General Practice - Practice Team Information (PTI)

Total contacts by staff discipline

The chart and table below show the estimated total numbers of face-to-face patient contacts for each staff discipline during each of the six financial years 2003/04 to 2008/09. GPs and practice-employed nurses combined had an estimated 23.5 million face-to-face contacts with patients in 2008/09 (with a 95% confidence interval of 22.5 to 24.4 million) with the nurses having a 30% share in this. This represents an increase of roughly 0.8 million per year compared to 2007/08 and 1.5 million compared to 2003/04, resuming the upwards trend that was observed from 2003/04 to 2006/07, but which was unexpectedly interrupted in 2007/08.

Estimated number of patient contacts ('Est' - millions) with the general practice team¹, including 95% confidence intervals ('CI');
Financial years 2003/04 to 2008/09 ^{2,3, 4}

¹ The general practice team includes GPs, practice nurses (PN), district nurses and health visitors. For PTI purposes, 'practice nurse' is defined as practice-employed nurses and their clinical assistants (e.g. phlebotomists and health care assistants), and 'GP' includes locums and registrars. District nurse and health visitor information is not available from 2006/07 onwards (for more detail see the What is PTI? page).
² Estimates are based on 59, 53, 51, 49, 48 and 58 PTI practices that submitted complete GP and practice nurse data for the years ending 31 March 2004, 2005, 2006, 2007, 2008 and 2009, respectively, and 46, 44, and 44 practices that submitted complete district nurse and health visitor data for the years ending 31 March 2004, 2005, and 2006 respectively. Figures are standardised by age, gender and deprivation.
³ Population source: Community Health Index (CHI) record, as at 30 September 2003, 2004, 2005, 2006, 2007 and 2008, respectively.
⁴ The rules to determine what records described a face-to-face contact and what records should be considered as administration were slightly updated in March 2010. This resulted in a net rise in the number of records being included in the analysis, and hence a slight increase of the estimated number of consultations. The new criteria have been applied to all new and historically collected information and hence the estimated overall numbers of contacts for the years 2003/04 to 2007/08 have risen slightly compared to figures published last year. Also, in March 2009 the statistical model used to calculate PTI estimates was updated so that figures produced from then onwards (including those on historic data) are not strictly comparable with those provided previously.  See the Note of Revisions for further information.

The estimated numbers of contacts generally rose for both GPs and practice-employed nurses between 2003/04 and 2008/09, although there was an interruption in this trend in 2007/08, in particular for practice-employed nurses. The number of GP contacts rose by 5.6% from 15.6 to 16.5 million over the six years, with only a small (but unanticipated) dip occurring in 2007/08. Estimated contacts with practice-employed nurses rose by 22.4% from 6.4 million in 2003/04 to 7.8 million in 2006/07, before a pronounced and unexpected drop to 6.7 million for 2007/08. The estimate for 2008/09 rose again to 7.0 million. Note that the confidence intervals for these estimates are fairly large, so some of these changes may be due to random variation.

However, the drop in 2007/08, particularly for practice nurses, was surprising, given the continuing shift of chronic disease management from GPs to nurses.  Two factors are likely to have caused a real fall in nurse contacts:

• There is some evidence that practices have become less likely to cover holidays and other absences of regular nurses by employing bank, agency or locum nurses, resulting in a reduction in the numbers of nurse contacts in the year. This is indicated, for example, in the results of the National Primary Care Workforce Survey 2009. Feedback from individual PTI practices also suggests that this is the case.
• Where PTI practices changed their practice IT system (from Gpass to either InPS-Vision or EMIS), brief practice closures during the period of switch-over will have caused short-term drops in contacts with both GPs and nurses. For PTI practices this would have been a particular issue during 2007, when a relatively large number of practices moved system.

Also, part of the reported decrease in nurse contacts is likely to be due to changes in data recording:

• Changes in the employment status of practice-based nurses can impact on whether these nurses record data on their patient consultations for PTI.  For example, some practice-employed nurses have either stopped recording consultations for PTI or their records were no longer captured when they become employees of the NHS Board, even though they continue to provide the same services in the practice.
• Face-to-face healthcare assistant or phlebotomist contacts may sometimes be misrecorded as 'administration' records (which are not included in PTI analyses).  This can occur where staff (with some clinical training) assist nurses in simple clinical tasks for part of the week, and undertake administrative tasks for the rest of the week. Feedback from individual PTI practices suggests this has become more common in recent years.

Source: Practice Team Information  (PTI), ISD Scotland (Last updated 30 March 2010)

Related information:
Excel version of this chart and table  (30KB)
Contact rates by staff discipline, by practice  

  

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