What is Practice Team Information (PTI)?

Practice Team Information (PTI) collects information from a sample of Scottish general practices about face-to-face consultations (in a surgery or the patient's home) between patients and a member of the practice team. The practice team is currently defined for PTI purposes as
- all GPs including locums and registrars (GPs in training), and
- practice-employed nurses and their clinical assistants (for example, phlebotomists and health care assistants) - referred to here as practice nurses for short. Some of the nurses employed by NHS Boards to work in specific practices may also record data for PTI.

PTI evolved from Continuous Morbidity Recording (CMR), a scheme that collected information on GP contacts only. CMR was first piloted in 1990 in a small number of practices in Scotland. By 1998 a large sample of practices, all using the GPASS (General Practice Administration System for Scotland) clinical IT system, were participating and the CMR dataset became recognised as a 'national' dataset. Recognising that members of the practice team other than GPs make a significant contribution to patient care, in 2001 ISD began a number of pilot projects in CMR practices to expand data recording to include patient contacts with practice nurses, district nurses and health visitors. This culminated in April 2003 in the original GP-based CMR being formally superseded by PTI.

Since 2003 the organisation of the health service, particularly in primary care, has been in constant change. As a result, district nurses and health visitors (collectively referred to as community nurses) found it increasingly difficult to record their patient contacts for PTI, in particular because they increasingly work across a geographical area and, unlike practices nurses, are not attached to just one or two practices. A number of practices stopped recording district nursing and/or health visitor data during 2006/07 and others considered leaving PTI due to the disproportionate amount of resource required to sustain this part of the data collection. To safeguard the survival of PTI, the decision was taken in 2007 to stop recording community nursing data and focus on GP and practice nurse data only. This means that there are now three years of data available on the wider practice team (2003/04 to 2005/06 inclusive) and six years of data on the more narrowly defined practice team (GPs and practice nurses only) (2003/04 to the latest year, 2008/09).

Another major change over recent years has been a shift away from the use of GPASS (NHS Scotland's national clinical IT system for general practices) towards other, commercial clinical IT systems.  Numerous practices across Scotland, including some of those participating in PTI, have moved to using InPS-Vision or EMIS systems and all practices are expected to have moved by March 2012. Of the 58 PTI practices that were used to calculate national estimates for the financial year 2008/09, 11 were using InPS-Vision and 3 were using EMIS. Data from non-GPASS practices were used for the first time for the publication of PTI figures on 31st March 2009, when data from nine practices using Vision were included.  The move to use data from IT systems other than GPASS has brought with it substantial challenges to the PTI team with regard to data extraction, processing, quality assurance and analysis from these different systems. However, inclusion of these data is essential for the continuation of PTI to preserve the broad representativeness of the PTI practice sample.

Currently just over 60 practices contribute to PTI, covering some 6 per cent of the Scottish population. Of these, 58 had complete GP and practice nurse data over the financial year April 2008 to March 2009. The total population in the practice sample is a reasonable reflection of the Scottish population with regards to age, gender and deprivation, and small imbalances due to these factors are addressed during data analysis through a process of direct standardisation (see the Statistical notes  page for more details).

PTI data can be used to estimate numbers of patients consulting and the number of consultations in Scotland, shown for individual years or as trends over time, overall or broken down by gender, age or deprivation, for any condition presenting to general practices in Scotland (subject to the limitations of clinical coding and/or of small numbers for some conditions). The data can also be used to determine the most commonly seen conditions/diseases.

PTI data are frequently sought to get an indication of population prevalence of a particular condition. However, PTI can only provide estimates of 'prevalence' of patients consulting rather than actual population prevalence (this is discussed in more detail in the section on Uses and limitations of the data ). If a wider range of staff disciplines is included, the estimated number of patients consulting is likely to be closer to the number of patients suffering from a condition (at least if some patients are seen exclusively by the additional disciplines). More information on this issue can be found on the page Impact of inclusion of more staff disciplines on patient counts.