Network contract directed enhanced service (NCDES): supporting information

A framework for GP contract reform to implement The NHS Long Term Plan published in January 2019, which describes significant investment in Primary Care Networks (PCNs) through the Network Contract Directed Enhanced Service (DES).

The seventh year of the the Network Contract DES began in April 2025. The data being collected provides information to allow effective management of the contract. The indicators are organised into the following areas:

• Cancer
• Structured medication reviews and medicines optimisation
• Tackling health inequalities

Suppression has been applied to the .csv file where small numbers could be disclosive. Suppressed figures are represented with *, and the logic for the suppression is as follows:

• For fractional indicators with 1 PCA specified: where denominator <2 and PCA > 0, the denominator and PCA value are suppressed for the indicator
• For fractional indicators with >1 PCA specified: where denominator = 0 and the sum of all PCAs is equal to the value of any one PCA, all PCA values are suppressed for the indicator
• Exclusion counts are not included for any indicators

Prior to the release of data for November 2022, the logic used was slightly different:
Where the denominator count for an indicator = 0 and the value of one PCA count for the indicator is equal to the sum of all PCA counts for an indicator, all PCA values and the value of the associated register are suppressed.

Investment and Impact Fund (IIF) disclosure control

Some IIF indicator measures previously published as part of this series use Hospital Episode Statistics (HES) as a data source. To these measures we apply a strict statistical disclosure control in accordance with NHS England protocol. This suppresses small numbers to stop people identifying themselves and others, to ensure that patient confidentiality is maintained. The logic for the suppression is as follows:

• Sub-national counts between 1 and 7 (inclusive) will be displayed as ’*’ (zeroes will be unchanged)
• All other counts will be rounded to the nearest 5

Read more about HES suppression here: https://digital.nhs.uk/data-and-information/data-tools-and-services/data-services/hospital-episode-statistics/change-to-disclosure-control-methodology-for-hes-and-ecds-from-september-2018

The .csv file is structured as follows with example data items provided:

The accompanying data dictionary file provides descriptions of the indicators and measures included in the .csv file, and can be joined to the .csv file on the indicator code (IND_CODE) and measure (MEASURE) fields respectively. Examples of the data dictionaries are provided below to show how they are structured:

Indicators dictionary

Measures dictionary

The Network Contract DES data are released in monthly .csv files (contained within zip files due to their size). These files can be loaded into a database for querying, or can be interrogated using the pivot tables feature in Microsoft Excel.

Please note that .csv files may not open in applications such as Microsoft Excel due to the number of rows included in the dataset. Users may wish to import the file directly into a database, or alternatively use a text editor to split the file for import/use in applications such as Microsoft Excel.

Alternatively data is provided in a zip file with a single CSV for each ruleset.

Items included

The .csv file includes the following items:

Fractional indicators

These are comprised of a number of measures:

• Numerator - the number of patients who have received the relevant intervention. Identified in the data dictionary as items with a MEASURE of 'Numerator'.
• Denominator - the number of patients who were eligible to receive the relevant intervention. Identified in the data dictionary as items with a MEASURE of 'Denominator'.

• Personalised care adjustment (PCA) - the number of patients excepted from the indicator due to having a personalised care adjustment (PCA) specified.
  
  PCAs can be applied to patients for a number of specified reasons and are usually the result of a patient or a GP decision at a personal level. Examples of PCAs could be patient or carer refusal of treatment, a patient cancels or does not attend a consultation appointment, or a GP’s advice that two types of medication or treatment methodology should not be administered simultaneously.
  
  Patients with PCAs are not included in indicator denominators.  However, where a patient has received the intervention and also has a PCA recorded against an indicator, the patient will be counted in the numerator and the denominator but not against the PCA (i.e. intervention trumps PCA).
  
  PCAs can be identified as measures with a MEASURE_TYPE of 'PCA' in the data dictionary.

• Exclusions - the number of patients who are not eligible for inclusion in the denominator for definitional reasons (e.g. does not fall within the specified age range). These are not included in the release.

Indicators CAN02 and CAN01

The specification of these indicators is currently under review. The capture of referral-level information via the General Practice Extraction Service (GPES) and the manner in which referrals are recorded and updated in general practice means that activity may be captured in duplicate. In the majority of cases, this will result in double-counting in both the numerator and denominator. However, there are instances where an updated referral will be duplicated in the denominator and not the numerator. Users are therefore advised to interpret these indicators with caution; changes may be implemented later in the reporting year, and the nature of any changes will be detailed in due course.

June 2024 - Indicators using LD_COD

Due to an error in the updating of the code reference sets, the following indicators should be treated with caution for practices using TPP as a GP system supplier:

• HI01
• HI03
• HI27
• VI02

5 concepts which denote that a patient has a learning disability were incorrectly removed from the LD_COD code cluster:

• 984661000000105    Mild learning disability (disorder)
• 508171000000105    Severe learning disability (disorder)
• 931001000000105    Significant learning disability (disorder)
• 984671000000103    Moderate learning disability (disorder)
• 984681000000101    Profound learning disability (disorder)

Where patients had these concepts on their record, these patients may have incorrectly been excluded from these indicators.

This issue will be rectified from July 2024 and as these indicators are cumulative this should not have any impact on the data which is used for achievement, payments, or management information at the end of the financial year.

Indicator NCD011 and NCDMI132

Practices using EMIS as a GP system supplier returned a '0' count for indicators NCD011 and NCDMI132 in the period April 2023 - October 2023.

Indicator NCD123

NHS England is aware of on-going data quality issues with this metric; we are investigating further and are working with relevant teams to identify if there is an appropriate solution to get this resolved.

Practices using EMIS as a system supplier may not have accurate indicator values for the period April 2023 - October 2023. This data should be interpreted with caution.

Indicator NCD112

Due to the way that dates are sometimes applied to faecal immunochemical test (FIT) results when they are received by GP practices, the numerators recorded for NCD112 may have miscounted patients for April and May 2023. During this time period some GP system suppliers may have returned '0' counts for NCD112.

Practices using EMIS as a system supplier may not have accurate indicator values for the period April 2023 - October 2023. This data should be interpreted with caution.

Indicator NCDMI180

Please note that for data from April to June 2023 indicator NCDMI180 may erroneously exclude/include some patients who have had a medication error in relation to oral non-steroidal anti-inflammatory drugs (NSAIDs) therefore this data should be treated with caution and caveated appropriately.

Indicator  NCD120 and NCDMI182

In October 2023, some codes were added to the learning disability SNOMED CT cluster (LD_COD) due to incorrect reference information. We were made aware of these in November 2023 and published a corrected release on 27 November. A thorough review of LD_COD was subsequently conducted and an additional release with further amendments was published on 29 December. There is a delay of up to six weeks following publication of a code cluster content change to allow system suppliers to implement changes.

During the period impacted by this issue, GP learning disability registers could have been artificially inflated. This will have initially impacted November data but then improved throughout December and January as GP system suppliers implemented the required technical fixes, with registers returning to expected levels for the February extracts.

Although performance monitoring will have been difficult during this period, all issues were resolved prior to the end of the financial year and so, year-end positions will be accurate.

April-June 2023

Practice suppression

Please note, due to technical issues with data collection, inaccurate data has been suppressed for approximately 60 practices in April, 300 practices in May, and 16 practices in June using the EMIS system. All data has been suppressed with a * for the affected practices.

Payment/MI indicators

Initially, the collection for the 2022-23 service year only included data for payment indicators only; management information indicators were added to the collection in August 2022.

Indicator NCD011

The data for NCD011 may erroneously exclude some patients who do have high blood pressure. This is due to the way that some GP clinical systems capture and manage blood pressure records containing a systolic or diastolic value only. The implementation of this indicator is therefore currently under review and the data should be treated with caution.

Indicator NCD112

Due to the way that dates are sometimes applied to faecal immunochemical test (FIT) results when they are received by GP practices, the numerators recorded for NCD112 may be miscounting patients. The implementation of this indicator remained under review for the 22/23 financial year and the data should be treated with caution. Some GP system suppliers may have returned '0' counts for NCD112 during this time period. Please note this issue has been rectified from June 2023 in the 23/24 financial year.

Indicator NCD114

Indicator NCD114 may erroneously exclude/include some patients who have had a medication error in relation to oral non-steroidal anti-inflammatory drugs (NSAIDs) therefore this data should be treated with caution and caveated appropriately. Please note this issue has been rectified for 2023-24.

Indicators NCDMI105-110, NCDMI134, NCDMI135, NCDMI138-165, NCD018

Data for the following indicators may be shown as 0. This is because in order to extract these indicators as specified in the business rules, some system supplier development work was required which was not possible to conclude in time for the initial collection of the management information indicators:

• NCDMI105 - 110
• NCDMI134 - NCDMI135
• NCDMI138 -165

Indicator NCD018 is also subject to this development work and data for this indicator may also be shown as 0 at present.

September 2022

Seasonal flu indicators

Due to a technical issue relating to the update of the refsets containing the injectable seasonal flu vaccination codes, data for indicators NCD002, NCD003 NCDMI025, NCDMI026 and NCDMI027 may not be representative of activity in the month of September 2022 and should be interpreted with caution and caveated appropriately.

Practice omissions

Please note, due to technical issues with data collection, approximately 870 practices using the EMIS system that were included in the August 2022 extract are not included in the September 2022 extract.

May 2022

Practice omissions

Please note that due to technical issues with data collection there is no data for the following practices for May 2022:

Dr Jefferies & Partners, 292 Munster Road (E85029)

Eightlands Surgery (B85020)

Elm Tree Surgery (A81608)

Greasbrough Medical Centre (C87603)

Walker Medical Group (A86011)