Treatment Function Maintenance Group (TFMG) Treatment function acceptance criteria

The National Specialty List Standard was introduced by DSCN 34/2002 in September 2003 as a replacement for Specialty and Specialty Function codes respectively. The ‘ISB0028 – National Specialty List’ information standard was last updated in 2012. The standard will be renamed ‘DCB0028 Treatment Function and Main Specialty Standard’ as part of the updated April 2020 Information Standards Notice (ISN) release.

Main Specialty

The Main Specialty is the specialty within which the Consultant is recognised or contracted to the organisation. Main Specialties are normally aligned to the European Specialist Medical Qualifications Order 1995 and European Primary and Specialist Dental Qualifications Regulations 1998, in Anglicised form. Changes to the list are governed by the Health Care and Associated Professions statutory instrument.  

Default/pseudo-main specialty codes to identify the work of non-consultant lead professionals such as midwives, nurses and other care professionals have also been included.

Treatment Function

This is the specialised service within which the patient is treated. It includes most of the main Specialties and also approved sub-specialties, special interests and services provided by non-doctors and dentists.

Treatment Function Codes are used to record, report on, extract and flow activity undertaken, irrespective of the type of healthcare professional who performs it and are not restricted to consultants.

To maintain the list of Treatment Functions, NHS Digital needs to obtain expert help from professionals working in relevant fields. The Treatment Function Maintenance Group (TFMG) was established in 01 December 2004 and performs the role of an Expert Reference Group with responsibility for considering and approving change requests, against the Treatment Function Eligibility Criteria.

The members of this group will work in healthcare capacities in trusts, relevant teams within NHS England and NHS Improvement, and specialist teams within NHS Digital itself – secondary care analysis, community and mental health, NHS Data Model and Dictionary and clinical informatics. The Data Standards Assurance Service (DSAS) will also attend meetings of the group in an advisory, but not voting, capacity.

The TFMG objectives are to to suggest suitable codes for inclusion and to consider and approve new, or changes to existing, Treatment Functions.

These may be the result of

• changes to the Main Specialty (resulting from changes to legislation)
• policy initiatives e.g. National Tariff Payment System
• requirements from NHS and other users

Further information is available with the TFMG terms of reference. 

Any proposed changes to Treatment Functions (TF)  will need to be agreed by the TFMG using the following criteria:

Essential criteria

• it must be a distinct area of clinical care for which all activity can be linked to a Main Specialty Code. Non-clinical areas are excluded.
• it should not be limited to an individual setting unless services are setting-specific.
• before any proposed new TFC 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 TFC. Often this means there will be a recognisable ‘Department of {proposed new TF}’.
• it must be practical to collect.

Desirable criteria

• a TF is not usually a specific disease
• a TF is not usually a specific type of treatment.
• a TF is a homogeneous area of clinical care that is definable in some way and which is meaningful to clinicians.
• activity within the area of clinical care should achieve a reasonable volume in terms of admitted patient episodes and/or outpatient attendances per year and / or total cost to the NHS. Judgement of each candidate TFC will be on a case-by-case basis.
• a TF has historically related to hospital settings. This will be reviewed for the next release, with the potential to formally expand the scope in future. See Appendix A for examples of codes which could be added

The proposals received for new Treatment Functions can be described using the following types

• children’s version of existing specialities (paediatric endocrinology)
• mainly non-clinical specialities proposing a significant clinical element (anaesthetics)
• special interests within existing specialised services, where these are considered a distinct service in their own right (perinatal psychiatry)
• multidisciplinary services to which more than one specialty contributes (spinal injuries)
• services delivered by an eponymous healthcare profession other than medicine (speech and language therapy)
• to support changes relating to national strategic or policy developments.

Types of requests exceptionally considered 

• condition specific (cystic fibrosis)
• community services (community nursing)

Requests for new Treatment Functions, or amendments to existing Treatment Functions, should be made by [email protected]. 

A web portal is  being developed to allow web-based submissions of such requests in the future.

In the next release of the DCB0028 Treatment Function and Main Specialty Standard, consideration will be given to the inclusion of TFCs representing non-hospital settings, such as community services. This could include codes which are currently listed as ‘Service or Team Type Referred to (Community Care)’ in the Community Services Data Set (CSDS).

A list of these codes is shown on the NHS Data Model and Dictionary website.  

Examples include

• community paediatrics service 
• district nursing service 
• family support service
• health visiting service 
• school nursing service