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Core National Diabetes Audit

The Core National Diabetes Audit (NDA) is one of the largest annual clinical audits in the world, integrating data from both primary and secondary care sources, making it the most comprehensive audit of its kind.

This audit is part of the National Diabetes Audit Programme.

Aims and objectives of the core audit

The Core NDA answers five important questions.

  1. Is everyone with diabetes diagnosed and recorded on a practice diabetes register?
  2. What percentage of people registered with diabetes received the nine National Institute of Health and Care Excellence (NICE) key processes of diabetes care?
  3. What percentage of people registered with diabetes achieved NICE defined treatment targets for glucose control, blood pressure and blood cholesterol? 
  4. What percentage of people registered with diabetes are offered and attend a structured education course? 
  5. For people with registered diabetes what are the rates of acute and long-term complications (disease outcomes)?

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

Participation in the audit

General practices and specialist services are required to participate in the audit using the General Practice Extraction Service (GPES). Secondary care 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.

Individual patients can still opt out of sharing their data for research and planning purposes

If you have opted out of sharing your data for research and planning purposes then it won’t be used within the NDA. Patients that previously had a “type 2 opt-out” have had it automatically converted to a national data opt out.

Find out more about the national data opt-out.

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 personal data we collect

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.

Core NDA data collection

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:

  • 2018-19 audit collected for the period 1 January 2018 to 31 March 2019
  • 2019-20 audit collects for the period 1 January 2019 to 31 March 2020
  • 2020-21 audit collects for the period 1 January 2020 to 31 March 2021

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 

Please note that actual dates of data extraction are subject to change without notice.

Secondary care and specialist services

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, 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 under Further information.

What you need to do for the next Core NDA data collection 

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.

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. For specialist services, a full list of data items is available in the Secondary Care CSV Specification.

Access the National Diabetes Audit reports

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.

Contact us

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
  • clinical system (if applicable)

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.

Related pages

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    Diabetes UK

    We are Diabetes UK. Our vision is a world where diabetes can do no harm. We’re leading the fight against the UK's biggest and growing health crisis.

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    Patient-friendly NDA reports - Diabetes UK

    Find out what reports have been published in the latest audits of diabetes care in England and Wales and download and read our easy-to-read versions aimed at people with diabetes and the general public.

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Last edited: 8 November 2019 2:40 pm