on behalf of all DHBs
SPECIALIST SURGICAL SERVICES GENERAL SURGERY SERVICE
TIER LEVEL TWO
SERVICE SPECIFICATION
STATUS:
MANDATORY 
Approved to be used for mandatory
nationwide description of services to be
provided.
Review History
Approved by Nationwide Service Framework
Coordinating Group (NCG)
Published on NSFL
Date
28 September 2010
September 2010
Review: of General Surgery Service Specification (2001)
Amendments: Standard Māori health, entry and exit criteria,
support services, service linkages table, quality requirements,
purchase units and reporting requirements. Added Specialist
Assessment and purchase unit code S00011
Consideration for next Service Specification Review
August 2010
within five years
Note: Contact the Service Specification Programme Manager, National Health Board Business
Unit, Ministry of Health to discuss the process and guidance available in developing new or
updating and revising existing service specifications.
Web site address Nationwide Service Framework Library: http://www.nsfl.health.govt.nz/
GENERAL SURGERY SERVICE
SPECIALIST SURGICAL SERVICES
TIER LEVELTWO
SERVICE SPECIFICATION
This tier two Specialist Surgical Services - General Surgery Service (the Service) service
specification must be used in conjunction with the overarching tier one Specialist Medical
and Surgical Services service specification. This Service is also linked to the Services for
Children and Young People service specifications and the tier three, Breast Cancer
Surgery Service Specification.
Refer to the tier one service specification headings for generic details on:








Service Objectives
Service Users
Access
Service Components
Service Linkages
Exclusions
Quality Requirements
Elective Services
The above heading sections are applicable to all service delivery.
1.
Service Definition
General surgery encompasses surgery of the skin, abdominal wall and cavity, the
gastrointestinal system, the peritoneum and its contents, the endocrine system, the breast
and vascular systems. In some secondary facilities general surgeons routinely perform
some head and neck, thorax, orthopaedics, plastic surgery, urology and gynaecology
procedures.
The Service provides surgical assessment and management of:

symptoms or signs, either chronic or acute, suggestive of disease or dysfunction in
the salivary, oesophageal, gastro-intestinal, hepato-biliary, breast, endocrine and
vascular systems as well as the integument, subcutaneous tissues or musculature

symptoms or signs of disease or dysfunction in other organ systems secondary to the
disorders above

acute and chronic pain of any cause

acute trauma not specifically designated above.
Assessment and management may require multidisciplinary input and clarity of the
responsibility for care co-ordination, with general surgery playing a greater or lesser role,
depending on specific needs of the patient.
2.
Service Objectives
2.1. General
The Service maintains an acute capacity to see and treat all cases referred on an urgent
basis in accordance with established clinical guidelines.
Specialist Surgical Services - General Surgery Service, tier two service specification. August 2010
Nationwide Service Framework
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2.2. Māori Health
Refer to tier one Specialist Medical and Surgical Services and Services for Children and
Young People service specifications.
3.
Service Users
Service users are eligible people who require assessment and treatment for a general
surgery condition.
The Service will maintain an acute capacity with the ability to see and treat all cases
referred on an urgent basis in accordance with established clinical guidelines. Acute
referrals will be accepted under these arrangements irrespective of domicile.
4.
Access
Refer to tier one Specialist Medical and Surgical Services and Services for Children and
Young People service specifications.
5.
Service Components
5.1. Processes
The management of an individual by the Service involves a complex sequence of
relationships and events. The level of intervention varies according to the individual’s
clinical condition, the qualification /training of medical /surgical staff, and the level of
clinical support available.
The Service is responsible for providing:

stabilisation and onward referral to an appropriate level of care as required or
stabilisation and definitive treatment of all patients and from time of presentation to
discharge back to the referring medical practitioner

assessment and diagnosis of patients in emergency and non-acute contexts. A close
liaison with specialist emergency services is necessary and easy access to
telephone or other consultation services for general practitioners / primary carers are
encouraged and expected

specialist assessment with a written plan of care

therapeutic procedures and post-procedure management

provision of appropriate after hours care to people undergoing day surgery,
including arrangements for re-admission where required

appropriate follow up and treatment of all patients undergoing surgery in line with
accepted standards of clinical practice and specialist follow-up and rehabilitation
including co-ordination of multi-disciplinary activity

follow up, re-admission and treatment of all patients where complications arise in
the course of treatment by the service (this may include appropriate referral to
higher level of care)

long term follow-up and revision treatment, as required, for surgery undertaken,
(this may include appropriate referral to other providers)

liaison with primary care providers.
Specialist Surgical Services - General Surgery Service, tier two service specification. August 2010
Nationwide Service Framework
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5.2. Support Services
The Service is supported by, but not limited to, the following service providers:


clinical support services such as:
–
laboratory services
–
pharmaceutical services
–
imaging services
allied heath support services such as:
–
occupational therapy
-
physiotherapy
-
social workers

ancillary services

interpreting services (including sign language.)
6.
Service Linkages
The Service should be well integrated with other general and specialist services and that
there is effective consultation, liaison and referral between services and sub-specialities.
Refer to the tier one Specialist Medical and Surgical Services service specification and
Services for Children and Young People service specifications.
The Service is required to establish effective links and working arrangements and
cooperation with, but not limited to, the following service providers:
Service Provider
Nature of Linkage
Accountabilities
Primary Health Care
services, General
Practitioners, Nurse
Practitioners, District Nurses
Other health professional
Specialists and registered
medical practitioners
Referral and consultation
Liaison with primary health care
organisations and community
based rehabilitation services
that support continuity of care.
Referral and consultation
Clinical consultation and referral
services that supports continuity
of care
Social services, counselling,
home help, community
services, new migrant
Community Health Workers
Referral and liaison
Assessment, treatment and
intervention that supports
seamless service delivery and
continuity of care
Community and social
services, District Nurses
Referral and liaison
Consumer support groups
Consumer support and
information
Assessment, treatment and
intervention that supports
seamless service delivery and
continuity of care
Effective regional linkages to
ensure patients access
appropriate services
Providers of Disability
Support Services
Referral
Liaison
Work collaboratively with
intellectual and other disability
Specialist Surgical Services - General Surgery Service, tier two service specification. August 2010
Nationwide Service Framework
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Service Provider
7.
Nature of Linkage
Accountabilities
Collaboration
support services and facilitate
access to those services when
needed.
Exclusions
Where people are eligible for services funded under the Injury Prevention, Rehabilitation,
and Compensation Act 2001, they are excluded from receiving the Service through public
funding under Vote: Health.
8.
Quality Requirements
The Service must comply with the Provider Quality Standards described in the Operational
Policy Framework or, as applicable, Crown Funding Agreement variations, contracts or
service level agreements.
9.
Purchase Units and Reporting Requirements
Purchase Units are defined in the joint DHB and Ministry’s Nationwide Service Framework
Purchase Unit Data Dictionary. The following Purchase Units apply to this Service:
PU Code
PU Description
PU Definition
Unit of
Measure
Unit of
Measure
Definition
S00001
General
Surgery Inpatient
Services
(DRGs)
Cost
Weighted
Discharge
A numerical
measure
representing the
relative cost of
treating a patient
through to
discharge.
S00002
General
Surgery (incl
Vascular
Surgery) - 1st
attendance
Attendance
Number of
attendances to a
clinic/department/ac
ute assessment unit.
National Non
Admitted
Patient
Collection
(NNPAC)
S00003
General
Surgery (incl
Vascular
Surgery) Subsequent
attendance
General
Surgery (excl
vascular
surgery) - 1st
attendance
DRG WIESNZ
Discharge. Additional
Information is found in
the NZ Casemix
Framework for Publicly
Funded Hospitals which
gets updated every
year.
First attendance to
general surgeon or
medical officer at
registrar level or above
or nurse practitioner for
specialist assessment.
Follow-up attendances
to general surgeon or
medical officer at
registrar level or above
or nurse practitioner.
Attendance
Number of
attendances to a
clinic/department/ac
ute assessment unit.
NNPAC
First attendance to
general surgeon or
medical officer at
registrar level or above
or nurse practitioner for
specialist assessment.
Follow-up attendances
to general surgeon or
medical officer at
registrar level or above
or nurse practitioner.
Attendance
Number of
attendances to a
clinic/department/ac
ute assessment unit.
NNPAC
Attendance
Number of
attendances to a
clinic/department/ac
ute assessment unit.
NNPAC
S00006
S00007
General
Surgery (excl
vascular
surgery) Subsequent
attendance
National
Collections or
Payment
Systems
National
Minimum Data
set (NMDS)
Specialist Surgical Services - General Surgery Service, tier two service specification. August 2010
Nationwide Service Framework
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PU Code
PU Description
PU Definition
Unit of
Measure
Unit of
Measure
Definition
S00008
Minor
Operations
Minor surgical
procedures
Procedure
S00009
Breast
Multidisciplinary
Clinic
Procedure - 1st
Attendance
Attendance
S00010
Breast
Multidisciplinary
Clinic
Procedure Subsequent
Attendance
Surgical non
contact First
Specialist
Assessment Any health
specialty
Provision of "one stop
shop" concept - access
to all relevant health
professionals,
diagnostics and a clear
treatment plan.
Provision of "one stop
shop" concept - access
to all relevant health
professionals,
diagnostics and a clear
treatment plan.
Following a request
from a GP or
community based
Nurse Practitioner, a
review by a registered
medical practitioner of
registrar level or above
or registered nurse
practitioner of patient
records and any
diagnostic test results,
development of a
written plan of care for
the patient and
provision of that plan
and other necessary
advice to the referring
GP or Nurse
Practitioner. This does
not include the triaging
of referral letters. The
patient should not be
present during the
assessment.
Number of
procedures
completed
Number of
attendances to a
clinic/department
/acute assessment
unit.
NOT PURCHASED
FOR NNPAC USE
ONLY - preadmission
visit for General
Surgery procedure paid
for as part of CWD
price
S00011
S00PRE
General
Surgery
Preadmission
visit
National
Collections or
Payment
Systems
NNPAC and
NMDS
NNPAC
Attendance
Number of
attendances to a
clinic/department
/acute assessment
unit.
NNPAC
Written
plan of care
Written plan of care
provided by the
specialist to the
referring GP
NNPAC
Attendance
Total number of
inpatient beds that
are available to be
occupied during the
period multiplied by
the number of days
they are available
during that period.
To be counted as
available the bed
must be resourced,
and either empty or
occupied by a user
of this service.
NMDS
Specialist Surgical Services - General Surgery Service, tier two service specification. August 2010
Nationwide Service Framework
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PU Code
PU Description
PU Definition
Unit of
Measure
Unit of
Measure
Definition
National
Collections or
Payment
Systems
NMDS
S00CANC
General
Surgery
Cancelled
Operation
Attendance
Number of
attendances at PreAdmission Clinic
S15001
Cardiothoracic Inpatient
Services
(DRGs)
Cost
Weighted
Discharge
A numerical
measure
representing the
relative cost of
treating a patient
through to discharge
NMDS
S15002
Cardiothoracic 1st attendance
Attendance
Number of
attendances to a
clinic/department/ac
ute assessment unit.
NNPAC
S15003
Cardiothoracic Subsequent
attendance
Attendance
Number of
attendances to a
clinic/department/ac
ute assessment unit.
NNPAC
S25CANC
ENT Cancelled
Operation
NOT PURCHASED
FOR COUNTING USE
ONLY - General
Surgery cancelled case
not expressly
purchased.
DRG WIESNZ
Discharge. Additional
Information is found in
the NZ Casemix
Framework for Publicly
Funded Hospitals which
gets updated every
year.
First attendance to
general surgeon or
medical officer at
registrar level or above
or nurse practitioner for
specialist assessment.
Follow-up attendances
to cardiothoracic
surgeon or medical
officer at registrar level
or above or nurse
practitioner.
NOT PURCHASED
FOR COUNTING USE
ONLY - ENT cancelled
case not expressly
purchased.
Attendance
Number of
attendances at PreAdmission Clinic
NNPAC
S25PRE
Otorhinolaryngo
logy /ENT
Preadmission
visit
Attendance
Number of
attendances at PreAdmission Clinic
NNPAC
S25001
Ear Nose and
Throat Inpatient
Services
(DRGs)
Cost
Weighted
Discharge
A numerical
measure
representing the
relative cost of
treating a patient
through to
discharge.
NMDS
S25002
Ear Nose and
Throat - 1st
attendance
Attendance
Number of
attendances to a
clinic/department/ac
ute assessment unit.
NNPAC
S25003
Ear Nose and
Throat Subsequent
attendance
NOT PURCHASED
FOR NNPAC USE
ONLY - preadmission
visit for
Otorhinolaryngology
/ENT procedure paid for
as part of CWD price
DRG WIESNZ
Discharge. Additional
Information is found in
the NZ Casemix
Framework for Publicly
Funded Hospitals which
gets updated every
year.
First attendance to ENT
surgeon or medical
officer at registrar level
or above or nurse
practitioner for
specialist assessment.
Follow-up attendances
to ENT surgeon or
medical officer at
registrar level or above
or nurse practitioner.
Attendance
Number of
attendances to a
clinic/department/ac
ute assessment unit.
NNPAC
Specialist Surgical Services - General Surgery Service, tier two service specification. August 2010
Nationwide Service Framework
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PU Code
PU Description
PU Definition
Unit of
Measure
Unit of
Measure
Definition
National
Collections or
Payment
Systems
NNPAC
S35PRE
Neurosurgery
Preadmission
visit
Attendance
Number of
attendances at PreAdmission Clinic
S35001
Neurosurgery Inpatient
Services
(DRGs)
Cost
Weighted
Discharges
A numerical
measure
representing the
relative cost of
treating a patient
through to
discharge.
NMDS
S35002
Neurosurgery 1st attendance
Attendance
Number of
attendances to a
clinic/department/ac
ute assessment unit.
NNPAC
S35003
Neurosurgery Subsequent
attendance
Attendance
Number of
attendances to a
clinic/department/ac
ute assessment unit.
NNPAC
S40CANC
Ophthalmology
Cancelled
Operation
NOT PURCHASED
FOR NNPAC USE
ONLY - preadmission
visit for Neurosurgery
procedure paid for as
part of CWD price
DRG WIESNZ
Discharge. Additional
Information is found in
the NZ Casemix
Framework for Publicly
Funded Hospitals which
gets updated every
year.
First attendance to
neurosurgeon or
medical officer at
registrar level or above
or nurse practitioner for
specialist assessment.
Follow-up attendances
to neurosurgeon or
medical officer at
registrar level or above
or nurse practitioner.
NOT PURCHASED
FOR COUNTING USE
ONLY - Ophthalmology
cancelled case not
expressly purchased.
Attendance
Number of
attendances at PreAdmission Clinic
NNPAC
S40PRE
Ophthalmology
Preadmission
visit
Attendance
Number of
attendances at PreAdmission Clinic
NNPAC
S40001
Ophthalmology
- Inpatient
Services
(DRGs)
Cost
Weighted
Discharge
A numerical
measure
representing the
relative cost of
treating a patient
through to
discharge.
NMDS
S40002
Ophthalmology
- 1st attendance
Attendance
Number of
attendances to a
clinic/department/ac
ute assessment unit.
NNPAC
S40003
Ophthalmology
- Subsequent
attendance
NOT PURCHASED
FOR NNPAC USE
ONLY - preadmission
visit for Ophthalmology
procedure paid for as
part of CWD price
DRG WIESNZ
Discharge. Additional
Information is found in
the NZ Casemix
Framework for Publicly
Funded Hospitals which
gets updated every
year.
First attendance to
ophthalmologist or
medical officer at
registrar level or above
or nurse practitioner for
specialist assessment.
First attendance to
ophthalmologist or
medical officer at
registrar level or above
or nurse practitioner for
specialist assessment.
Attendance
Number of
attendances to a
clinic/department/ac
ute assessment unit.
NNPAC
Specialist Surgical Services - General Surgery Service, tier two service specification. August 2010
Nationwide Service Framework
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PU Code
PU Description
PU Definition
Unit of
Measure
Unit of
Measure
Definition
National
Collections or
Payment
Systems
NNPAC
S40004
Minor Eye
Procedures
Procedure
An individual
operative/diagnostic/
assessment
procedure.
S40005
Eye Argon
Laser
Outpatient procedures
where the purpose of
the attendance is to
receive the procedure
and the patient is not
admitted. Excludes
laser treatments.
Laser eye procedures.
Includes YAG and
Argon. .
Procedure
NNPAC
S60004
Pulsed Dye
Laser
Treatment Initial
assessments
Attendance
S60005
Pulsed Dye
Laser
Treatment
Treatment
Number of
attendances for
treatment.
NNPAC
S60007
Plastic Surgery
Minor
Procedures
Procedure
The number of
individual
operative/diagnostic/
assessment
procedures in the
period.
NNPAC
S60PRE
Plastic Surgery
Preadmission
visit
Initial assessment by
appropriate clinician
and development of a
treatment plan for
children up to 18 years
with lesions that are
clearly visible from a
distance of 2 metres on
skin not usually covered
by clothing.
Treatment for children
up to 18 years with
lesions that are clearly
visible from a distance
of 2 metres on skin not
usually covered by
clothing.
Minor procedure
conducted under local
anaesthetic within an
outpatient setting.
Outpatient procedure
where the purpose of
the attendance is to
receive the procedure
and the patient is not
admitted. Includes
removal of lesion,
excision of lesion and
biopsy under local
anaesthetic.
NOT PURCHASED
FOR NNPAC USE
ONLY - preadmission
visit for Plastic Surgery
procedure paid for as
part of CWD price
An individual
operative/diagnostic/
assessment
procedure.
Individual
assessments.
Attendance
Number of
attendances to a
clinic/department/ac
ute assessment unit
or domiciliary.
NNPAC
S60CANC
Plastic Surgery
Cancelled
Operation
NOT PURCHASED
FOR COUNTING USE
ONLY - Plastic Surgery
cancelled case not
expressly purchased.
Attendance
Number of
attendances to a
clinic/department/ac
ute assessment unit
or domiciliary.
NNPAC
NNPAC
Specialist Surgical Services - General Surgery Service, tier two service specification. August 2010
Nationwide Service Framework
9
PU Code
PU Description
PU Definition
Unit of
Measure
Unit of
Measure
Definition
National
Collections or
Payment
Systems
NNPAC
S75CANC
Vascular
Surgery
Cancelled
Operation
Attendance
Number of
attendances at PreAdmission Clinic.
S75PRE
Vascular
Preadmission
visit
Attendance
Number of
attendances at PreAdmission Clinic.
NNPAC
S75001
Vascular
Surgery Inpatient
Services
(DRGs)
Cost
Weighted
Discharge
A numerical
measure
representing the
relative cost of
treating a patient
through to
discharge.
NMDS
S75002
Vascular
Surgery
Outpatient - 1st
attendance
Attendance
Number of
attendances to a
clinic/department/ac
ute assessment unit.
NNPAC
S75003
Vascular
Surgery
Outpatient Subsequent
attendance
NOT PURCHASED.
They are for
REPORTING to
NNPAC use only Vascular Surgery
cancelled case not
expressly purchased.
NOT PURCHASED.
They are for
REPORTING to
NNPAC USE ONLY preadmission visit for
Vascular procedure
paid for as part of CWD
price
DRG WIESNZ
Discharge. Additional
Information is found in
the NZ Casemix
Framework for Publicly
Funded Hospitals which
gets updated every
year.
First attendance to
vascular surgeon or
medical officer at
registrar level or above
or nurse practitioner for
specialist assessment.
Follow-up attendances
to Vascular surgeon or
medical officer at
registrar level or above
or nurse practitioner.
Attendance
Number of
attendances to a
clinic/department/ac
ute assessment unit.
NNPAC
SH01001
Sexual Health –
First Contact
Assessment, diagnosis
and education,
including any necessary
diagnostic tests, HIV
testing and necessary
pre-test counselling.
Contact
The number of face
to face contacts
between a health
professional and a
client or group of
clients, for the
provision of clinical
services. A contact
does not include:
phone consultations,
discussions
between health
professionals
regarding a client's
care, any contact
where the sole
purpose of the
contact is the
provision of supplies
or consumables.
NNPAC
Specialist Surgical Services - General Surgery Service, tier two service specification. August 2010
Nationwide Service Framework
10
PU Code
PU Description
PU Definition
Unit of
Measure
Unit of
Measure
Definition
SH01002
Sexual Health –
Follow Up
Treatment of patient
with diagnosed sexually
transmitted infections
(SFI), contact tracing,
counselling and
education or referral as
necessary.
Contact
MS01001
Nurse Led
Clinic
Assessment, treatment,
or education and/or
management clinics led
by a nurse specialist for
specialist groups of
Client excluding
Education &
Management of
diabetes, respiratory,
and cardiac Client that
are covered in other
purchase units. This
also excludes clinics led
by a Nurse Practitioner.
Attendance
The number of face
to face contacts
between a health
professional and a
client or group of
clients, for the
provision of clinical
services. A contact
does not include:
phone consultations,
discussions
between health
professionals
regarding a client's
care, any contact
where the sole
purpose of the
contact is the
provision of supplies
or consumables.
Number of
attendances to a
clinic/department/as
sessment unit.
MS02005
Gastroscopy Any health
specialty
Gastroscopy performed
as an outpatient or
elective day case
regardless of the Health
Specialty providing the
service, and not
provided under any
other purchase unit.
Additional information is
found in the NZ
Casemix Framework for
Publicly Funded
Hospitals which gets
updated every year.
Attendance
Number of
attendances to a
clinic, day ward,
department, or
acute assessment
unit.
National
Collections or
Payment
Systems
NNPAC
NNPAC
NNPAC
Specialist Surgical Services - General Surgery Service, tier two service specification. August 2010
Nationwide Service Framework
11
PU Code
PU Description
PU Definition
Unit of
Measure
Unit of
Measure
Definition
MS02007
Colonoscopy Any health
specialty
Colonoscopy performed
as an outpatient or
elective day case
regardless of the Health
Specialty providing the
service, and not
provided under any
other purchase unit.
Additional Information is
found in the NZ
Casemix Framework for
Publicly Funded
Hospitals which gets
updated every year.
Attendance
Number of
attendances to a
clinic, day ward,
department, or
acute assessment
unit.
National
Collections or
Payment
Systems
NNPAC
The Service must comply with the requirements of national data collections where
available.
Specialist Surgical Services - General Surgery Service, tier two service specification. August 2010
Nationwide Service Framework
12