NHS Digital's Denise Downs Discusses SNOMED CT and Primary Care

Last month FPM caught up with Denise Downs, Senior Terminology Implementation and Education Specialist for SNOMED at NHS Digital. We asked Denise what the next few months and even years are set to look like with SNOMED finally on the horizon for general practice.

SNOMED has been present in NHS policy and strategy documents for more than 15 years but, after more than a decade of planning, the transition date of April 2018 will soon be here. First Practice Management has been on the cusp of all the latest news for the implementation and decided to catch up with Denise Downs, one of the leading figures in the switch to SNOMED. 

Denise has been working tirelessly for the past few years promoting, educating and now implementing the new coding software. Find out what she had to say here! 



Away from the camera we asked Denise a few more questions to get further details on the state of the switch to SNOMED. Here's the first part of out chat, stay tuned to the FPM Blog for part two. 

Plus, why not learn more about award-winning training providers Thornfields' new 'Introduction to SNOMED' course here

Could you give us some background on why the switch to SNOMED is happening?

There are a number of reasons why we need to change. The main one is we need all the NHS to use the same clinical terms across electronic patient records; this will enable data to be exchanged electronically and still be processed in every system for things like decision support tools.

We currently have three different coding systems in use, which restricts the flow of data electronically and can mean data has to be converted manually from one set of codes to another - this results in text degrades as we see from GP2GP. It is a waste of resources to recode things at each system interface as well as centrally maintaining three coding systems and writing searches across the different sets of codes!

What will the cost savings from the switch look like?

Read codes are so pervasive that the extent of change is considerable; currently anything for general practice has to be done in at least two terminologies (Read v2 and CTV3). After transition these will only need to be done in one; for example clinical guidance, QOF business rules, clinical audit searches – this alone will represent a big saving.

Text degrades have to be managed by practices and once everyone is on SNOMED CT there is no need for text degrades other than if local codes are used, and these should only be used for terms that have local relevance so wouldn’t need to be coded anyway. It is difficult to quantify the savings nationally, but they will be substantial.

How will the switchover work, and how will it affect clinical systems?

Each supplier is currently developing deployment plans for how the switchover will be achieved; they will provide learning materials on system changes ahead of go-live. Suppliers are still undertaking the development for the change to SNOMED CT; more information will become available as development finishes.

Suppliers will undertake ‘first of type’ testing with volunteer practices before rolling out the solution more widely. NHS Digital are assuring system changes so that systems work as required. Practices will be given notice ahead of time of the change by their system supplier.

Will there be any entries that will not transfer?

Every clinical Read code in records will have an appropriate SNOMED CT code associated with it; however there are a small number of ambiguous terms that won’t be available for data entry in the SNOMED system. NHS Digital publish a data quality guidance document that goes through these and lists the reasons why they are no longer available.

What are the administrative implications following the switch?

End users undertaking data entry in the practice will probably find it useful to have an introduction to SNOMED CT prior to the switch. Suppliers will provide information about any screen changes, but we don’t expect there to be any major system changes and suppliers have undertaken user focus groups to get feedback on their proposed changes.

As previously mentioned there will be some types of codes that are no longer available; these are detailed in the data quality guidance. Practices should ensure those undertaking data entry are aware of this ahead of the change and possibly undertake data quality reviews.

Some Read codes map to inactive SNOMED CT codes (codes no longer available for data entry), if these are used by practices then it is important that users know what to enter instead. Your GP IT service provider should be able to help with this.

The actual system changes and any administrative changes required will be managed by the system supplier and they will communicate the approach to practices nearer the time. We do not expect there to be any administrative tasks in the way you may experience with a system migration.


Stay tuned for the second part of the interview coming soon! 

Don’t be left in the cold by the switch to SNOMED - be prepared, confident and clear on what the change will mean for you and your practice by signing up for Thornfields’ SNOMED Workshop.


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Practice Manager - Bristol, BS40 6HF

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Practice Manager - Bristol, BS40 6HF

Closing Date: 30 June 2020

Salary: £43,700

Practice Manager - London, Clerkenwell

Closing Date: 10 June 2020

Salary: According to experience

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