General Practice - Practice Team Information (PTI)

Uses and limitations of PTI

Uses

PTI provides routine, central recording of activity (such as carrying out clinical checks or measurements) and morbidity (diagnoses, symptoms and signs) in general practices in Scotland. PTI data are used by the Scottish Government, NHS Boards and others within the NHS, charities, researchers and many others 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 and/or the availability of specific clinical codes to describe the condition. The data can also be used to determine the most commonly seen signs/symptoms/diagnoses in general practice.
• 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 counts of patient 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 information over and above GP recording gives a much more complete picture of patient care. In particular, the ongoing management of many chronic conditions is often covered 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 and gives a more complete picture of patient care.
• PTI records include a clinician identifier, allowing for analysis by staff discipline. Any shift in workload from one discipline to another can therefore be identified. Differences in the age, gender or deprivation profile of patients seen by each discipline can also be described.
• 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

• Patients consulting vs. prevalence.  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 may not be coded as a reason for consultation and the patient will not be included in the total number of patients consulting for diabetes during that year. 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.
• Small area estimates.  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 area smaller than the whole of Scotland. As a result, it is not possible to provide estimates for regions within Scotland, for example for individual NHS Board areas. However, there are other sources of information that provide health information on smaller geographical levels, for example ScotPHO (Public Health Observatory) provides public health intelligence at CHP (Community Health Partnership) level - see their website at http://www.scotpho.org.uk/home/Comparativehealth/Profiles/chp_profiles.asp.
• Rare conditions.   As PTI is based on a small sample of practices, and is therefore likely to give imprecise estimates of number of consultations or patients for rare conditions. This is clearly shown by the 95% confidence intervals shown for all estimates; for common conditions such as asthma these intervals are much smaller than for less common conditions such as multiple sclerosis. This should be considered when interpreting any figures shown on this website.
• Impact of local factors.  The fact that PTI is based on a small sample of practices in Scotland means that the data collected may be subject to significant fluctuations as a result of any factors that have an impact locally, such as departure of existing GPs or nurses, prolonged absences of staff (e.g. long term sick leave) or changes to the way that PTI practices manage their services. Although this effect is to some extent moderated by weighting contributions of individual practices to the overall estimates by their patient list size, there is still scope for these local factors to have a substantial impact on the overall estimates.
• Defining practice nurses.  Figures shown on the PTI website largely relate to consultations with GPs and practice nurses. For PTI purposes 'GPs' are defined as all GPs including locums and registrars (GPs in training), and 'practice nurses' as all practice-employed clinical staff other than GPs, including phlebotomists and health care assistants. The definition of practice nurse is not fully unambiguous, in that some nursing staff may be excluded although other staff with very similar workload but funded differently may be included. For example, a nurse working in the practice's treatment room may be funded by the NHS Board, and potentially work in other practices as well, and therefore generally not record for PTI.
• Age at consultation vs. age at fixed date.  Patient and contact rates are derived using population estimates based on the number of people registered with a general medical practice at the mid-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.
• Factors used in standardisation.  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 more important than any other factor.
• Changing methodology.  PTI data processing and analysis methods are under continuous review in order to deal with emerging knowledge of changes in recording practice. For the figures published on 30 March 2010 an updated set of rules was applied to determine what records described a face-to-face contact and what records should be considered as administration. 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 face-to-face consultations. For more details see Note of Revisions March 2010. These changes mean that figures shown on this website currently are not strictly comparable to these provided prior to 30 March 2010. The update of March 2009 saw more major changes with regard to analysis methods and inclusion of new data (details can be found in the Note of Revisions - March 2009). Similarly, in March 2008 PTI stopped reporting district nurse and health visitor information due to the feasibility of data recording by these disciplines becoming increasingly compromised (see Note of Revisions - March 2008). In March 2007 changes were made to the methodology regarding data filtering rules to deal with changes in recording practice (see Note of Revisions - March 2007). PTI analyses continued to provide estimated numbers of contacts and patients but from March 2007 onwards have not included incidence estimates. It is likely that because of other changes in primary care data recording, improvements in monitoring and quality assurance processes and technical advances the PTI analytical and data processing procedures will be subject to further change in the future.
  

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