General Practice - Practice Team Information (PTI)

How PTI data are collected

PTI data submissions are received from each general practice's clinical IT system on a monthly basis, which for most practices is a fully automatic process. Data are extracted on every recorded contact between a clinical member of the practice team and the patient. Although the practice can decide if the data are entered directly into the clinical system by the clinician or recorded onto a custom capture sheet for data entry by practice administrative staff, direct entry by the clinician is increasingly becoming the norm. All face-to-face contacts are recorded between patients (including temporary residents) and GPs (including locums and GPs in training) or practice-employed clinical staff (referred to for short as practice nurses but, also including, for example, phebotomists and health care assistants). From April 2003 to March 2006 contacts with community nurses were also recorded. Some of the nurses employed by NHS Boards to work in specific practices may have continued to record data for PTI, but thisis not always the case. The data include all house calls and out of hours contacts relating to the practice's own patients. However, entering data on telephone consultations is not mandatory for PTI, therefore PTI does not currently report on these.

Clinicians are asked to record the reason for the consultation, recording one or more signs, symptoms or diagnoses as applicable to each patient contact as specifically as possible. These are recorded in the practice computer system using the 'Read' clinical coding system. There is no physical limit to the number of Read codes that can be entered in respect of a single contact with a patient, but generally no more than ten codes are recorded for one consultation. More commonly, just one or two codes are recorded. Nursing staff are asked to record the main activity carried out during the consultation, along with the reason (diagnosis, symptom/sign) for this activity (if appropriate). PTI can provide a list of common nursing activities to assist correct data recording. GPs are generally not expected to record activities unless there is no specific morbidity (disease) associated with the activity (which is usually the case for, for example, giving vaccinations, over-45 health checks, etc.).

Currently, the majority of PTI practices still use the GPASS (General Practice Administration System for Scotland) clinical IT system to enter their data, but GPASS is being phased out and all practices are expected to migrate to another system by March 2012. A number of participating practices have already moved to other systems such as InPS Vision and EMIS and this number is now expected to increase rapidly.  Data can be extracted from all three systems for PTI purposes, but the procedures around data extraction and processing, quality assurance and subsequent analysis are still subject to further development. Information from clinical systems other than GPASS was first included in a PTI publication as part of the release on 31st March 2009. The largest changes were seen in the financial year 2007/08, when 9 of the practices moved to InPS-Vision, although the first PTI practice to move to Vision did so as far back as 2005.

PTI data are extracted from practices on a monthly basis and the team at ISD monitors the data continuously, aiming to provide timely feedback to practices regarding any obvious or potential data recording issues. This can include large drops in the number of records submitted, unusual combinations of codes, or cases where an activity (such as blood pressure measurement) is recorded but an associated reason for the activity (such as hypertension) is not. Practices receive regular reports on their data submissions as well as summaries of data recorded within their practice in comparison to national estimates. The data monitoring process has been adapted to include data submitted by practices using other systems than GPASS, but this process is still subject of further change as the team’s knowledge of these systems further develops and becomes tried and tested to the same extent as GPASS data. Findings from the data monitoring feed into the analysis methodology and therefore further fine-tuning of the analysis methods is also anticipated.

The PTI Quality Assurance (QA) procedures also include practice visits. Historically these focussed heavily on assessing the accuracy of clinical codes recorded in the electronic consultation record, as compared with narrative recorded in the patient record on signs, symptoms or diagnoses. The overall completeness of PTI data submissions was also examined, based on a comparison of contacts recorded in PTI data versus the number of filled patient appointments in the practice in the same period. This work was extremely labour-intensive, which meant that the PTI team could not make QA visits to all PTI practices on a regular basis. Additionally, the method of assessing coding accuracy became increasingly redundant as practices moved away from paper records towards paperless, or "paper-light" record keeping. Therefore the QA procedures were updated and as part of this, practices will be visited on an approximately yearly basis. The first cycle of ‘new style’ QA visits is due to be completed in April 2010. The focus is now more on assessing completeness of PTI data submissions and away from attempting to quantify coding accuracy. ISD's PTI team now spend more time meeting face to face with practice clinicians, managers and other staff to highlight and discuss any potential issues around recording data for PTI and to promote complete and accurate coding. To date, the findings of the visiting ISD staff and the feedback from practices who have received a new type QA visit have been very positive.  For more information on the PTI QA cycle, please contact the PTI team .

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