Integrated Care Boards (ICBs) and risk stratification

Risk stratification within the NHS refers to a process of applying algorithms and using tools to analyse data from multiple sources to identify high-risk patients who are likely to benefit from proactive care from their GP. The process uses national and GP data sources linked to a specific population to enable the early detection of patients at risk of conditions such as diabetes, heart disease or unplanned hospital admission. Risk stratification is used to improve overall health outcomes.

Risk stratification is undertaken at Integrated Care Board (ICB) level with the support of NHS England approved suppliers of risk stratification services. These services use risk stratification tools to analyse the data to identify patients at risk, before returning their details to their GP for appropriate follow up.

The risk stratification process covers the linking of GP data to national data collected from the Secondary Uses Service (SUS), which includes data from A&E attendance, emergency admissions, and mental health services.

This process requires the use of the NHS number to link multiple datasets and identify the higher risk patients that could benefit from targeted intervention in general practice. The NHS number acts as the key to identify an individual and for that reason the information used for risk stratification is treated as confidential.

Some patients will have their data analysed but the process will not lead to a care intervention. Therefore risk stratification is considered a purpose beyond individual care.

The use of data for purposes beyond individual care would usually require explicit patient consent. However, because it is not practical to seek explicit consent from a larger population, support can be sought under regulation 5 of the Health Service (Control of Patient Information) Regulations 2002. This is often known as section 251 support and requires an application to the Confidentiality Advisory Group (CAG).  Section 251 support enables the common law duty of confidentiality to be lifted for a period of time.

To support ICBs in this task, NHS England and system representatives have co-produced a user-friendly new risk stratification application template and supplementary information document for ICBs to use for their CAG applications.

The application template is populated with standard wording that has been approved by CAG and requires only minimal additions from each ICB. The ICBs can submit any specific wording, examples, or evidence needed to support their individual applications on the supplementary document provided along with the application template. The application template and the supplementary document must be completed and submitted together to CAG for assessment and approval.