NHS Digital Data Release Register - reformatted

Swansea University

Project 1 — DARS-NIC-267223-D4Q3F

Opt outs honoured: No - data flow is not identifiable (Does not include the flow of confidential data)

Sensitive: Non Sensitive

When: 2020/09 — 2021/02.

Repeats: One-Off

Legal basis: Health and Social Care Act 2012 – s261(1) and s261(2)(b)(ii)

Categories: Anonymised - ICO code compliant


  • Hospital Episode Statistics Admitted Patient Care
  • Hospital Episode Statistics Accident and Emergency


The research described in this Agreement is an integral part of a wider study funded by the National Institute for Health Research (NIHR). The overall study is divided into separate work packages and Cardiff University, as the contact organisation with the NIHR for this study, is leading on Work Packages relating to the existing academic and practitioner literature, the intervention taxonomy, and the qualitative research. Swansea University is the lead organisation for study Work Packages involving quantitative research, including the work described in this Agreement. Cardiff University has been included as a joint data controller because of its involvement in the earlier phases in this study. Cardiff University jointly scoped the need for this project and determined why this project is required. Cardiff University will not receive or process any data under this Agreement but may provide advice as part of the study management team. Only Swansea University will process the data under this Agreement. The NIHR is funding this project. There is a steering committee which provides advice to each delegated work package responsible teams. As such the NIHR is not a data controller as it only provides advice as requested by the joint data controllers Cardiff University and Swansea University. Lawful basis under GDPR GDPR Article 6 (1) (e) states that processing is lawful if it is necessary for the performance of a task carried out in the public interest. Swansea University has determined that the use of data under this Agreement to undertake an assessment of the various methods of deploying General Practitioners (GPs) working within Emergency Departments (EDs) is in the public interest from both clinical and economic perspectives. Furthermore, the processing proposed is necessary to provide the data required to make this assessment. GDPR Article 9 (2) (j) states that processing of personal data is lawful if it is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes and proportionate to the aim pursued, respect the essence of the right to data protection. Swansea University has determined that the processing outlined in this Agreement will enable assessment of various GPs-in-EDs models currently in use at Emergency Departments. This assessment is both in the public interest (as explained above) and, by defining clear objectives for the statistical analysis of the data requested, the processing is proportionate to the study’s research aims. Swansea University is requesting HES Accident & Emergency and HES Admitted Patient Care data at record level in order to strengthen the evidence base on different service models of GPs-in-EDs. This study seeks to understand the impact of such services on patient health outcomes; their experience and safety, and the health services resource use and related cost of delivering these models. The overall aim of the study is to determine the clinical and cost effectiveness of GPs-in-EDs models and to understand the ways in which service design and setting (context) generate variations in outcomes. The study is intended to evaluate the ability of different GPs-in-EDs models to achieve the key outcomes described in an effective practice framework (addressing greatest health needs first; only doing what is needed; reducing inappropriate variation) and the resources needed to deliver these outcomes. Swansea University is requesting pseudonymised patient level data only for specified study sites which include twelve Emergency Departments in England. The data subjects are all individuals who have created HES episodes at A&E, possibly followed by admission, during the period of time requested and minimised to the providers listed below. Swansea University is requesting pseudonymised patient level data providing information on admission date and time, gender, age, health event date and time, visit status (first attendance or re-attendance), attendance category, primary diagnosis, investigations, treatment and disposition codes, and mainly non-sensitive information relating to subsequent admission, episodes and discharge. Swansea University is requesting one data item which is categorised as sensitive; this field will facilitate, through analysis of HES A&E and HES APC fields, a more complete understanding of patient assessment and treatment following presentation at study site EDs. All other data requested is pseudonymised, personal, record level, special category data. Swansea University will use this record level data to calculate various ED-specific estimates to be used as outcome measures to compare different GPs-in-EDs models. These measures, in the form of appropriate summary statistics, include the average patient age and gender split; the total number of ED attendances; admissions; proportion of re-attendances; average waiting times, and the proportion admitted as an inpatient to the same hospital. The study team has only requested HES A&E and HES APC data fields required to execute the study's Statistical and Health Economics Analysis Plan (SHEAP) as approved by the independent Study Scrutiny Committee. The study team have also limited the request to the work package window between 2010/11 and 2018/19. This window has been chosen to provide a time frame before the first intervention of GPs-in-EDs and after the last intervention. The time before and after is to be able to analyse the effect of using the GPs-in-EDs model, from prior and post intervention data. At the data extraction stage, the study team will only request data relating to presentations to and attendances at Emergency Departments (EDs) at twelve English study sites. The sites are listed below, along with the Site Provider codes which, to the best of the study team’s knowledge, were in use over the study period. The twelve sites are as listed below; this is the final list of study Emergency Departments in England. The twelve sites and codes are: 1. Musgrove Park Hospital (Taunton and Somerset NHS Foundation Trust); code RBA11 2. Friarage Hospital (South Tees Hospitals NHS Foundation Trust); code RTR45 3. Chichester Hospital (Western Sussex Hospitals NHS Foundation Trust); codes RYR16 & RYR51 4. Airedale General Hospital (Airedale NHS Foundation Trust); code RCF22 5. Queen Elizabeth Hospital (Gateshead Health NHS Foundation Trust); codes RR7EN & RR729 6. Royal United Hospitals (Royal United Hospitals Bath NHS Foundation Trust); codes RD1C3 & RD130 7. St. George's (St. George's University Hospitals NHS Foundation Trust); code RJ701 8. North Tees (North Tees and Hartlepool NHS Foundation Trust); codes RVWAE & RVWNA 9. Manchester Royal Infirmary (Manchester University NHS Foundation Trust); codes RM326 & R0A1F 10. Countess Of Chester Hospital (Countess of Chester Hospital NHS Foundation Trust); codes RJR05 & RJR45 11. Warwick Hospital (South Warwickshire NHS Foundation Trust); codes RJC02 & RJC05 12. Southport & Formby Hospital (Southport & Ormskirk Hospital NHS Foundation Trust); codes RBN51, RET26, RVY25, RTV1G, RVY01 & RVY1Y. Swansea University has determined that there is no alternative, less intrusive method of obtaining the various site-level characteristics required to achieve the study’s objectives.

Expected Benefits:

Increasing demand on the United Kingdom (UK) National Health Service, urgent and emergency services is testing the capacity of the system and there are concerns about the consequent ability to deliver good quality care. One of the recommendations in a joint report by the Royal Colleges of Emergency Medicine, Paediatrics and Child Health, Physicians and Surgeons to address these pressures is that every Emergency Department (ED) should have a co-located primary care facility. However, the evidence base to support different service models of General Practitioners (GPs) working within EDs (GPs-in-EDs models) is weak. Understanding the impact of such a service on patient health outcomes, experience and safety and the health services resource use and related cost of delivering these outcomes is important. This research is intended to evaluate the ability of GPs in the ED setting and different GP models to achieve key outcomes in an effective practice framework: namely, addressing greatest health needs first; only doing what is needed; reducing inappropriate variation; and co-production and the resources needed to deliver these outcomes. It is anticipated that the research findings (due February 2021) will be of immediate interest to policy makers, service commissioners and providers. The study’s findings have the potential to shape the provision of GP services in EDs at all Emergency Departments in the UK. The potential impact is, therefore, considerable, effectively extending to the entire general population. It is difficult, in advance of undertaking the cost-effectiveness analyses proposed in this study, to quantify with any precision potential costs and savings but, should the study’s findings lead to savings in the NHS-wide delivery of such services, then these are likely to be considerable. Any benefits arising from the study will be to the NHS. The NHS includes the NIHR (the study funder), NHS Digital, as well as the study sites. The study team will only benefit from cost or efficiency savings as members of the public, i.e. in the same way as other members of the public using the NHS. Benefits will be measured directly by specific study outcomes. These include the appropriate treatment of patients on arrival at EDs; appropriate referrals to further services, either in the ED or elsewhere; and in the proportion of patients returning to the ED within specified time intervals.


To meet a condition of the research funding, Swansea University will produce a comprehensive study report containing appropriate summaries of the study data (including HES data), and analysis of that data. The deadline for this report is February 2021. The report will also form the basis of academic articles to be submitted to high-quality peer-reviewed journals, conference presentations, and other outputs, as specified in the study's dissemination strategy. In addition to fulfilling the requirements to submit a definitive study report to its funder (NIHR, the National Institute for Health Research), the study team will seek simultaneously to publish the main study findings in appropriate high-impact academic journals. Given that these findings concern the provision of GP services, and hence will be of widespread interest, it is envisaged that target journals will include The Lancet, the British Medical Journal, the British Journal of General Practice, and the Annals of Emergency Medicine - all with an international readership. It is also the intention of the study team to present study findings at appropriate National and International conferences, such as those annually hosted by the Health Technology Assessment international (HTAi). The study team will summarise findings for dissemination to NHS organisations. The Universities anticipate the study will provide the evidence base for unscheduled care delivery in Emergency Departments in England and Wales, evaluating different models of GPs in or alongside EDs for their effectiveness and safety, good use of resources and sustainability, suitable for local contexts. The Universities will explore strategies for dissemination with the Stakeholder group and other senior advisors, consisting of senior policy and operational representatives of both nations and from Royal Colleges (Emergency Medicine, General Practitioners). It is likely that this will involve presentations at leading national conferences, as well as securing invitations to smaller seminars and local meetings to a variety of professional and lay audiences. Timing of these communications will be in agreement with the funder, the NIHR. The study team is obliged by the terms of its funding to liaise with the NIHR in order to maximise impact by synchronising the publication of major outputs. The current target date for submission of the funder’s report is February 2021 but the report’s publication timetable is dependent on the NIHR’s reviewing processes. Similarly, conference presentations on study results are also embargoed by the funder until publication of its report. The study team will further liaise with the funder on this matter, again with the view of maximising impact.


Record level, pseudonymised HES A&E and HES APC data - minimised as described above - will be extracted from the HES A&E and HES APC datasets and securely disseminated to Swansea University. The data from NHS Digital will be combined with the corresponding equivalent SAIL (record level pseudonymised data for the sole Welsh A&E site - a study control). There will be no linkage of this combined data and this combination will allow for analysis using a study ‘control’ site. Further manipulation of the combined data will be required to generate summary characteristics for the extended control group. These summary characteristics will then be reported. Swansea University will, in accordance with the study's Statistical and Health Economics Analysis Plan (SHEAP), then calculate various Emergency Department specific estimates to be used as outcome measures to compare different GPs-in-EDs models. These measures, in the form of appropriate summary statistics, include the average patient age and gender split, the total number of ED attendances, admissions, proportion of re-attendances, average waiting times, and the proportion admitted as an inpatient to the same hospital. For continuous outcomes, appropriate summary statistics will be analysed. There is no requirement to re-identify individuals, and no re-identification will be attempted. Data processing will only be performed by substantive employees of Swansea University, the sole data controller and sole data processor. These employees will possess appropriate, certified and SAIL-specified training in data protection and confidentiality, such as that provided by the Medical Research Council. All NHS Digital data will be stored, processed and accessed at Swansea University, with secure access to study researchers solely via the SAIL Gateway. Study researchers will be accredited Sail Gateway users, will have completed appropriate and certificated training on Research Data and Confidentiality, and will only be able to access the data through SAIL’s secure two-factor authentication processes. These processes involve the use of a personalised ‘Yubikey’ device, issued only to accredited SAIL Gateway users.