Reporting Data Item

Business Justification

Definition

Note: Where ‘NHS Wales Data Dictionary’ the definition is as per the Data Dictionary.

Permissible Values

2. REFERRAL

2.0

ENCDv4.5b (2.1)

SPCDv1.0

(6.1)

NOGCA

Source of (cancer) referral

To allow ‘tracking’ through the clinical pathway, to identify patterns of referral and to assist in audit and waiting times monitoring.

This is a classification which is used to identify the source of referral of each episode or referral.

Permissible values are agreed by the clinical steering groups and conform to the requirements of the reporting output specifications. Currently there is no explicit requirement to map to terminologies or classifications. This will be kept under review.

•      Following an emergency admission (includes all acute admissions via A&E (Accident & Emergency), Medical Admissions Unit, etc.)

•      Following a domiciliary visit by the consultant

•      Referral from General Medical Practitioner (for out-patient or other non-emergency referrals)

•      Referral from out-patients by a consultant, other than in an A&E department

•      Referral of an in-patient by a Consultant

•      Referral from screening services

•      Self-referral (i.e. the patient was not seen previously by a GP)

•      Other source of referral (will include referrals from Private Healthcare)

•      Following an A&E attendance (i.e. an out-patient clinic attendance after an A&E visit)

•      General Dental Practitioner

•      Community Dental Service

•      Not known

2.1

ENCDv4.5b (1.3)

SPCDv1.0

(2.2)

NOGCA

Organisation code (referred to)

To monitor the proportion of cancer patients referred to a cancer site specialist or cancer site specific team. To be able to report by hospital code.

Unique identifier for each organisation or site within an organisation.

NHS Wales Data Dictionary

2.2

ENCDv4.5b (2.7)

SPCDv1.0

(6.2)

Consultant code (referred to)

To monitor the proportion of cancer patients to each cancer site specialist.

This item relates to the consultant to whom the referral is made and who is responsible for the overall care of the patient. If the referral is to a team, then this refers to the first consultant seen.

This item uses the nationally agreed form for consultant code or Independent Nurse.  It is the General Medical Council (GMC) code for the Consultant or the GP acting as a Consultant or locum Consultant, which is the unique identifier. The nurse's Registration Number will be used to identify the Independent Nurse.

NHS Wales Data Dictionary

2.3

ENCDv4.5b (2.6)

Date of receipt of cancer referral

To establish the start date for the specialist-based diagnosis and management process. To identify length of delay in the handling or referrals. Audit for standards and monitoring Cancer Waiting time targets.

The date that the referral request is received by the provider. [Applies to all referral routes, not just from primary care]

•      Date when letter/fax/electronic form is received. In the case of a written referral, this should be the date on which the letter or fax arrived in the hospital. The most likely source of this date will be a date stamp of the receiving department on the referral letter.

•      Date of verbal request.

•      Date of admission to hospital in the case of patients admitted as an emergency

•      The date of the first out-patient appointment, if the referral was a self referral.

2.4

ENCDv4.5b (2.13)

GOCI

Presentation of disease at referral

Facilitates the algorithm utilised to support Annual Operating Framework data collection and submission.

Indicates the presentation of the disease at referral. Definitions of the permissible values are as follows:

•      New diagnosis: patients referred at the time of the initial diagnosis

•      Recurrent disease: patients referred at the time of recurrent disease (previous radical treatment with a disease free interval)

•      Longstanding disease: patients who have longstanding disease cared for by another specialist and recently referred for an oncologist opinion.

•      Other; to be used when none of the above apply i.e. if a patient moves into the area but has already received radical treatment elsewhere and is currently disease free and referred for follow-up only.

Permissible values are agreed by the clinical steering groups and conform to the requirements of the reporting output specifications. Currently there is no explicit requirement to map to terminologies or classifications. This will be kept under review.

•      New diagnosis*

screen detected

clinically detected

•      Recurrent disease

•      Long-standing disease

•      Other

*Additional permissible values for ‘New diagnosis’ will be dependent upon the tumour sites inclusion to the ‘National Screening Programme’.