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NHS Standard Contract

The Introduction of Intraoperative Fluid Management to the NHS Standard Contract

NHS England remains firmly committed to the continuation of a full implementation of the recommendations set out in Innovation, Health and Wealth: Accelerating Adoption and Diffusion in the NHS. As part of this, providers should “demonstrate to commissioners that “trajectories for the intra-operative fluid management (IOFM) technologies are in place, which are consistent with National Technology Adoption Centre (NTAC)”.  

As part of the NHS Standard Contract’s Updated Technical Guidance, “Each provider which has not yet completed implementation of the high-impact innovations set out in Innovation, Health and Wealth, Accelerating Adoption and Diffusion in the NHS must agree within an SDIP action that it will take during 2014/15 to complete full implementation of all the innovations relevant to its services”

The OPCS-4 classification has recently been updated, to accurately reflect current NHS clinical practice. The use of Intraoperative Fluid Management (IOFM) in the NHS has increased significantly in the last five years and is predicted to continue to do so.

Y73.6  Intraoperative Fluid Monitoring

NHS England has commissioned NICE to take over the work of the NHS Technology Adoption Centre (NTAC). NICE Guidance (MTG3) on the CardioQ-ODM states “ODM should be considered for use in patients undergoing major or high risk surgery or other surgical patients in whom a clinician would consider using invasive cardiovascular monitoring”. The NICE recommendation states substantial available cost-savings of £1,100 per patient and recommends the CardioQ-ODM Oesophageal Doppler Monitor to guide fluid optimisation during surgery in over 800,000 surgical procedures in England annually.

Kent, Surrey & Sussex Academic Health Science Network commissioned The Cedar Report on IOFM. The report describes ‘the technologies currently available to the NHS, and indicated for IOFM, and summarises the evidence from published randomised trials (RCTs) for their efficacy regarding changes in hospital length of stay and post-operative complications, compared to standard care.’ The report demonstrates the large volume of clinical evidence available for ODM. Cedar produced this document as part of a contract with NICE for evidence preparation and assessment services.

Ensure that all procedures using IOFM are properly coded, using OPCS4 code: Y73.6, to demonstrate compliance with your local Service Development and Improvement Plan (SDIP).


  1. NHS Standard Contract 2014/15 – Updated Technical Guidance, NHS England, 24/02/2014 NHS Standard Contract
  2. Summary of Changes OPCS-4.6 – OPCS-4.7, Clinical Classifications Service, 07/11/2013 OPCS 4.6 – 4.7