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National Casemix Office

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

Reference material - find out about our reference material downloads, along with links to our archived material.

HRG4+ 2017/18 Local Payment Grouper - download the latest Local Payment Grouper application and supporting documents.

Prescribed Specialised Services 2017/18 Operational Tool - download the latest Operational Tool application and supporting documents.

The term casemix means:

  • the mix of cases (patients) seen by a consultant, hospital or region
  • how patient care and treatments are classified into groups - these groups provide a useful measure on which to make performance comparisons, to cost healthcare, or to fund it

The NCO are commissioned to develop and maintain a set of casemix groupings, called Healthcare Resource Groups (HRG), which provide a clinically-endorsed view of acute healthcare activities undertaken within the NHS in England. These groups are generated via the Grouper software (the current version is HRG4+).

HRGs are designed by clinicians to 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

icon Find out more about what we do [689.45KB] .


Tools and applications

Although primarily focused on traditional acute hospital services, the NCO's remit has extended to cover the development of IAPT tools and software to support national patient initiatives.

It also produces software to allow Prescribed Specialised Services activity, as defined by NHS England's Clinical Reference Groups, to be identified from nationally mandated data flows.


The NCO has been commissioned to develop a Casemix Classification for Community Care - Community Health Groups - and is progressing this through the establishment of a Casemix Community Expert Reference Group. This will bring together providers and commissioners of community care, along with policy, to ensure developments are not only useful but can be used within the operating environment of the NHS.

What we produce

We have a downloads section where users can access Costing and Payment Groupers, in addition to the Prescribed Specialised Services Identification Tool and user support documentation.

Design framework

The icon design framework [924.07KB] informs major stakeholders, including NHS clinicians, the Department of Health Payment by Results team (PbR) and the Casemix Service, of the rules and criteria to be followed when designing classification systems.


Also in this section

Download reference material

Download Costing, Payment Groupers and the Prescribed Specialised Services Identification Tool, along with supporting documentation.

Analysis and reports

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

For questions about the National Casemix Office, or to register for updates, please contact

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