The purpose of this page is to answer common questions from the GP practices and senior stakeholders about the joint National Services Scotland(NSS)/Public Health Scotland (PHS) project on GP In-Hours activity data. They include the original background to the project agreeing to begin looking at activity data, the approach to capturing data and the rollout of the new recording guidance and dashboard.
Overview
The pandemic highlighted the need for consistent, quality data which can be made available to practices, GP clusters, HSCPs, Health Boards and collated nationally to support sustainability and future planning of services. At the Scottish Local Medical Committees Conference in December 2020 the following motion was passed:
“That this conference acknowledges that the extent and volume of general practice workload remains unrecognised by health boards due to a lack of research data in primary care and calls on SGPC, SG and boards to work with relevant agencies to obtain accurate primary care data to allow appropriate service design.”
The primary purpose of data recording in GP practices is to accurately record information on patient’s health. However, there are many different ways the clinical information can be recorded in the IT systems which means that extracts of data from different practices are not necessarily compatible.
The initial phase of the GP In-Hours project focused on a data extract from practices to allow exploratory analysis of the data currently held. This helped inform subsequent phases to further analyse the accuracy of the data being recorded and agree revised encounter recording guidelines. Data extracts were initiated at the start of February 2022 for those practices who had not requested to be excluded from the project, and work continues to rollout national encounter recording guidelines for practices and work towards higher quality data nationally.
Since Feb 2022, a number of extracts of aggregated data have been taken from practices. The data includes information on the number of “encounters” where an encounter is anything from a face-to-face appointment with a GP to a medication review conducted without the patient present. The project team worked with a small number of GPs to process the encounter data into meaningful categories.
The preliminary in-hours general practice activity data was then shared with NHS Board Chief Executives and Health and Social Care Partnership (HSCP) Chief Officers on 12 September 2022 to illustrate the type of analyses possible. As this work is exploratory in nature, NHS Board and HSCP data were anonymised at that time. Following further consultation with the SGPC and the RCGP, it was agreed that this data will now be published and made available as experimental statistics at an NHS Board and HSCP level.
In addition to the national publication above, the project team took forward the creation of new encounter recording guidance. This was piloted in September 2022 with a group of practices to validate the draft guidance, and a number of GP stakeholder groups were also invited to review the proposed guidance. The guidance was launched to all practices in April 2023.
To help practices work with their own data, and better scrutinise local encounter recording an in-practice dashboard was developed and piloted alongside the guidance. The in-practice dashboard began being rolled out to practices in April 2023.
What data is being targeted from practices?
The GP In-hours activity project focuses on encounters/consultations delivered by GP practices in Scotland.
The in-practice dashboard utilises the following data items:
- the date of each encounter
- the type of each encounter
- the HCP role of the member of staff that recorded the encounter
The project team are also collecting regular aggregate extracts of encounter data from participating practices at health board/HSPC level.
Are all practices included in the planned work?
The work is being taken forward with the hope of including all practices nationally, however all practices were given the opportunity to deny permission for the national extracts and prevent their data being included in the initial analysis. Around 50 practices nationally opted not to allow the initial extracts, although many noted a willingness to be considered for future phases of the work.
All practices are being asked to follow the encounter recording guidance, and will be able to access the in-practice dashboard regardless of whether they chose not to participate in the national data extracts.
Is any patient identifying information being utilized for the planned analysis/extracts?
No. All data being extracted is non-identifiable and there are no plans for patient level data being utilized outside of the practice.
What are the plans for the extracted data?
Initial plans on the national extracts have completed exploratory analysis at an HSCP/board level to better understand the current position of activity data. It is understood that there is considerable variation between practices/health boards and that initial analysis will not be fully representative of activity or demand on practices across the country. At this stage the data is is considered Experimental Statistics – Guide to experimental statistics – Office for National Statistics (ons.gov.uk)
The intial work with the national data helped to inform the development of the new recording guidance and the in-practice dashboard now being rolled out for practices to be able to scrutinise their own data.
Are you also looking at appointment data?
At present the analysis is based only on encounter data as described above. It has been noted that appointment data could shed further light on the activity levels at practice, and work on appointment data may be taken forward in a future phase of work to further develop the analysis of activity generally.
How are we accessing the data from practices?
Albasoft are providing the data on behalf of NSS by utilizing their established “data-pump” extract tool. The data required will be targeted by Albasoft with an appropriate query, and the data will then be aggregated together at HSCP level before being passed to PHS for analysis.
No data is extracted for the provision of the in-practice dashboard which displays the practices own data with nothing leaving the practice.
Why is the data being collected via Albasoft?
Albasoft have a proven track record with their software having been used extensively during the COVID-19 vaccination programme to extract vaccine uptake data from GP practices. Albasoft also developed the Scottish Therapeutics Utility (STU) which has been in use for many years in Scotland. They are currently able to extract data from all practices across Scotland.
Does it draw from all clinical systems?
The extracts can be taken from both EMIS and VISION (the 2 major suppliers to GPs). It is known that some practices utilize additional “bolt-on” to capture appointment data, and this will not be targeted as a part of the initial extracts.
Can a practice participate in the national extracts after initially declining?
Yes. If a practice asked not to be included in the initial analysis, it is still possible for that practice to request to be included in future analysis. An email to the mailbox (nss.gpactivity@nhs.scot) highlighting the request to rejoin the work will be sufficient and ensure inclusion in future extracts.
What happened after the initial monthly extract was taken in Feb 2022?
NSS and PHS analysts worked with the data gathered and with pilot practices to explore data quality and current approaches to recording. Further monthly extracts and revisions to the initial analysis and mapping were carried out to better understand and refine reporting e.g. automated entries showing as practice activity and variation between clinical systems. The work has helped to inform the national publication and the development of the guidance and in-practice dashboard.
Who has been consulted on the planned work?
The plans for the project as a whole have been discussed and agreed with BMA Scottish General Practitioners Committee (SGPC) and the Royal College of General Practitioners (RCGP).
Was the plan always to publish data?
There were no plans to publish immediately after the extracts were initiated, as it was anticipated that the variation in recording and lack of data quality would prevent data being of a publishable standard. The phases of the work since that time have helped better understand and utilise the data available, and the choice now is to share the data nationally while acknowledging there is still considerable work to do to refine and improve data quality.
The project continues with teh rollout of the guidance and in-practice dashboard, and we will continue to work with practices to improve data recording and ensure data is available nationally at a level that allows for publication, which is in line the aims of RCGP Scotland and SGPC.
Who is the analysis being shared with?
The preliminary in-hours general practice activity data was shared with NHS Board Chief Executives and Health and Social Care Partnership (HSCP) Chief Officers on 12 September 2022 to illustrate the type of analyses possible. As this work is exploratory in nature, NHS Board and HSCP data were anonymised at that time.
The national data has since been released by Public Health Scotland on 6 December 2022 showing in-hours general practice activity from January 2018. It presents data extracted from participating practices across NHS Scotland for NHS Boards and HSCPs and is updating monthly.
Is practice level data being shared?
No. For the national extracts the data shared is not at practice level, but an aggregate of activity delivered by the practices at a Health Board and HSCP level. Cluster and Practice level data will not be available. We will work with SGPC and RCGP Scotland to agree any finer granularity of required summary data and write again to advise you in advance of plans to provide this information.
The In-practice dashboard will display each practice’s own data but nothing is shared outside of the practice.
What will be made available to review at practice level?
The in-practice dashboard provides breakdowns for encounters in the practice based on the following fields:
• the date of each encounter;
• the type of each encounter; and
• the HCP role of the member of staff that recorded the encounter.
The dashboard allows you to review and consider the above broken down in a number of ways, including different time periods.
The data may be inconsistent/incomplete at present, is that being anticipated in the analysis?
Yes. There are a lot of variation in recording of the information and PHS analysts will highlight where this is an issue in the national extracts. It is hoped providing practices access to the in-practice dashboard will help identify and resolve data quality issues going forward.
It is also understood that the initial extracts target only one measure of practice activity, without giving a full impression of activity/demand on practices. The below diagram has been highlighted as illustrative of what we might understand from the initial extracts and what would not be likely to be fully represented.
The hope is that future phases of the work will help to ensure the data being collected at practices can be understood and analysed correctly as a part of the wider picture of practice demand moving forward.
How do practices go about improving recording to better reflect the picture at practice level?
The new encoutner recording guidance document is a key reference point for all practices looking to review and quality assure their own data. Where possible practices should like to embed the new approach to recording in their practice. In addition, the in-practice dashboard will offer practices a quick reference point for assessing their own recording, and to assist with the resolution of recording issues at a local level.