Which specialty?

For a long time, specialty has been a convenient way of summarising information on hospital activity. We talk about 'going to see a specialist', but what does 'specialty' actually mean?

Used correctly, specialty can provide a useful tool for grouping activity, for example into surgical and non-surgical care. But over time the specialty list had become out of date and out of step with the way in which care is provided.

Background

When the data sets from which HES is derived were originally established, an item termed Specialty Function code was included and became referred to colloquially as the 'main specialty'. Later, a second, data item came into being called the Consultant Specialty Function code and this became known as 'treatment specialty'. In many instances, organisations either didn't use the Consultant Specialty Function code or copied it exactly from the Specialty Function code. Both of these data items reflected information about the consultant providing the care and not about the care of the patient, yet it was for this purpose that specialty was typically used, especially at a national level for central returns.

In 2003, an NHS led group set out to revise the specialty codes so that they could be used either as a reliable means of describing the practitioner leading the patient's care or of categorising hospital services as delivered to patients. As a result, a Data Set Change Notice (DSCN 26/2003) was issued in which the old Specialty Function code became the Main Specialty. Main Specialty is that in which the consultant is contracted or recognised. The Main Specialty code list is taken from the European Specialist Medical Qualifications Order 1995 and the European Primary and Specialist Dental Qualifications Regulations 1998. There are also role specific main specialty codes that may be used to identify the work of non-consultant lead professionals such as midwives and nurses.

The old Consultant Specialty Function code was renamed Treatment Function Code and aims to describe the service within which the patient is treated, regardless of whether they are treated by consultant or non-consultant professionals and not dependent upon the qualifications or registration of a consultant. Treatment Function provides a rather more precise definition of the service in which the patient is treated.

Treatment Function

In order to become a Treatment Function a service has to fulfil most of the following criteria or characteristics:

• It must be a discrete and homogeneous area of clinical care that is definable in some way and which is meaningful to clinicians
• It must be an area of clinical care that could be used to describe the lead clinical responsibility for the care and treatment of patients. Non-clinical treatment functions are excluded.
• There is often a recognisable 'Department of...'
• Usually a treatment function is not a specific disease
• Usually a treatment function is not a specific type of treatment
• There has to be 'enough' activity nationally to warrant the introduction of a new treatment function. Similarly, some older treatment functions may in time be removed because there is no longer sufficient activity nationally to support it as a separate service.

Subspecialty and Clinic Type

It is quite possible and acceptable to have local 'sub-specialties' or 'clinic types' (when referring to Choose and Book) that do not qualify as treatment functions or main specialities, but which are of use for local purposes. The distinction between 'treatment function' and 'subspecialty' is not absolute, but is made with reference to the criteria listed above. In broad terms it is likely that they will have these features:

• Subspecialty: This is often an entity at the level of a specialist interest of a consultant, such as endocrine surgery or (unlike for treatment function) might even be a single condition, such as cystic fibrosis. Local usage is not regulated, but data sets containing subspecialties must include the treatment functions to which they map if the activity is to be valid for national purposes.
• Clinic type: These terms relate principally to the referral process, and therefore include terms that express the presenting nature of the clinical problem. They are regulated by the Choose and Book structure and must always map to treatment functions.

Change requests

The Treatment Function Maintenance Group, which is sponsored by The NHS Information Centre, meets regularly to consider change requests and to update or clarify the guidance on the use of the codes. Data Set Change Notices (DSCNs) are issued on the Connecting for Health website as and when necessary.

DSCN 10/2005 deals with a change in definition. Treatment function 308, formally known as Bone and Marrow Transplantation should now be called 'Blood and Marrow Transplantation'. This is with immediate effect.

DSCN 17/2005 (Implementation 1 April 2025) deals with a number of issues:

• The restoration of 190 Anaesthetics (outpatient activity only)
• Introduction of 211-291 Paediatric treatment functions
• 323 Spinal Injuries to be used by specialist units and outreach services only
• 810 Radiology has been removed

Furthermore, there are the following Psychiatric sub-divisions:

• 720 Eating Disorders
• 721 Addiction Services
• 722 Liason Psychiatry
• 723 Psychiatric Intensive Care
• 724 Perinatal Psychiatry

DSCN 02/2007 introduces new Treatment Function Codes:

• Clinical Physiology
• Clinical Neurophysiology
• Nuclear Medicine
• Diagnostic Imaging
• Audiology

In addition, Sleep Studies is renamed Respiratory Physiology.

Useful links

NHS Data Dictionary list of Main Specialty Codes and Treatment Function Codes