Core National Diabetes Audit

The Core NDA answers five important questions.

Also included within the Core NDA are three other components, the:

• Diabetes Prevention Programme
• Insulin Pump report
• Diabetes Care for people with Learning Disabilities and Severe Mental Illness

The NDA data is used for:

• clinical commissioning group (CCG) diabetes profiles
• Improvement and Assessment Framework (IAF) metrics
• cardiovascular disease commissioning for value focus packs
• Diabetes Outcomes Versus Expenditure (DOVE) tool – cost effective prescribing
• Care Quality Commission (CQC) and Getting It Right First Time (GIRFT) metrics

General practices and specialist services are required to participate in the audit using the General Practice Extraction Service (GPES). Secondary care and structured education providers submit data manually via the Clinical Audit Platform.

Patients included in the Core NDA

The Core NDA includes data recorded about all people of all ages with diagnosed diabetes in England and Wales before the audit period end date.

Included are:

• people with all types of diabetes mellitus, with the exclusion of gestational diabetes
• people who are at high risk of developing diabetes, either with a diagnosis of non-diabetic hyperglycaemia, impaired glucose tolerance or pre-diabetes
• information about referral and attendance on the Diabetes Prevention Programme (DPP) - this data is collected as part of the Core NDA primary care extract

Are children included in the NDA?

Although we collect data for all ages from primary care, we do not specifically collect data from paediatric specialist units. The Royal College of Physicians and Child Health (RCPCH) is commissioned to deliver the National Paediatric Diabetes Audit. We work closely with the RCPCH improve the care of children with diabetes.

NDA and the National Data Opt-out

The NDA is a mandatory collection for the NHS. NHS England uses powers under section 254 of the Health and Social Care Act 2012 to direct NHS Digital to collect the data. The information is required by NHS Digital under section 259 of the 2012 Act to comply with the National Diabetes Audit Directions 2017.

In line with section 259, all organisations in England that are in scope of the NDA Data Provision Notice, must comply with the requirement and provide information to NHS Digital in the form, manner and period specified.

We are obliged to apply the national data opt out if we supply the data onwards to any other organisation. For example, if a research body applies for NDA data via the Data Access Request Service (DARS) run by NHS Digital, then we are required to apply the NDO to the data before supplying the data extract to the research body. We do this by checking the patient cohort against the national register.

Raise awareness of the NDA

NHS Digital and Diabetes UK have created resources to help organisations inform their patients about the audit. Patient information leaflets and posters for display in your practice/clinic are available to download.

Diabetes UK produces a patient-friendly version of the audit reports.

The Core NDA collects:

• demographic (patient identifiable) data for the purpose of linking patient records across the audit
• the clinical observation data required to answer the agreed diabetes audit questions - this allows providers’ performance to be assessed against national defined standards of diabetes care

We combine the data received from primary and secondary care to create a single record for each individual.

Personal confidential data (date of birth, postcode) are also used to validate the NHS number as no information on the name of an individual is collected.

The data collection intervals for different services are described below.

Annual audit collection period

The Core NDA collects information for a 15-month audit period – for example:

• 2020-21 audit collects for the period 1 January 2020 to 31 March 2021
• 2021-22 audit collects for the period 1 January 2021 to 31 March 2022

Primary care data collection

The data is extracted quarterly from general practices via the General Practice Extraction Service. All eligible practices will receive an invite via the Calculating Quality Reporting Service (CQRS) to participate in the audit. Once the invite has been accepted the practice will automatically be included in all extracts for that audit period. Practices will need to "opt in" again at the start of each audit period. Exactly how this "opt-in" model will work depends on the clinical system used.

Find more information about how NHS Digital collects information from primary care practices.

Indicative timings for extraction are:

• November 2019: collection of data from January to September 2019
• February 2020: collection of data from January to December 2019
• May 2020: collection of full audit year data 

Primary care data collection

The data is extracted quarterly from general practices via the General Practice Extraction Service.

All eligible practices will receive an invite via the Calculating Quality Reporting Service (CQRS) to participate in the audit.

Once the invite has been accepted the practice will automatically be included in all extracts for that audit period. Practices will need to opt-in again at the start of each audit period. Exactly how this opt-in model will work depends on the clinical system used.

Find more information about how NHS Digital collects information from primary care practices.

Indicative timings for extraction are:

• November 2020: collection of data from January to September 2020
• February 2021: collection of data from January to December 2020
• May 2021: collection of full audit year data 

Actual dates of data extraction are subject to change without notice.

For general practice, the collection will be facilitated via the GPES. The NHS Digital NDA, Primary Care support, and GPES teams have worked together to define the specifications and timescales for the quarterly collections which will take place automatically according to the defined schedule.

Secondary care and specialist services data collection

Secondary care and specialist services have access to the Clinical Audit Platform which enables continuous data collection thought the audit year.

Data submitters can add updated clinical information as and when an individual patient has a new observation (such as blood pressure check and HbA1c reading), and there is also the option to complete a bulk upload of information at a suitable time (rather than waiting for a finite submission window). Data submitters will also be able to track their organisations progress throughout the year. 

There is a final cut-off date each year when the data will be extracted from all providers to build the reports from, but the providers will be able to continue to enter data at any time. 

Full guidance documents and the user registration form can be found below.  

Specialist diabetes out-patient services should work with their insulin pump clinics and either:

• add clinical information as and when a patient has a new observation
• complete the Specialist Service template for their hospital/trust, then use the "export to .csv" function to create 5 .csv files

The resulting files can then be uploaded the Clinical Audit Platform (users will first need to register for this platform).

For primary care, a full list of data items, including the SNOMED codes used for the extraction, are available in the Core NDA Business Rules document.

Services that only provide diabetes structured education services should register to have access to the Structured Education Portal (NDASE). 

Access to the Structured Education portal (National Diabetes Audit) is restricted to:

• organisations in England which only provide structured education services (and no other specialist diabetes services)
• any organisations in Wales which provide structured education services

If you are unsure which part of CAP you need to register for, please contact diabetes@nhs.net for guidance.

Structured Education providers should either:

• add attendance information as and when the patient is offered and attends a diabetes structured education programme
• complete the Structured education provider template

The resulting file can then be uploaded to the NDA Structured education portal. Users will first need to register to this platform.

Full guidance documents can be found below:

View the latest NDA reports

Analyse your data

The audit reports will provide you with information on audit participation in primary and secondary care/specialist services.

The audit reports will provide you with national level Information for:

• prevalence
• care process completion
• treatment target achievement (HbA1c, blood pressure, cholesterol)
• Referral and attendance at structured education
• comparisons for people with a learning disability compared to their peers
• comparisons for people with a severe mental illness compared to their peers
• complication rates (cardiovascular, amputations, ketoacidosis episodes)

It will also provide you with local-level information for:  

• registrations
• demographic distributions for age, diabetes type, social deprivation, ethnicity
• complications
• care process completion
• treatment target achievement

Data access requests

The Core NDA dataset is now available via the Data Access Request Service (DARS). This includes all published NDA data up to and including 2016-17. Full details of the process and how to apply are available on the DARS webpages.

To keep up to date with what’s happening in the NDA you can register your details with the team.

Please include your:

• name
• email address
• job title
• organisation name
• organisation code

Email this information to diabetes@nhs.net.

For further information about the audit email diabetes@nhs.net or call 0300 303 5678. Note that lines are open Monday to Friday 9am to 5pm.