(Alpha) NHS England Demographics Implementation Guide

WARNING

Important: This guidance is under active development by NHS England and content may be added or updated on a regular basis.
This Implementation Guide is currently in Draft and SHOULD NOT be used for development or active implementation without express direction from NHS England.

Patient Registration

Actors, Transactions and Content Modules

Use Case

Following a healthy childhood and after completing his schooling, Joshua leaves home to start a new job in a nearby city. As part of starting his new job at his new company, Joshua registers with a local GP.

The GP receptionist will begin a patient registration process and this will often include completion of a form e.g. GMS1 Form. Once completed details on the form are used to retrieve the NHS England Patient Demographic record from PDS which is used to create a local demographic record. Other details on the form are used to populate the local EPR record (e.g. weight, smoking status, etc)

Process Flow

Pre-conditions:

GP Receptionist has access to the EPR/PAS. Receptionist is unable to find the patient on the EPR/PAS.

Main Flow:

Receptionist initiates the registration process and patient completes the registration form providing the necessary personal information, which the receptionist then uses to retrieve the PDS record. If a matching record is found, then the data is used to create a local EPR.

Post-conditions:

New patient's registration process is successfully completed. Create Patient is likely to be triggered.

Standards

Services

Register with a GP Surgery

The Register with a GP surgery service includes a set of mandated questions needed for patient registration with an NHS GP surgery.

Patients are also asked a series of questions based on their personal circumstances. Where possible the service uses information that the NHS already knows about the patient to reduce the number of questions they have to answer.

The questions asked during the online registration process are all that are needed to successfully progress a patient registration.

It is not possible for a patient to leave mandatory fields unanswered as the service uses data validation. This means that even if a patient's registration contains unanswered questions you should still have all the necessary information you need to progress their registration.

Here are the 4 categories of questions patients might come across:

Mandatory questions - these are essential questions asked to all patients.
Optional health questions - all patients are asked these questions, but they are optional to answer.
Extra questions - some patients may be asked extra questions based on their specific situation.
Customised questions - questions tailored to individual patient needs and circumstances.

More details of the questions asked can be found on the NHS Digital service pages

Examples

Examples generated for the Register with a GP Surgery service are linked below, including the form definition.

Process Map

The expected end-to-end process for the Register with a GP Surgery is detailed below:

Resource Constraints

The Register with a GP Surgery Form has been represented through a Questionnaire resource, developed using the LHC-Forms Form Builder Tool.

The draft Form Definition can be found on the IOPS FHIR Development and Testing Tool. It is expected this will be moved into an NHS England Forms Library once this has been developed. Please note that this definition is pending review from NHS England Data Standards and Terminology teams

Filling of the form should result in a QuestionnaireResponse resource. Guidance on the generation of a QuestionnaireResponse resource for Structured Data Capture can be found on the IHE Structured Data Capture pages.

Individual questions can be extracted from the QuestionnaireResponse in the form of other clinical/administrative resources, e.g. Patient for demographic details and Observation for specific patient reported observations. Examples of the QuestionnaireResponse and extracted resources are linked from the Examples page.

New NHS Number Allocation

Use Case

Name	Create a record for a new patient
Version	0.1
ID	n/a
Owner	NHS England. Team responsible for delivery – Demographics 101.
User Story Summary (Clinical Overview)	As a PDS FHIR user with Healthcare Worker Access I want a new NHS number to be allocated for individuals, when no existing NHS number exists So that the individual's medical information can be attached to an NHS number
Actors (Role)	Healthcare professional (excluding GPs)
Frequency of Use	Used daily by multiple NHS trusts.
Triggers	Secondary healthcare provider searches for an individual (for example, using the 'Search for a patient' endpoint in the PDS FHIR API). If an NHS number is not found, then a request to allocate a new NHS number is submitted. Likely use cases for requesting a new NHS number through primary care are adoption, gender reassignment, unhoused individuals seeking medical care, or a new NHS number being required due to domestic violence or witness protection. As part of a birth registration. 'Birth Notice allocation' (BNA) in NCRS (National Care Record Service) or the 'Birth Notice allocation endpoint in PDS HL7 is used for this. For a visitor or migrant to the UK. NHS number will be created as part of the Home Office immigration data feed.
Pre Conditions	Patient is seeking medical care. Patient's demographics information is known, such as name, gender, date of birth address, and communication details. Healthcare work has attempted to locate Patient but has been unable to find an existing NHS number.
Post Conditions	Patient's medical data can be attached to a NHS number on local systems.
Main Course	If no NHS number exists for the submitted individual, a new NHS number is allocated and returned to the user.
Alternate Course	If a single NHS number exists for the supplied demographic data, then this found NHS number is returned to the user.
Exception	If multiple NHS numbers are found for the supplied demographic data, then an error message is returned to the user.

Process Map

This page is to aid vendors in creating a new patient within PDS.

Framework	FHIR Interaction	FHIR Profile
IHE PIXm	RESTful API	Profile-England-Patient-PDS

Patient Constraints

The items stated are the mandatory elements for the profile https://fhir.nhs.uk/England/StructureDefinition/England-Patient-PDS. These are the differentials only, see the Profile for more details

element	min
Patient.name	1
Patient.gender	1
Patient.birthDate	1
Patient.address	1

Examples

New patient with Minimum Information Required

New patient with Interpreter Required

Programmes

Personal Demographic Service (PDS)

Access patients' personal information, such as name, address, date of birth, related people, registered GP, nominated pharmacy and NHS number using the FHIR version of the Personal Demographics Service API.

Personal Demographics Service- FHIR API