Letter from NHS England for action – accurate coding of diabetic patients issue

Please see the letter below from NHS England for action. You can also download it here.



Dear Colleague,

**ACTION REQUESTED – ACCURATE CODING OF DIABETIC PATIENTS ISSUE ** To complete the validation of your patients by 11th of July 2022

We are writing to you to request action to support the accurate coding of diabetic patients.

An issue has been identified relating to SNOMED coding in primary care and its impact on identification of eligible individuals for diabetic eye screening.

Explanation of identified issue and important Safety Action

The NHS Diabetic Eye Screening (DES) programme uses a software system called GP2DRSto accurately identify people with diabetes on your patient list who are eligible for eye screening. It does this by using SNOMED codes that are indicative of a diagnosis of diabetes.

In October 2021 an issue was highlighted where various SNOMED codes relating to “On examination diabetic foot” were found in patients’ notes in general practice but no other diagnostic diabetes codes were in their records. 

These codes do not trigger an invite for diabetic eye screening as they are not indicative on their own for a diagnosis of diabetes. However, a small percentage (approx. 5%) of these individuals do have diabetes but have no other diagnostic codes for diabetes on their GP electronic medical record. Therefore, the individuals with non-diagnostic codes for diabetes require validation and a diagnostic code for diabetes added to their medical record in their GP practice so they can be called for screening if appropriate.

Investigations indicate the majority of these non-diagnostic codes were added to pre-diabetic individuals or other non-diabetes conditions who do not require diabetic eye screening.

To help to rectify this issue, these codes have been removed from the GP2DRS SNOMED code set as they are not indicative on their own for a diagnosis of diabetes.

In order to support practices, NHS Digital Secure Electronic File Transfer (SEFT) system will be used to enable individual GP practices to receive the list of relevant patients registered at the practice (NHS numbers).

The GP practice can then add a diagnostic code for diabetes if appropriate to ensure individuals are referred to and receive diabetic eye screening.

Actions required
by 11th of July 2022.

Actions to be completed as soon as possible and no later than six weeks after receipt of communication.

  1. Complete registration request sent from NHS Digital’s Secure Electronic File Transfer (SEFT) service in order to securely receive a list of NHS numbers of patients registered at the practice affected by the issue.

NHS Digital SEFT team will send an email to the member of staff in the practice who recently submitted the practice’s annual electronic declaration. The practice will be provided with a SEFT user account. Once the SEFT user account has been established the practice will be able to login and download a list of NHS numbers of patients registered at the practice.

This email will be sent to the practice on 30th of May 2022 appearing from seft.team@nhs.net with “SEFT DES SNOMED CODING” issue in the email subject line. If you are unable to locate this email please contact seft.team@nhs.net

  1. Review and validate each patient to ensure that medical records are updated.

How to validate patients on GP IT software:

Search the record for each individual patient from the SEFT folder, using their NHS number and search text Diabet.

These patients will have one of the following 17 codes added to their record:

Review each patient record to determine if they do have diabetes. If they do have diabetes, add an additional and definitive Diagnosed with diabetes mellitus SNOMED code to their record. If they do not have diabetes no additional action is required.

Search for next patient until list is complete.

Then no further action is required.

Additional information

The list of patients was compiled on 04 January 2022 and some of these patients may have already been reviewed and coded correctly in the interim period.  If this has occurred no further action is required.

If the patient identified is no longer registered with your practice a PDS search will need to be undertaken and the new surgery informed of the coding issue.

GP practices should complete the validation of their patients by 11th of July 2022.

This action has been agreed following a multi-agency investigation into the data issue and the clinical guidance provided by Dr Peter Scanlon (National Clinical Lead for DES).

Thank you in advance for your help and support with this request.

If you have any questions about SEFT please contact seft.team@nhs.net, or for any other queries about the NHS Diabetic Eye Screening programme, please do not hesitate to contact your local screening and immunisation team or email the central DES team england.phs7apmo@nhs.net.


Yours sincerely,

Dr. Ursula Montgomery, Director of Primary Care

Patrick Rankin, National Programme Manager Diabetic Eye Screening Programme

Dr. Peter Scanlon, National Clinical Lead, Diabetic Eye Screening Programme