Page last updated: 25-MAR-2008

General Practice - Practice Team Information (PTI)

Uses and limitations of PTI

Uses

PTI provides routine, central recording of activity and morbidity in general practice in Scotland. PTI data are used by health boards and others within the NHS, the Scottish Government, charities, research and many other organisations and persons to inform policies and develop a better understanding of health and primary health care in Scotland. Some of the uses of PTI information are as follows:

  • 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 practice in Scotland, subject only to the limitation of small numbers for some conditions. The data can also be used to determine the most commonly seen conditions/diseases.
  • Records include a limited amount of information on the patient, allowing analysis to be carried out by age, gender and deprivation category. This sets PTI aside from the Quality & Outcomes Framework (QOF), which provides overall prevalence rates only, and makes PTI a valuable source of information to investigate demographics of patients with conditions included in the QOF clinical domains. The level of detail available on patients makes PTI a useful source of information for research.
  • The inclusion of nursing disciplines over and above GP recording gives a much more complete picture of patient care. Many chronic conditions are increasingly managed by nurses rather than GPs. Including nursing contacts in calculations of numbers of patients consulting for any given condition will result in figures that are closer to the population prevalence compared to analysis based on GP contacts only.
  • PTI records include a clinician identifier, allowing for analysis by staff discipline. Any shift in workload from one discipline to another can therefore easily be identified. Differences in the age, gender or deprivation profile of patients seen by each discipline can also be recognised.
  • PTI offers information on the number of patients consulting, but also on the number of consultations per patient, with any clinician within the practice team. This allows for a comparison between numbers of consultations for different conditions (by discipline), showing differences in workload for the same number of patients depending on the condition.
  • Because the date of each consultation is recorded, PTI offers an insight into changes of workload in the practice over the year.


Limitations

  • PTI estimates for a given condition are based on patients contacting a member of the practice team for that condition at some point during the year of interest. PTI measures active problems; a lifelong or previous condition will not be recorded unless the patient had a contact with the practice that was directly related to that condition. If, for example, someone with diabetes consults because of a cold and not because of diabetes, their diabetes will not be coded as a reason for consultation. PTI estimates of the rate of patients consulting should therefore not be regarded identical to the population prevalence. For conditions requiring regular intervention by primary care clinicians it may be close, but for stable and well-managed conditions requiring little or irregular intervention, or for conditions managed mainly outwith primary care, PTI figures are likely to be (substantially) lower than the true Scottish prevalence.
  • The number of practices participating in PTI is relatively small, and therefore the regional coverage is insufficient for the sample to be regarded as representative for any region. As a result, it is not possible to provide estimates for any region within Scotland, for example for individual NHS Board areas.
  • As PTI is based on a small sample of practices, it is not suitable for estimating the prevalence of rare conditions. Where there are only a small number of consultations observed within PTI practices for a specific condition, it would not be appropriate to use these as an estimate of the number of consultations for Scotland as a whole. 
  • Patient and contact rates are derived using population estimates based on the number of people registered with a general medical practice at the midway point of the financial year (30th September). Any person not registered with a practice at the time of the population extract would not be included in the population totals, e.g. a baby born after September or a person joining the practice after this date. Conversely, any person not yet removed from the practice list is included, e.g. a person who has moved away without notifying the practice. The latter category is likely to be larger than the former because there is an incentive to be registered with a medical practitioner (to obtain access to medical care). As a result the population size is likely to be slightly overestimated, resulting in a slight underestimation of patient and contact rates.
  • In common with many other health data sets, standardisation within PTI can take account only of measured factors that influence health status. Although standardisation can take account of differences in the distribution of age, gender and deprivation between the PTI sample and Scotland, there might well be other factors that influence the number of patients and contacts recorded for certain health conditions. Examples could be NHS Board (e.g. the way that services are configured) or other geographical factors. As outlined above, the PTI sample is too small to contain a representative sub-sample for each NHS Board and therefore if NHS Board policy has any effect, this cannot be accounted for. However, for most conditions the combined effect of age, gender and deprivation is thought to be far more important than any other factor.
  • Following a substantial review of PTI data processing and analysis in 2006/07, a new methodology has been developed for the analysis of PTI data. As a result, analyses continue to provide estimated numbers of contacts and patients but do not now include incidence estimates. For further information about the review and subsequent changes to analysis, see the Note of Revisions.