Summary of information for child health care services

Generic subscriptions are used where a provider organisation hosts a service which is commissioned to work with a particular cohort of the population

• CHIS providers are usually commissioned to provide a service for children who are registered with GP practices belonging to particular CCGs or who are resident in a particular CCG according to postcode. They therefore have two generic subscriptions, however NEMS de-duplicates at source so that the message is only sent once
• health visiting services are usually commissioned to cover children who are resident by postcode in a particular local authority. They will have one generic subscription
• DPCHRs usually use an explicit subscription for a child, however it is possible in the future that a CHIS provider or Integrated Care System (ICS) might commission a DPCHR provider for a particular geography

A generic subscription is also possible on an organisational basis, that is, relating to individuals who are registered with a specific organisation, but this is currently only applicable for GP organisations.

In terms of an age range for subscriptions, they work in the following way:

If the age range in the subscription is set to `0 – 20` and the patient’s date of birth is 20/08/2019 at 12:15:00 then the subscription will match if the date is between the following dates, 20/08/2019 – 20/08/2039.

The lower age is inclusive, but the upper age is only inclusive for the day on which the patient turns that age, so in the example above the subscription will match up to the patients birthday but will not match the day after.

Generic subscriptions are used where a provider organisation hosts a service which is commissioned to work with a particular cohort of the population.

A CCG merger is when two or more CCG areas are combined to create a new larger CCG. In this scenario the original CCGs effectively ceases to exist and a new CCG comes into existence. Such mergers are usually implemented at the beginning of a financial year and are usually known about up to 6 months in advance, thus there is time to plan in the change in subscription.

The information about what areas/postcodes a CCG covers is defined outside NEMS and NHS Digital and is release at regular intervals. NHS Digital takes a copy of the data when it is release and then applies it to the Spine so that the updated information can be used by Spine services such as the NEMS.

Impact to NEMS generic subscription

If a generic subscription has been created by a provider, which asks for event messages related to patients who fall within the remit of a CCG which is being replaced as part of the merger, when the CCG merger happens and that CCG no longer exist events will stop flowing based on those subscriptions because no patients will be associated with those CCG ODS codes, the patients will be associated with the NEW merged CCG ODS code.

Managing subscriptions

If a subscriber is going to be affected by the CCG merger, i.e. their existing generic subscriptions are for CCGs which are being replaced and the subscriber is going to be responsible for the new merged CCG, the subscriber needs to manage their subscriptions to maintain the feed of event messages.

The simple process which should be followed in to maintain that feed of event messages is as follows

• before the CCG merge occurs, and before the NHS Digital load the updated Office for National Statistics Postcode Directory (ONSPD) data onto the Spine, the subscriber should create a new generic subscription associated with the new merged CCG ODS code. This will mean that at the point the updated CCG mapping data is loaded onto the Spine the messages will start flowing for patients based on their association with the new CCG.
• after NHS Digital have loaded the updated ONSPD data onto the Spine and information is flowing based on the new subscription, the old subscriptions will now be redundant. These old generic subscriptions which include CCG ODS codes which no longer exist should be delete from the NEMS.

The non-NEMS birth notification application (BNA) process works on a different cohort of mothers/babies to the NEMS message. In the BNA each maternity unit is assigned a ‘partner Child Health Organisation (CHO) to whom its births will be sent regardless of where the mothers/babies actually live. The cohort is therefore ‘babies delivered in a particular maternity unit’. A CHIS will use one of 3 methods to check/receive their births from the maternity unit

• an HL7 message direct into the CHIS system
• subscription to a daily email from BNA to receive births as an attached spreadsheet
• logging on to the BNA application each morning to search for their births

If they receive births from their maternity unit partner who turn out not to reside in their area, they transfer them to the responsible CHIS.

If a child is not registered with a GP (up to 8 weeks old) then the Mother’s GP Practice CCG is used to determine if the record meets the REGISTERED generic subscription rule. If the baby remains unregistered with a Practice after 8 weeks, then they will only meet a RESIDENCY generic subscription rule.

By contrast, the NEMS birth notification message works off the mother/baby CCG based on postcode which maps to the CCG generic subscription set up on NEMs. It is a more accurate method of assigning the responsible CHIS.

If a CHIS is receiving the BNA HL7 message, it may request this is stopped at the time of cutover to NEMS. This does not pose a problem as the CHIS will continue to check their partner cohort by one of the other two methods. Once all CHIS are using NEMS, Discovery could be done on whether aspects of the BNA can be de-commissioned.

Any organisation wanting to do this will need to send an email to the National Service Desk at least 10 working days in advance of the go-live and the exact date and time of the stoppage needs to be coordinated with the organisation’s cutover plan.

DCH NEMS regression testing

To ensure that suppliers regularly keep up to date with Spine Releases and to allow them to test quickly we ask that suppliers put together a regression pack for NEMS that can be run during the Spine monthly integration test phase between the release being cut and deployed to Live.   The integration test window for each Spine release is known months in advance and can be planned for by suppliers accordingly.

This will be a re-usable strategy to mitigate the risk of both breaking changes that we are able to communicate and unintended impact to suppliers while we are making frequent changes to the code base.

It is important to understand that, even if a piece of development work is small (e.g. if an New Work Request (NWR) is sized as 10 days of work), the work will not be 'ready' or 'done' until it is tested and released in line with our release process.

Please email NHS Digital live services for the release details.

Using the iteration dates on this calendar, you can work out when the release cut will be taken, and when the live release will be scheduled.

As part of regression testing cycle it is advised that a regression testing pack for NHS Login is run weekly. This is for any supplier who uses NHS Login as part of their release. To be included in the NHS Login Release Note please email the NHS Login support team.  

Guidance on accessing the NEMS test tool, DEP environment and Smartcard configuration is available within the DCH NEMS Project Implementation Guide.

If using the NEMS test tool, please inform the test team of your activity so they can manage any updates to the tool outside of your testing window. Please contact [email protected]. 

To request a live MESH mailbox the supplier must complete the apply for a new MESH mailbox form.  You will need to also tick the box to confirm this is a digital child health request,  This process can take 10 days to be completed. 

Contact [email protected] to ensure that these are the latest workflow IDs.

The respond to and Initiator workflow IDs should also always be requested. 

Contact [email protected] to ensure that these are the latest CATBAG IDs for your Live ASIDs and Path to Live Environment endpoints.

When making changes to subscriptions using the API, please follow the best practice guidance

• always agree the subscriptions with your customer/end user organisation before implementation
• the changes must always be added to the NRL NEMS stakeholder rollout form and submitted to [email protected] for information purposes so the NEMS Controller Catalogue can be maintained.
• always test the changes in the DEP environment and carry out some end-to-end testing to ensure messages are flowing as expected
• when putting subscriptions into the LIVE environment, always put a subscription into LIVE before the deadline to ensure endpoints are correctly configured and avoid potential delays to cutover activities. The start date will avoid messages flowing prematurely.
• when managing a change to an ODS code on an existing subscription, always ensure the subscription end date is after the start the new ODS code is legally operating to ensure the changeover takes place successfully. Ensure the changes are updated into the Rollout form and submitted to [email protected]

As part of your conformance to your NHS Digital Connection Agreement you must share the Data Sharing Arrangement (DSA) with your customers that are implementing NEMS.  For the most recent version, please email [email protected] and cascade this to your customers, and user organisations.  A signed copy must be submitted by the customer as part of their on-boarding checklist process.

Read the Digital Child health transparency notice.