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 five financial years 2003/04 to 2007/08. Note that

• Figures shown here have not - unlike previous publications ? been adjusted upwards to reflect the small degree of under-recording for PTI found through historical Quality Assurance work. As a result the figures shown on this page will appear approximately 5% lower than previously published.
• Alongside all estimates we show for the first time the 95% confidence intervals (in brackets). These intervals indicate the range within which the true value is likely to lie.
• GPs are defined for PTI purposes as all GPs including locums and registrars (GPs in training). The label ?practice nurse? in this publication refers to practice-employed nurses and their clinical assistants (for example, phlebotomists and health care assistants).  District nurse and health visitor data are available only from 2003/04 to 2005/06 (these data are no longer collected as part of PTI - for more detail see the What is PTI? ).

GP and practice-employed nurses combined had an estimated 21.8 million face-to-face contacts with patients in 2007/08 (with a 95% confidence interval of 20.2 to 23.3 million) with the nurses having a 30% share in this. This represents a drop of roughly 1.4 million per year compared to 2006/07, which is a break with the increasing trend over the previous four years.

The drop in contacts with practice-employed nurses (from 7.4 to 6.5 million, or 13%) was much larger than for GP contacts (from 15.7 to 15.3 million, or nearly 3%). GP contact numbers were relatively stable from 2003/04 to 2007/08 and the fluctuation was not statistically significant when taking into account the confidence intervals around these estimates. In contrast, contacts with practice-employed nurses had been rising considerably up to 2006/07 and the sharp drop for 2007/08 is a significant break with this trend. This is surprising giving the continuing shift of chronic disease management from GPs to nurses.

There is no single explanation for the drop in GP contact numbers and in practice nurse contact numbers, but it could in part relate to practices changing their primary care IT system during the financial year 2007/08 from GPASS to InPS-Vision. During the changeover period a brief dip in the number of consultations could be expected due to practice closures for training days, system switchover, etc., or potentially also due to any teething problems in recording contacts for PTI on the new system.

The drop in practice nurse contacts could also be a result of it becoming less common for practices to employ a bank/agency/locum nurse to cover holidays, sick leave or other absences of their own nurse(s), resulting in a drop in the number of nursing contacts over the period of absence. This has been reported by a number of PTI practices. Other factors may be changes to nurse employment status and/or delegation of workload to clinicians not recording for PTI. For example, specialist nurses employed by the NHS Board to work in one or more practices will typically not record for PTI. Another factor could be an increase in clinical activities being mistaken for administrative entries due to administrative staff taking on basic clinical activities, like taking blood samples, without their staff identifier being updated to reflect this change in duties. Practice feedback suggests such changes are increasingly common.

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/locum nurses, resulting in a reduction in the numbers of nurse contacts in the year.
• Where PTI practices changed their practice IT system, brief practice closures during the period of switch-over will have caused short-term drops in contacts with both GPs and nurses.

However, part of the reported decrease 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 may stop recording consultations for PTI 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 / phlebotomist contacts may sometimes be misrecorded as ?administration? records (which are not included in PTI analysis).  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 practices suggests this has become more common in recent years.

Estimated number of patient contacts¹ (millions) with the general practice team², (including 95% confidence intervals³ );
Financial years 2003/04 to 2007/08⁴

¹ Based on 59, 53, 51, 49 and 47 PTI practices that submitted complete GP and practice nurse data for the years ending 31 March 2004, 2005, 2006, 2007 and 2008, 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. Contrary to figures published prior to 31st March 2009, these estimates are NOT adjusted for any under-recording found through Quality Assurance assessments, because this cannot be quantified consistently over recent years. Hence the figures shown are approximately 5% lower than these produced previously for the same time period.
² The general practice team includes GPs, practice nurses, 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.
³ As the estimates are based on data from a sample of practices, 95% confidence intervals are included to indicate the accuracy of these estimates.  For further information see the  Note of Revisions
⁴ Population source: Community Health Index (CHI) record, as at 30 September 2003, 2004, 2005, 2006 and 2007, respectively.

Note: Due to improvements made to the statistical model used to calculate PTI estimates for all years and the larger number of practices now included in the PTI sample for the years 2003/04 to 2005/06, figures shown here are not strictly comparable to these provided prior to 31 March 2009.  See the Note of Revisions for further information.

Source: Practice Team Information  (PTI), ISD Scotland (last updated 31 March 2009)

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

  

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