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DSC Notice: 26/2003
Date of Issue: July 2003
NHS Information
Standards Board
Subject:
Updated National Specialty List
Implementation Date: 1st April
2004
DATA SET CHANGE CONTROL PROCEDURE
This paper gives notification of changes to be included in the NHS Data Dictionary and the NHS CDS
Manual as appropriate. These will be consolidated into the publications in due course.
Summary of Changes:
Production of revised speciality list that is fit for purpose
The NHS Information Standards Board (NHS ISB) is responsible for approving information standards.
The NHS ISB is supported by the Management Information Standards Board, the Clinical Information
Standards Board and the Technical Standards Board.
The packaging of standards document is under review. Any changes will be notified in due course.
Please note that the website address has changed, and that Data Set Change Notices are now
located at:
http://www.nhsia.nhs.uk/dscn/pages/default.asp and on the NHSnet at:
http://nww.nhsia.nhs.uk/dscn/pages/default.asp
DATA SET CHANGE NOTICE 26/2003
Reference:
DSCN 26/2003
Subject:
Updated National Specialty List
Type of Change:
Data Standard
Effective Date:
1 April 2004
Produced by:
NHS Wide Clearing Service: National User Group –
Specialty List Review Subgroup & NHS Information
Authority
Sponsoring body:
Peter Drury, Information Policy Unit
Background
1. A project to update the national specialty list was proposed by the NHS Wide
Clearing Service National User Group (NUG) through the Specialty List Review
Sub Group. Thus the requirement came from NHS users to provide national codes
for the transmission of sub-specialties being recorded locally.
2. The Updated National Specialties List was conditionally approved as a
Requirement and Draft Standard by the Information Standards Board on 28
March 2003 subject to actions detailed in the output document (www.isb.nhs.uk).
The sponsor is Dr Peter Drury, Information Policy Unit.
3. The output document actions are all covered in this paper:
 ongoing maintenance (paragraph 18)
 strategic fit with SNOMED and ICRS (para. 33 and 34)
 costing for implementation (para. 22 and 30)
 updated technical, organisational and behavioural guidance (paras 24-28)
 clarification of scope in relation to Allied Health Professionals (para 35)
 evidence of testing nursing & midwifery codes (para 35)
4. A wider consultation took place in February and March 2003. The results have
been incorporated into this final paper.
5. Three pilot sites piloted the updated national specialties list. The implications for
implementation guidance are incorporated into this paper. The reports will be
published on the Data Standards web page:
http://www.nhsia.nhs.uk/datastandards/pages/default.asp
Purpose of standard
6. The National Specialty List is a list of Specialty Function Codes for Medical &
Dental specialties (eg 100 General Surgery, 300 General Medicine, 140 Oral
Surgery) used for recording the main specialty of the consultant and the treatment
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specialty for the patient in Health Care systems and transmitted in Central Returns
and Commissioning Data Sets.
7. The Requirement is to produce a revised specialty list that is fit for purpose. This
involves
 defining specialty and clarifying the use of main specialty and treatment
specialty
 identifying sub-specialties that qualify as national treatment specialties
 identifying Paediatric specialties in a more systematic way
 updating specialty names where necessary
 identifying specialties that are inappropriate to use as treatment specialties
 making recommendations on the recording of joint consultant clinics ie
more than one specialty involved in one outpatient clinic
 reviewing the linkage between Medical & Dental workforce specialties
 maintaining the ability to compare activity data over time eg Hospital
Episode Statistics data mapping between old and new codes
 making recommendation on the process for updating and maintaining the
specialty list.
Scope
8. Specialty Function codes are recorded in Health Care systems to describe the
main specialty in which the consultant is contracted or recognised and the
treatment specialty in which the patient is treated. The information is transmitted
in central returns and commissioning data sets. The information is used mainly for
activity analysis and workforce planning.
9. The stakeholders for the requirement are medical & dental consultants, other
clinical staff taking the lead responsibility for the care of patients, Trust managers
and commissioners, users of activity data (Department of Health: Hospital
Episode Statistics, Statistics, Finance and Workforce), NHS Wide Clearing
Service, Informatics staff and Software suppliers.
Standard - Specification
10. Main specialty – this is the specialty in which the consultant is contracted or
recognised. It relates to Workforce planning and will align to the same set of
specialties as recognised by the European Specialist Medical Qualifications Order
1995 and European Primary and Specialist Dental Qualifications Regulations
1998. As its use is restricted to hospital consultants it will also include pseudo
codes to identify Nurses, Midwives and other Health Care Professionals as
required.
11. Treatment specialty – this describes the specialised service within which the
patient is treated. The list of valid specialties has been renamed “Treatment
Function” and updated to include new treatment functions and exclude
non-treatment functions. The activity of non-medical & dental staff can be
described using treatment functions eg main specialty – Nurse; treatment function
– Gastroenterology.
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12. The code for ‘Joint consultant clinic’ will be discontinued as it provides no
information on treatment function; activity will be recorded against the managing
main specialty and treatment function.
13. Definition of Treatment Function - a treatment function will be recognised as a
valid descriptor of patients treated within any particular NHS organisation if there
is a clearly recognised and separate service provided within that organisation.
Guidance is incorporated in Annex A.
14. Candidates for approval as new Treatment Function codes have come from a
variety of sources. Some are already in use in commissioning and reporting
activity and are sent in Commissioning Data Set messages as VGPs (Very
General Purpose Fields) but are limited to local use as there is no national
standard. Others have been proposed by clinical groups. Yet others are already in
use in grouping Outpatient Healthcare Resource Groups (HRGs) used in
reference costs or identifying services specified by the National Specialist
Commissioning Advisory Group (NSCAG).
15. All aggregate central returns should be based on Treatment Function rather than
Main Specialty. Until the aggregate return forms are updated with the new
treatment functions Trusts will have to use the existing specialties. Use of the new
codes may reduce comparison with historical data for aggregate returns. This is
not the case with commissioning data sets which carry both the main specialty and
treatment function, as comparison with historical data can largely be achieved
through cross-tabulation with main specialty.
16. The original submission included a requirement to separately identify Paediatric
specialties with a ‘P’ suffix that could not be accommodated in this submission.
The use of a ‘P’ suffix would increase the length of the specialty code from 3 to 4
characters. This would force software changes that are not cost-effective on their
own. There will be no change to the existing format/length for the EDIFACT
message. Additional Paediatric Treatment Functions to support the NSF for
Children will be considered by the Maintenance Group for implementation in
April 2005.
17. Information Standards Board review – the standard will be reviewed within three
years in accordance with ISB policy.
18. Maintenance of the treatment function list – This process will be sponsored by the
Information Policy Unit who will commission the NHSIA to establish a
Treatment Function maintenance group containing representatives from all the
stakeholders. The scope of the maintenance group is limited to maintenance of the
treatment function list and proposals for the formal ISB review. The guidelines in
Annex A should be used to assess the proposal for new treatment functions. The
maintenance group will work on the following issues and report back 12 months
from the approval date of the Standard.
 HIV and Termination of Pregnancy – these proposals were removed as a
pragmatic response to the enhanced sensitivity of the conditions
 Paediatric specialties – this is an important area which requires further
consultation and debate
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


Midwife episode – the proposal to replace this with Obstetrics as a Treatment
function requires further debate
Explore Nurse and Therapist led activity requirements
Review proposals received in the consultation
19. The revised list for main specialty has the following additions to bring it into line
with the European Specialist Medical and Dental Qualifications:
 Oral & Maxillo Facial Surgery
 Endodontics
 Periodontics
 Prosthodontics
 Surgical Dentistry
 Critical Care Medicine (also known as Intensive Care Medicine)
 Paediatric Cardiology
 Tropical Medicine
 General Dental Practice
 Community Health Services Dental
 Public Health Medicine
 Public Health Dental
The full list is in Annex B in the table headed Main Specialty.
20. The revised list for treatment function has the following additions to bring it into
line with current practice:
 Transplantation Surgery
 Breast Surgery
 Colorectal Surgery
 Hepatobiliary & Pancreatic Surgery
 Upper Gastrointestinal Surgery
 Vascular Surgery
 Maxillo Facial Surgery
 Burns Care
 Cardiac Surgery
 Thoracic Surgery
 Cardiothoracic Transplantation
 Critical Care Medicine (also known as Intensive Care Medicine)
 Hepatology
 Diabetic Medicine
 Bone & Marrow Transplantation
 Haemophilia
 Clinical Immunology
 Allergy
 Intermediate Care
 Respite Care
 Clinical Microbiology
 Sleep Studies
 Tropical Medicine
 Neonatology
 Well Babies
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

Gynaecological Oncology
Interventional Radiology
The following existing specialities should not be used as treatment functions:
 Anaesthetics
 Clinical Physiology
 Clinical Cytogenetics & Molecular Genetics
 Nuclear Medicine
 Clinical Neuro-physiology
 Antenatal clinic (use Obstetrics)
 Postnatal clinic (use Obstetrics)
 General Practice (use Obstetrics or appropriate Treatment Function);
General Medical Practice should be used for Main Specialty
 General Pathology
 Blood Transfusion
 Haematology (see Clinical Haematology)
 Histopathology
 Immunopathology (see Clinical Immunology)
 Medical Microbiology (see Clinical Microbiology)
 Neuropathology
 Community Health Services Medical
 Occupational Medicine
 Nursing Episode (use appropriate Treatment Function); Nursing Episode
should be used for Main Specialty)
 Joint Consultant Clinics
The full list is in Annex B in the table headed Treatment Function.
Implementation Plan
Introduction
21. The implementation plan is based on the experiences of the pilot sites. However,
it is recognised that some of the conclusions in this report are based on limited
data and evidence. The pilot sites simulated the implementation of the new
Treatment Function codes. To pilot for real would have risked the exchange of
commissioning data sets and abstract to HES. It was considered that the
simulation would provide the implementation experience and guidance required
from the pilot sites.
22. The major messages have been in communication and training. There is
overwhelming clinical and managerial support for the recognition of new
treatment functions and usefulness of being able to report activity against the new
treatment functions at national level which offsets the implementation effort. The
cost of software changes are held to be minimal – “A few such codes have been
added in the past – such as specialty 560 – with apparently no significant
information system problem for Trusts or users of systems needing to include
those codes” (Royal Free Hampstead pilot site report). The experience of the
addition of 950 Nursing episode (DSCN 8/2001) in the recent past bears
DSCN 26/2003
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testimony to the cost and ease of local system changes. There are no changes to
national messages eg NHS Wide Clearing Service / EDIFACT . The issue of a
DSCN to specify the changes is held to be important in identifying any software
changes as part of the maintenance contract (where this incorporates DSCNs) and
in assigning the changes a priority and date for action.
23. The site identified in the draft standard and the three pilot sites are all continuing
to use local specialty codes which will be replaced by the new treatment function
codes when the standard is approved.
Organisational Implementation
24. Effective date 1 April 2004 - The revised codes and definitions will replace the
existing codes and definitions and be used in all commissioning data sets and
central returns with effect from 1 April 2004. The old list will still be accessible in
the change log of the NHS Data Dictionary for historical records. There have been
minimal changes to existing codes and specialty names. Data collection includes
all Trusts and non NHS providers of NHS activity.
25. The decision to recognise any of the new treatment functions should be taken by
care providers. The major part of the work associated with the introduction of new
treatment functions is making the decisions about which to use. Where the Trust
already uses the same or a closely related concept as a local specialty, the new
treatment function should be adopted. The full list of new codes should be
reviewed to identify any new treatment functions which are appropriate for
existing services not already identified locally. It will be up to each individual
organisation to decide whether it needs to use any of the additional treatment
functions.
Technical implementation
26. There will be only minor changes to systems in the Trust. The Data Set Change
Notice will inform Patient Administration System suppliers of the specification
for changes, and these changes will be incorporated into the next version of the
software just as in any other DSCN, the cost often included in the annual
maintenance charge. Strictly speaking it could be said that the cost of this change
would be that the supplier might delay some other change into a later year, but
since this change is not complex that would be a somewhat marginal effect.
“National specialties are not used in other major systems in the Trust. The
information department will however have to add these specialties to its reports to
commissioners, but this has been done on numerous occasions in the past when
mappings of new local specialties have been introduced, and this is a small
change in terms of information systems” (Royal Free Hampstead pilot site
report).
The following issues may need to be considered:
 Which clinicians need to have which new treatment functions mapped to them.
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




What training is required to address data quality issues - which
specialty/treatment function to use from a referral letter, which
specialty/treatment function to use on an admission.
Which clinics should be mapped under the new treatment functions eg new
Breast clinics are quite identifiable but the follow-up patients are booked under
a General Surgery clinic code.
Waiting lists would need to be changed over - this might be on an individual
patient basis for Outpatients, but could be done ‘en masse’ for Admitted
patients. Waiting list names may be mapped to specialty so these would either
need to be changed over to new treatment function or additional ones set up.
If the clinic/patient specialty/treatment function changes, it would be necessary
to know which letter templates to use as the letters are mapped to specialty and
if this changes the templates need to be reviewed.
Wards are also mapped to specialties so these may have to be updated
eventually.
Data Quality
27. Trusts should have systems in place to monitor data quality. Implementation will
include training, changes to procedures if necessary and changes to systems.
There may be an opportunity for the mapping to new treatment functions to be
done behind the scenes using the automated processes; or the use of consultant
specific pick lists which reduce the opportunity for random choice. Pragmatically
a mixture of both direct change and automated processes would need to be used to
implement the changes to fit local circumstances.
Human behavioural guidance
28. Most Trusts are accustomed to introducing new local PAS specialties. The stages
are:
 agreement to the new entity by relevant clinical, managerial and commissioning
staff;
 identification of the planned use and prediction of the effects of the changes;
 the addition of the treatment function and code to the PAS masterfile by the
PAS team;
 training of front line staff by the relevant managers in the use of the new
treatment functions;
 reporting demand and activity according to the new treatment function.
There should be a recognised procedure for capturing, resolving or escalating
queries arising from the use of new treatment functions.
A list of Frequently Asked Questions (FAQs) will be maintained on the Data
Standards website, based on queries raised during the consultation process and
subsequent queries raised through the NHSIA.
http://www.nhsia.nhs.uk/datastandards/pages/default.asp
Training
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29. The training and awareness of the new treatment functions was not simulated in
detail so as not to confuse front line staff. In fact the change to treatment
functions itself is invisible to front line data entry staff such as clinic, ward and
A&E clerks, because the mapping to national specialty lies behind the data entry
screens on PAS. It is mainly the information staff and the users of their reports,
such as managers and senior clinicians, who need to be made aware. But in those
cases where existing entities are being used slightly differently, or where a new
entity is being introduced at a local PAS specialty level, then there needs to be the
most training and awareness.
Impact in terms of cost and staff
30. The pilot sites estimated that the cost impact of a full implementation would be
close to zero, since the minor software changes if any would be routinely
incorporated in a forthcoming version of the PAS. The impact on the small
number of data entry staff affected by the consequent introduction of new local
specialties on PAS is in terms of training and getting used to choosing the new
codes. However since the specialty is attached to the consultant, the range of
errors possible is confined to those available on the system for any individual
consultant. In other words the member of staff could not make a gross error of
choosing a completely unrelated specialty. Overall the impact and cost is very
minor.
“Since the introduction of some of the new specialties would have considerable
clinician support coupled with the fact that specialty changes are not new to
Trusts there would not be technical or operational reasons against these changes”
(Plymouth Hospitals pilot site report).
Summary of Benefits
31. The pilot sites reported the following benefits:

significant reduction in confusion about what a specialty comprises, and
removal of known errors;

improved faith within the Trust about definitions and reporting;

reflection of some important aspects of modern medical care;

more intuitive understanding for users of Trust data at all levels about what is
being described in data sets and aggregated statistics.
Dependencies
32. There are no dependencies for the introduction of this standard to update the
national specialties list.
Strategic fit
33. Strategic fit with SNOMED CT
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Staff from the SNOMED CT programme have reviewed the updated national
specialties list, and concluded that with a limited number of new additions to
SNOMED CT, there would be adequate content to record the proposed revised
National Specialty List. A number of detailed comments were made about precise
terminology representation, some of which referred to the main specialty codes
which are approved by the ESMQ and EP&SDQ.
34. Strategic fit with Integrated Care Records Service (ICRS)
The Output Based Specification draft 02 does not go down to the detail of specialty
but there is a good strategic fit on a number of issues.
ICRS has a particular focus on National Service Frameworks (NSF), National
Institute for Clincial Excellence (NICE) and Commission for Health Audit and
Improvement (CHAI). “The service (ICRS) shall enable the collection of mandated
items to support NSFs or specific codes to support specialty-specific areas of
practice.” The new treatment functions support NSFs eg Breast Surgery for Cancer.
“ICRS must enable information to be abstracted from operational patient records to
enable aggregation and analysis of this data.” National specialties have a major role
to play in aggregation.
The eBooking service documented in the ICRS is supported by national specialties.
ICRS provides for ‘Information for secondary purposes’ eg Central Returns (HES
etc), Quarterly Returns and Annual Returns. “The service shall interface with other
information systems to enable seamless access of data, and to minimise duplicate
data entry.” “The service shall enable clinical data to be organised under nationally
or locally determined headings.” It is clear that specialties already exist in the data
that ICRS will be supporting. Updating the national specialty list will improve the
contribution that specialties can make in describing some of the distinctive features
of modern medicine.
Staff groups affected
35. The standard provides for the recording of activity by lead health care
professionals other than hospital consultants. There is little current experience of
recording nurse-led care within admitted patient care and no provision within
existing Department of Health guidance for Allied Health Professionals. The pilot
sites were only able to demonstrate the existing functionality of midwife
recording. Despite this, it is recommended that the functionality remains within
the standard to allow the development of this growing area of activity.
36. The consultation did not result in the identification of specific nurse or therapist
led services which fit the definition of treatment function. It is recommended that
the maintenance group address these issues.
Consultation
37. Consultation on the impact assessment took place between February and March
2003. The stakeholders consulted included:
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Medical professions via ACIG (Academy of Colleges Information Group)
Nursing Professions via NPIG (Nursing Professions Information Group)
Allied Health Professionals via CPIAG (Clinical Professions Information
Advisory Group)
NHSIA Informatics Stakeholders
Dept Of Health: HES, Workforce, Finance and Central Returns
NHS Wide Clearing Service
System suppliers via Intellect (the trade body for the UK based information
technology, telecommunications and electronics industry)
NHSIA website and ‘What’s new?’
The results of the consultation have been included in this proposal.
Independent Evaluation
38. The Hospital Episode Statistics (HES) team analysed the data from the pilot sites
and produced a report which included the following comments:

“Having read the report on the pilot we believe that it has been shown to be
possible to implement the changes reliably and at a minimal cost, which will be
outweighed by the benefits to the Service and to national statistics.

We have been concerned for some time that the current national specialty list
can be misleading when used for high level analyses. At the same time, we need
some way to continue to monitor trends in activity at specialty or specialty
group level, that provides meaningful time series.

We are also aware that the current list is out of date and doesn’t reflect modern
practice and healthcare delivery. The pilot has demonstrated that the new
specialties can be used in a clinical setting and are more appropriate.

The proposal gives us the option of looking at the consultant qualifications in
relation to the care delivered or analysing from the service/patient perspective,
which may remove some of the current difficulties associated with using
specialty codes. We believe that the pilot has demonstrated that both these
functions can be achieved. The amendments will also bring HES data collected
via the Admitted Patient Care CDS into line with workforce statistics. We are
keen to preserve a means of ‘mapping back’ the new proposed specialties to a
limited list so as to prevent fragmentation. We believe this could be achieved
by cross-tabulation of main specialty (which will be those recognised by the
European Specialist Medical Qualifications Order 1995 and the European
Primary and Specialist Dental Qualifications Regulations 1998) and treatment
specialty, which will use the enhanced list.”
HES had a number of specific issues which resulted in some changes to the proposal
and the referral of outstanding issues to the maintenance group for their early
consideration.
Impact on NHS if standard was not approved
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39. The impact of the Standard not being approved is to encourage proliferation of
local sub-specialty codes in VGPs in commissioning data sets and elsewhere
which prohibits sharing, comparing and exchanging data at a national level and
national analysis being out of step with clinical developments. The NHS Wide
Clearing Service National User Group (NUG) will monitor the use of VGPs
post implementation and provide a list of outstanding sub-specialties for which
Trusts and Commissioners appear to have a continuing requirement, to the
Maintenance Group.
Additional Information:
For further information regarding this DSCN contact:
Barbara Fogarty
Data Standards Manager
Data and Information Standards Programme
NHS Information Authority
[email protected]
Alaric Cundy
Director of Clinical Information
Barts and The London NHS Trust
[email protected]
Dr Pam Westley
Information Policy Unit
Department of Health
[email protected]
DSCN 26/2003
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ANNEX A
Guidelines for judging the eligibility of new or current candidate Treatment
Functions
Every member of the Treatment Function list should satisfy these criteria:







It must be a discrete and homogenous area of clinical care that is definable
in some way and which is meaningful to clinicians.
It must be an area of clinical care that could be used to describe the lead
clinical responsibility for the care and treatment of patients. Non-clinical
treatment functions are excluded.
It must be practical to collect.
Before any proposed new ‘treatment function’ can be considered for
addition to the national list, it must be demonstrated that there is at least one
NHS Trust in which there is a specific function concerned with the proposed
new treatment function. Often, this means, there will be a recognisable
‘Department of {proposed new treatment function}’.
Usually, a treatment function is not a specific disease.
Usually, a treatment function is not a specific type of treatment.
Activity within the area of clinical care should achieve a reasonable ‘critical
mass’ in terms of admitted patient episodes and / or outpatient attendances
per year and / or total cost to the NHS. The sub group has decided not to be
prescriptive on this point in terms of minimum numbers per year, but rather
leave judgement of each candidate to a case-by-case consideration. Linked
to this point:
 Treatment functions with low volumes nationally should be
reviewed regularly for continued national recognition
 Treatment functions with high volumes nationally should be
checked from time to time by the standing sub group to assess
whether there is clinical justification for sub-division.
NB It is important to note that not all patients referred or treated by a service will have
that particular condition and so treatment function should not be allocated
retrospectively by analysis of diagnosis or intervention. In the example of
Gynaecological Oncology a significant number of patients referred by GPs and others
are found upon examination not to have cancer. So a proportion of the workload
reported will relate to patients with no malignant disease.
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ANNEX B
Updated National Specialty List - Treatment Function Codes and Main Specialty
Codes
Notes
 This updated list separates Treatment Function Codes and Main Specialty
Codes.
 Treatment Functions have been expanded to describe the increasing
specialisation of patient care.
 Main Specialty has been aligned to the European Specialist Medical
Qualifications and European Primary and Specialist Dental Qualifications
which corresponds with Workforce planning specialties.
 Existing three character codes have been retained with minimum changes. The
underlying principle is not to delete or re-use any codes because of issues with
historical data. Some re-naming has been allowed.
code
TREATMENT FUNCTION
Comments and Guidance
Use it to cover sub specialties not elsewhere
listed, such as Endocrine Surgery
100 GENERAL SURGERY
101 UROLOGY
102 TRANSPLANTATION SURGERY Excludes Cardiothoracic Transplantation.
Includes Renal transplants and liver transplants.
Suspected neoplasms, cysts, etc. Does not
include cosmetic surgery.
103 BREAST SURGERY
104 COLORECTAL SURGERY
105 HEPATOBILIARY AND
PANCREATIC SURGERY
Includes Liver Surgery but excludes Liver
Transplantation see TRANSPLANTATION
SURGERY.
106 UPPER GASTROINTESTINAL
SURGERY
107 VASCULAR SURGERY
110 TRAUMA & ORTHOPAEDICS
120 ENT
130 OPHTHALMOLOGY
140 ORAL SURGERY
141 RESTORATIVE DENTISTRY
142
143
144
150
160
161
PAEDIATRIC DENTISTRY
ORTHODONTICS
MAXILLO-FACIAL SURGERY
NEUROSURGERY
PLASTIC SURGERY
BURNS CARE
See also MAXILLO-FACIAL SURGERY
Endodontics, Periodontics and Prosthodontics
are all mono-specialties within Restorative
Dentistry.
Mouth, jaw and face related surgery
See also BURNS CARE
To be used by recognised specialist services
only – but including ‘outreach’ facilities
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170 CARDIOTHORACIC SURGERY
171
172
173
174
180
190
191
192
Should only be used where there are no
separate services for Cardiac Surgery and
Thoracic Surgery
PAEDIATRIC SURGERY
CARDIAC SURGERY
THORACIC SURGERY
To be used by recognised specialist services
CARDIOTHORACIC
only – but including ‘outreach’ facilities
TRANSPLANTATION
ACCIDENT & EMERGENCY
code no longer in use as a Treatment
Function
PAIN MANAGEMENT
To be used where the person with lead
CRITICAL CARE MEDICINE
responsibility for the care of the patient is a
specialist in Critical Care Medicine (previously
known as Intensive Care Medicine)
Use it to cover sub specialties not elsewhere
listed, such as Metabolic Medicine
300 GENERAL MEDICINE
301 GASTROENTEROLOGY
302 ENDOCRINOLOGY
303 CLINICAL HAEMATOLOGY
DIABETIC MEDICINE now has separate code
Minor change of name. See also BONE AND
MARROW TRANSPLANTATION and
HAEMOPHILIA
305
306
307
308
CLINICAL PHARMACOLOGY
HEPATOLOGY
DIABETIC MEDICINE
BONE AND MARROW
TRANSPLANTATION
309 HAEMOPHILIA
310 AUDIOLOGICAL MEDICINE
311 CLINICAL GENETICS
separate code to ENDOCRINOLOGY
Previously in CLINICAL HAEMATOLOGY
Previously in CLINICAL HAEMATOLOGY
Does not include Audiology or Hearing Tests
To be used by recognised specialist services
only – but including ‘outreach’ facilities
313 CLINICAL IMMUNOLOGY AND Should only be used where there are no
ALLERGY
separate services for Clinical Immunology
and Allergy
314 REHABILITATION
315 PALLIATIVE MEDICINE
316 CLINICAL IMMUNOLOGY
317 ALLERGY
318 INTERMEDIATE CARE
Intermediate Care encompasses a range of
multi-disciplinary services designed to
safeguard independence by maximising
rehabilitation and recovery after illness or
injury
319 RESPITE CARE
320 CARDIOLOGY
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321
322
330
340
341
350
352
360
361
370
400
410
420
421
422
PAEDIATRIC CARDIOLOGY
CLINICAL MICROBIOLOGY
DERMATOLOGY
THORACIC MEDICINE
SLEEP STUDIES
INFECTIOUS DISEASES
TROPICAL MEDICINE
GENITO-URINARY MEDICINE
NEPHROLOGY
MEDICAL ONCOLOGY
NEUROLOGY
RHEUMATOLOGY
PAEDIATRICS
PAEDIATRIC NEUROLOGY
NEONATOLOGY
424 WELL BABIES
430 GERIATRIC MEDICINE
450 DENTAL MEDICINE
SPECIALTIES
460 MEDICAL OPHTHALMOLOGY
501 OBSTETRICS
502 GYNAECOLOGY
See also SLEEP STUDIES
Special Care, High Dependency and
Intensive Care
use when NEONATAL LEVEL OF
CARE = 0 - Normal Care: Care given by
the mother or mother substitute with
medical and neonatal nursing advice if
needed.
Includes Oral medicine and Dental and
Maxillo-Facial radiology
Any admission / attendance associated with a
pregnancy including a miscarriage but not
including a planned termination.
See also GYNAECOLOGICAL
ONCOLOGY
503
510
520
560
610
620
700
710
711
712
713
715
GYNAECOLOGICAL ONCOLOGY
code no longer in use
Use OBSTETRICS.
code no longer in use
Use OBSTETRICS
MIDWIFE EPISODE
code no longer in use
If GP Maternity use OBSTETRICS as
Treatment Function
code no longer in use
If GP ‘other than Maternity’ use appropriate
treatment function
Previously known as Mental Handicap
LEARNING DISABILITY
Previously known as Mental Illness
ADULT MENTAL ILLNESS
CHILD and ADOLESCENT
PSYCHIATRY
FORENSIC PSYCHIATRY
PSYCHOTHERAPY
OLD AGE PSYCHIATRY
DSCN 26/2003
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800 CLINICAL ONCOLOGY
(previously RADIOTHERAPY)
810 RADIOLOGY
811 INTERVENTIONAL RADIOLOGY
822 CHEMICAL PATHOLOGY
990 code no longer in use
code
100
101
110
120
130
140
141
142
143
145
146
147
148
149
150
160
170
171
180
190
191
192
300
301
302
303
304
305
310
311
312
MAIN SPECIALTY
Surgical Speciaties
GENERAL SURGERY
UROLOGY
TRAUMA & ORTHOPAEDICS
ENT
OPHTHALMOLOGY
ORAL SURGERY
RESTORATIVE DENTISTRY
PAEDIATRIC DENTISTRY
ORTHODONTICS
ORAL & MAXILLO FACIAL
SURGERY
ENDODONTICS
PERIODONTICS
PROSTHODONTICS
SURGICAL DENTISTRY
NEUROSURGERY
PLASTIC SURGERY
CARDIOTHORACIC SURGERY
PAEDIATRIC SURGERY
ACCIDENT & EMERGENCY
ANAESTHETICS
code no longer in use
CRITICAL CARE MEDICINE
Medical Specialties
GENERAL MEDICINE
GASTROENTEROLOGY
ENDOCRINOLOGY
CLINICAL HAEMATOLOGY
CLINICAL PHYSIOLOGY
CLINICAL PHARMACOLOGY
AUDIOLOGICAL MEDICINE
CLINICAL GENETICS
CLINICAL CYTOGENETICS and
DSCN 26/2003
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313
314
315
320
321
330
340
350
352
360
361
370
371
400
401
410
420
421
430
450
460
500
501
502
510
520
560
600
601
610
620
700
710
711
712
713
MOLECULAR GENETICS
CLINICAL IMMUNOLOGY &
ALLERGY
REHABILITATION
PALLIATIVE MEDICINE
CARDIOLOGY
PAEDIATRIC CARDIOLOGY
DERMATOLOGY
THORACIC MEDICINE
INFECTIOUS DISEASES
TROPICAL MEDICINE
GENITO-URINARY MEDICINE
NEPHROLOGY
MEDICAL ONCOLOGY
NUCLEAR MEDICINE
NEUROLOGY
CLINICAL NEURO-PHYSIOLOGY
RHEUMATOLOGY
PAEDIATRICS
PAEDIATRIC NEUROLOGY
GERIATRIC MEDICINE
DENTAL MEDICINE
SPECIALTIES
MEDICAL OPHTHALMOLOGY
Obstetrics and Gynaecology
not in use
OBSTETRICS
GYNAECOLOGY
code no longer in use
code no longer in use
MIDWIFE EPISODE
General Practice
GENERAL MEDICAL PRACTICE
GENERAL DENTAL PRACTICE
code no longer in use
code no longer in use
Psychiatry
LEARNING DISABILITY
ADULT MENTAL ILLNESS
CHILD and ADOLESCENT
PSYCHIATRY
FORENSIC PSYCHIATRY
PSYCHOTHERAPY
DSCN 26/2003
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715 OLD AGE PSYCHIATRY
Radiology
800 CLINICAL ONCOLOGY
(previously RADIOTHERAPY)
810 RADIOLOGY
Pathology
820 GENERAL PATHOLOGY
821 BLOOD TRANSFUSION
822 CHEMICAL PATHOLOGY
823 HAEMATOLOGY
824 HISTOPATHOLOGY
830 IMMUNOPATHOLOGY
831 MEDICAL MICROBIOLOGY
832 code no longer in use
Other
900 COMMUNITY HEALTH
SERVICES MEDICAL
901 OCCUPATIONAL MEDICINE
902 COMMUNITY HEALTH
SERVICES DENTAL
903 PUBLIC HEALTH MEDICINE
904 PUBLIC HEALTH DENTAL
950 NURSING EPISODE
990 code no longer in use
DSCN 26/2003
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