NHS England North West commissioned MIAA to provide independent advisory support to the North West Clinical Coding Workstream to address long-standing variation in clinical coding job descriptions, pay banding, role titles and progression routes. The review provided:

• A standardised comparator framework and band-by-band role summaries for Bands 3–8b+.
• A capability matrix covering coding expertise, judgement, information quality, communication, leadership, autonomy and digital readiness.
• A clinical coding career pathway and transition roadmap to support succession planning.
• A band-specific training and development plan, including NCCQ, auditing, training, leadership, data analysis and AI-related skills.
• An options appraisal recommending full board-endorsed adoption of the framework as the preferred option.

The Challenge

Clinical coding underpins NHS reimbursement, audit readiness, data quality, service reporting, business intelligence, governance and organisational assurance. However, national clinical coding job profiles have not been significantly updated since Agenda for Change was introduced in 2004. Local evolution of roles has created inconsistent responsibilities, grading and career pathways, with some organisations disadvantaged by reliance on outdated profiles.

Working with regional clinical coding leads across Cheshire and Merseyside, Greater Manchester, and Lancashire and South Cumbria, the team coordinated evidence collection, stakeholder engagement and comparator analysis.  

Our Approach

The review established a coherent seven-level pathway: Band 3 developmental practice; Band 4 autonomous operational coding; Band 5 advanced expert practice; Band 6 specialist leadership; Band 7 service management; Band 8a trust-wide operational leadership; and Band 8b+ strategic corporate accountability. Three transition points were identified as particularly important for workforce planning: Bands 3→4, 5→6 and 7→8a/8b+.

The Outcome

The framework creates a practical basis for stronger consistency, assurance, capability and resilience across the clinical coding workforce.

• Consistency and job matching: Clearer differentiation of autonomy, complexity, leadership and organisational influence at each band.
• Workforce resilience: Better visibility of pipeline gaps, succession risks and specialist leadership capacity.
• Career progression: A transparent route from supervised learning to corporate leadership, including progression to Band 5 following successful NCCQ completion.
• Board assurance: Stronger line of sight over coding quality, audit readiness, reimbursement confidence and organisational reporting.
• Digital readiness: Greater emphasis on validation, exception handling, documentation quality, digital literacy and safe AI oversight.
• Regional and national influence: Evidence to support review of national Agenda for Change profiles and future workforce policy.

The Clinical Coding Standardisation Framework Programme demonstrates how independent advisory support can convert fragmented local evidence into a clear, future-facing workforce model. By combining regional engagement, detailed comparator analysis and practical implementation recommendations, MIAA created a platform for more consistent role design, stronger professional pathways, improved board assurance and safer adoption of AI-enabled coding. 

Client feedback

"I have found the Clinical Coding Workforce Project very valuable. One of the biggest benefits has been bringing Clinical Coding leads together to look collectively at the variation that exists across roles, banding, development and career progression, rather than individual organisations trying to address these issues in isolation.

The project has helped create a much clearer workforce and career framework from developmental coding roles through to specialist and strategic leadership. I particularly welcome the emphasis on training, succession planning and protecting the future Clinical Coding workforce as technology and AI begin to change how coding services operate. For me, the real value will be in how we now use this work. It provides a strong evidence base for organisations to review their own structures, identify gaps and develop clearer and more attractive career pathways for Clinical Coding staff.

MIAA’s facilitation has been a key part of this. They have provided the structure and independent support to bring the different organisations and perspectives together, coordinated the evidence and maintained focus on achieving a practical regional outcome. The collaborative approach has allowed us to share existing job descriptions, workforce information and career frameworks, identify areas of consistency and variation, and test the emerging findings with colleagues across the region."

Laura Siadankay, Head Of Clinical Coding
Liverpool University Hospital NHS Foundation Trust