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National Casemix Office

The National Casemix Office (NCO) designs and refines classifications used to describe NHS healthcare activity in England. These classifications underpin the national reimbursement system from costing through to payment, and support local commissioning and performance management.

Download Groupers and tools - download the latest HRG4+ Costing or Payment Groupers and the latest Prescribed Specialised Services Tool, along with supporting documents.

Our definitions, remit and deliverables - this page contains the science of casemix, the design framework and details of our stakeholder engagement, along with more information about casemix.

Casemix analytics - find additional information, including the clinical appraisals carried out on the Reference Costs collections which evaluate the performance of HRG4+.

Improving Access to Psychological Therapies (IAPT) payment and outcomes tool - find out more about the payment and outcomes tool tool that supports the Improving Access to Psychological Therapies (IAPT) payment model.

Casemix describes the mix of patients seen by a consultant, hospital or region, and how this patient care and treatment can then be classified into groups. These manageable groups provide a useful measure on which to make performance comparisons, to cost healthcare, or to fund it. Within the English NHS, these groupings are called Healthcare Resource Groups (HRGs) and are created and maintained by the NCO. 

The NCO are commissioned to create casemix currencies and the associated software to apply the design algorithms by NHS England. The HRGs provide a clinically-endorsed view of acute healthcare activities undertaken within the English NHS, which underpins both the National Reference Costs collection and the National Reimbursement System. The most current version is HRG4+. 

The NCO engages with more than 250 healthcare professionals via Expert Working Groups (EWGs) covering all clinical areas. The HRG designs are updated annually and represent clinical care, within the boundaries of available, nationally mandated data. The HRG4+ classification can acknowledge the additional resource use required when treating patients who:

  • have multiple complications and comorbidities that affect the clinical input for their care
  • require surgery at a very young age
  • require multiple procedures undertaken at the same time, within the same hospital admission or attendance
  • require surgery that utilises new devices, or innovation in the traditional clinical approach
  • require more complex care

Register for updates

Register for updates about the latest Grouper releases and casemix products. When a new Grouper product is released, you will be contacted via email.

Also in this section

Downloads - Groupers and tools

Download the latest HRG4+ Costing or Payment Groupers and the latest Prescribed Specialised Services Tool, along with their supporting documents.

Our definitions, remit and deliverables

Find out more about the National Casemix Office (NCO), its context within the health service, casemix methodology and the development and design of HRGs.

Casemix analytics

Find news, information and downloads related to our latest analysis and reports.

Improving Access to Psychological Therapies payment and outcomes tool

Find out more about the payment and outcomes tool that supports the Improving Access to Psychological Therapies (IAPT) payment model, which the National Casemix Office (NCO) is commissioned to provide.

Register for updates

Register here and keep up-to-date with the latest Grouper releases and casemix products. When a new Grouper product is released, you will be contacted via email.

If you have a question about our Grouper products, please call 0300 303 5678 or email enquiries@nhsdigital.nhs.uk.

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