Mechanisms
If Trust has signed up to full completion of MDS and is not providing full dataset then Information Breach Notice will be issued – may lead to financial penalties
If Trust has signed up to Data Quality Improvement Plan (DQIP) the Trust will be monitored against that plan
2017/19 Contract:
Trusts will receive CQUIN monies to adopt dm+d code within agreed timescales

9. Other Work Ongoing work with Pharmacy System Suppliers
Enable use of dm+d codes
Development of standardised reports to feed MDS
Work with NHSi
Development of drugs MDS dashboards to be published on Model Hospital website
Identification of outliers
Ensure NHSE drugs MDS is aligned with other drug data requirements (intraoperability)
Work with NHS Digital
Understand where dm+d codes do not exist and develop solutions
Development of Information Standard for NHSE drugs MDS which can also be applied to other commissioners

10. Next Steps
Include dm+d requirement and NHS England drugs MDS in HPTP plans
Work with contract, finance and informatics teams to understand implications of MO CQUIN, i.e. current position and requirements to meet triggers
Review Model Hospital dashboard to identify Trusts who are compliant with requirements
Speak to Pharmacy Systems Suppliers about dm+d implementation and standard reports

11. Any Questions?

12. Why are these fields important to commissioners?
Data Item
Example
Purpose
Justification
Month/year
DD/MM/YYYY
To identify the relevant month and year at the point of payment
To identify activity per month/year upon receipt of data
Create date
Date of data creation
Date and time that will be used to ascertain the latest version of the dataset submitted.
Required to ensure correct version used
Organisation code (provider)
ODS code of provider submitting invoice related to backing data
To identify who requires reimbursement for the treatment already provided.
Required to match activity, to provider and ensure payment
Organisation code (commissioner)
ODS code of commissioner
To identify responsible commissioner
NHS England Commissioned Service Category
SS, AF, HJ
The NHS England Service Category Code should be derived with reference to the published hierarchy for assigning NHS England-commissioned services
To identify appropriate NHS England-commissioned service

13. Data Item Example Purpose Justification NHS Number
The unique identifier for the patient
Needed to determine if the individual is the responsibility of the commissioner and to determine whether patient has received correct number of treatments
Local Patient Identifier
Local patient identifier
To ensure any issue or payment is attributed to the same patient
To identify the individual to the healthcare provider. Particularly as NHS Number is not always known
Person Birth Date
Date of birth
To identify patient age
Needed to determine if the individual is the responsibility of the commissioner.
Where applicable required to confirm policy compliance
Where appropriate used for validation purposes eg child in adult specialty
Postcode of Usual Address
To identify usual residence
This is required for identifying the usual residence of patients
General Medical Practice Code (Patient Registration)
SUS Derived Practice
To ensure that the appropriate commissioner is identified. This identifies the approximate location of the patient and the fact they are in receipt of medical care.
Identifying the relevant practice helps to determine the relevant commissioner.
Required to map specialised services to CCG geographies for collaborative commissioning purposes.

14. Data Item Example Purpose Justification
Hospital Provider Spell Number/ Outpatient Attendance Identifier
Hospital Provider Spell Number/AE or OP Attendance identifier unique within Provider for the patient event
To ensure that spell number can be linked to drug administration
To allow validation between spell number and drug administration
Specialised Service Code
NCBPS01c
To identify the treatment and source of the invoice, to facilitate any challenges
Describes service or location to identify point of challenge
Where applicable required to confirm policy compliance
Service line reporting nationally
Issue type
Inpatient (Via Internal Pharmacy)
To determine dispensing route for medication
To distinguish between different dispensing routes
Drug Delivery Date
Administration date for IP Admissions; Prescription Date for OP.
To ensure that drug delivery can be linked with patient spell
Therapeutic Indication
Hepatitis C
Indication for treatment
Describes indication for treatment to identify point of challenge, particularly for drugs with multiple commissioners
Activity Treatment Function Code
370
Proxy for indication in Trusts without electronic prescribing.
Drug Code
To identify the prescribed drug or help commissioner confirm that the invoice payment is appropriate.
To identify commissioner (for example, those determined by NICE Guidelines) and whether prescription is justified or a non-brand alternative is available. Note codes mandated from June see link

15. Data Item Example Purpose Justification Drug name BNF name
To identify the prescribed drug or help commissioner confirm that the invoice payment is appropriate.
To identify commissioner (for example, those determined by NICE Guidelines) and whether prescription is justified or a non-brand alternative is available.
Drug Mode of Delivery
ORAL
Details should be inserted when the drug code is not given
Strength
100mg
Volume
100ml
To identify commissioner (for example, those determined by NICE Guidelines) and whether prescription is justified or a non-brand alternative is available. Complete if a liquid delivery, else leave blank.
Pack Size 28
Quantity 56
This may be packs size X pack, the quantity of drug given (when pack size and no. of packs is not relevant) or the weight of the drug (ensuring unit of measurement is also given)
To determine quantity issued

16. Data Item Example Purpose Justification Supplier Unit Price £
Unit price paid to supplier
To identify price paid by Trust with no on-costs
Commissioner Unit Price
Unit price charged to commissioner to include agreed on costs
Allows commissioners to easily identify what charges relate to the drug and what relate to the on-cost for that drug
Home Delivery Charge
Charge for home delivery
Allows commissioners to easily identify what charges relate to the drug and what relate to the home delivery charge for that drug
VAT charged
Yes/no
To determine if VAT has been applied to charges
The price charged to NHS England should include VAT only for medicines dispensed via Trust internal pharmacies. The price charged for medicines dispensed via outsourced/ subsidiary pharmacies or homecare, should exclude VAT, i.e. NHS England should only be charged the net cost of the drug