Fit notes issued by GP practices in England - Extract specification

This specification provides detail on what has been extracted from GP systems. It is expected to be of interest to users who are familiar with NHS primary care systems.

An electronic fit note on a GP system is known as a Med3 file.

The extracted Med3 activity file comprises an envelope and a payload.  The following details the data items that are included in the practice envelope and each Med3 activity record.

Data items 

The fit note functionality in a GP practice system provides additional data fields for free text and patient information. These were considered too disclosive for the extract and are not included. 

Definitions 

• File: extract from supplier, contains many envelopes;
• Envelope: extract from a given GP Practice, contains the individual fit notes and header information;
• Fit note: individual Med3 extract.

File level validations

• If the fit note file does not correspond structurally to the schema then reject whole file
• If the GP practice code is not valid as per DSS corporate reference data then reject whole file
• Check record count per file is correct. If incorrect then the file should still be processed but flagged as a data quality issue to investigate.

Fit note level validations

• The ValidPeriodDays value (if supplied) must be no more than 4 digits in length and an integer, otherwise reject individual Med3.
• The ValidPeriodWeeks value (if supplied) must be no more than 3 digits in length and an integer, otherwise reject individual Med3.
• The ValidPeriodMonths value (if supplied) must be no more than 2 digits in length and an integer, otherwise reject individual Med3.
• The ValidPeriodIndefinite value (if supplied) must say 'INDEFINITE' (not case sensitive), otherwise reject individual Med3.

• If the Extract Date is before the Statement Date Time then reject individual Med3.
• If the Statement Date is before December 2014 then reject individual Med3.
• The data type for a given field must conform to the expected data type, otherwise reject individual Med3.
• The Med3 does not have 
  • ValidPeriodStartDate OR AssessmentDate

AND at least one of the following:

• ValidPeriodDays
• ValidPeriodWeeks
• ValidPeriodMonths
• ValidPeriodIndefinite 
• ValidPeriodEndDate

then reject individual eMed3.

• A single flag must be given for MFW or NFW, if both or neither are selected the eMed3 should be rejected.
• Issuer profession must be one of the following (not case sensitive): Doctor, Nurse, Physiotherapist, Occupational Therapist, Pharmacist. Otherwise reject individual eMed3.
• Sex field must contain one of the following: 0, 1, 2, 9. Otherwise reject individual eMed3.

File level deduplication

Duration calculation 

• If no ValidPeriodStartDate is supplied, or it = 01-01-1900, then AssessmentDate is used in it's place for the DurationDays calculation.
• IF ValidPeriodIndefinite is supplied THEN DurationDays = 0
• IF ValidPeriodIndefinite is not supplied AND (ValidPeriodDays + (days in ValidPeriodWeeks) + (days in ValidPeriodMonths)) >= (ValidPeriodEndDate – ValidPeriodStartDate) THEN DurationDays = (ValidPeriodDays + (days in ValidPeriodWeeks) + (days in ValidPeriodMonths))
• IF ValidPeriodIndefinite is not supplied AND (ValidPeriodEndDate – ValidPeriodStartDate) >= (ValidPeriodDays + (days in ValidPeriodWeeks) + (days in ValidPeriodMonths)) THEN DurationDays = (ValidPeriodEndDate – ValidPeriodStartDate)
• ELSE DurationDays = NULL - no else required as prior Validations ensures that this calculation is possible.

Code mapping to ICD10

Definition: fit note diagnostic codes need to be mapped to ICD10 and aggregated to a chapter level, and up sub-chapter codes. The extracted data includes diagnostic codes in the practice’s coding system. These are read clinical codes version 2 (Read) and clinical terms version 3 (CTV3) or SNOMED which is in the process of replacing Read and CTV3.

Business rule: These codes are mapped to the ICD10 coding system, using NHS England reference mapping tools.

Standards: NHS England reference mapping tools. Codes are updated by NHS England on a 6 monthly basis, and suppliers are expected to update their systems to incorporate new codes. Historical codes are not deleted.

NIS-retired codes: If data contains retired codes, as is likely for the historical data, where possible these will be mapped to the relevant ICD10 chapter even if mapping at sub-chapter level is not possible.

Linked fit notes

Assumption:  The same linking ID will be present for consecutive, as well as non-consecutive, fit notes.

Business rule: For calculating duration of a linked episode, two or more fit notes will be considered linked if:

• They have the same linking ID.
• They are consecutive, that is,
  • the statement date of the newer fit note is the within the period of the previous fit note, or
  • the statement date is the same as the end of the previous fit note, or
  • the statement date falls within 7 days of the end of the previous fit note.

If two fit notes have the same linking ID, but are more than 7 days apart, (end date and statement date) they will be considered separate episodes.

Where a patient moves practices, the linking ID will follow the patient if the fit note data is transmitted successfully by GP2GP record transfer.  In these cases, display of linked fit note data will take the GP Practice ID from the most recent individual Med3 in the episode.

In a series of linked fit notes, the gender and diagnosis code is taken from the first fit note in the series. The GP practice code is taken from the last fit note.