Page last updated: 25-MAR-2008

General Practice - Practice Team Information (PTI)

 

Statistical Publication Notice

25 March 2008

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Practice Team Information (PTI) Yearly Update (2006/07)


INTRODUCTION

Practice Team Information (PTI) provides routine, central recording of activity (consultations and treatment) and morbidity (types of illness) from a sample of general practices in Scotland, which is used to calculate national estimates for Scotland. These estimates are used by NHS Boards and others within the NHS, the Scottish Government, charities, research and many other organisations and people to inform policies and develop a better understanding of health and primary health care in Scotland. The website provides information on the process of data collection and analysis and shows estimates of the numbers of patients consulting and the numbers of consultations, by age and gender, staff discipline, practice or condition. This information is updated annually to include new data and to apply any improved methodology.

KEY POINTS

  • GP and practice nurses together had an estimated total of 23.7 million face-to-face contacts with patients in 2006/07. This represents an increase of roughly 400,000 per year from the 22.6 million estimated for 2003/04. Practice nurses have a large share of the activity, with almost half as many consultations as GPs.
  • Of the patients registered with a practice, over 8 in 10 (82%) had at least one face-to-face contact with a GP or practice nurse 2006/07.  The average (mean) number of contacts per registered patient was 4.1.
  • Generally, contact rates are much higher in females compared to males, and increase with age.
  • The most commonly recorded reason for a GP consultation is for digestive/abdominal symptoms and signs. Practice nurses mainly see patients with chronic conditions, and of these the most frequently recorded is high blood pressure (hypertension). More than 30% of their contacts are for conditions related to the new GP contract (QOF). Their most common activity is taking blood samples.

INTERPRETATION

The figures shown on the website are estimates based on a relatively small sample of Scottish practices. Although the population of the PTI practices is broadly representative of Scotland with regard to age, gender and deprivation, there may be other factors of local importance that are not taken into account. Care should therefore be taken with the interpretation of the figures, in particular when small numbers are involved.

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 as 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 main change for 2006/07 data compared to previous years is the absence of community nursing (district nurse & health visitor) information. Due mainly to ongoing changes in the way the service is organised, community nurses found it increasingly difficult to record their patient contacts for PTI. A number of practices stopped recording district nursing and/or health visitor data during 2006/07 and others considered leaving PTI because of the disproportionate amount of resource required to sustain this type of data collection. To safeguard the survival of PTI at least in a reduced form, at 1 April 2007 collection of district nursing and health visitor data was therefore stopped. Unfortunately, the completeness of the community nursing data still collected over the year 2006/07 was insufficient to allow calculation of nationally representative estimates. Hence, the 2006/07 figures are based on GP and practice nurse data only. Comparable figures are provided for the previous three financial years. For 2003/04 to 2005/06, also shown are estimates based on the ?full? practice team. ISD Scotland is engaged in ongoing efforts to collect data from community nursing professionals via developing a Community Nursing Census.

DETAILED FINDINGS

  • GP and practice nurses together had a total estimated 23.7 million face-to-face contacts with patients in 2006/07. This represents an increase of roughly 400,000 per year from the 22.6 million estimated for 2003/04. Practice nurses have a large share of the activity, with almost half as many consultations as GPs. The 23.7 million total for 2006/07 breaks down to about 16.0 million contacts for GPs and 7.7 million contacts for practice nurses. Whereas GP contact numbers appeared to decrease slightly between 2003/04 and 2005/06 (from 16.0 million to 15.7 million), by 2006/07 they were back up to the same level as in 2003/04.   In contrast, the number of practice nurse contacts has been rising continuously over the four years for which these data have been collected (from 6.5 million in 2003/04 to 7.7 million in 2006/07, although the rise between 2005/06 and 2006/07 has not been as evident as in previous years.
  • Of the patients registered with a practice, over 8 in 10 (82%) had at least one face-to-face contact with a GP or practice nurse in 2006/07. The overall average (mean) number of contacts per registered patient was 4.1; this average does however include those patients not visiting their practice at all. Over three quarters of registered patients (76%) saw a GP at least once during the year, and for these patients the median number of GP contacts was 3. Less than 5% of these patients had more than 10 contacts in the year. More than 44% of registered patients saw a practice nurse at least once during the year, and these patients had a median of 3.0 practice nurse contacts in the year, with 3% of these patients having more than 10 contacts. However, these figures can vary greatly between practices.
  • Apart from the youngest and oldest age groups, contact rates are (much) higher in females compared to males. Contact rates are lowest in the 5-14 year age band (less than 2 GP or practice nurse contacts per year) and highest in the oldest age band of 75 plus (over 8 per year).
  • The most frequent reason to visit a GP is for digestive/abdominal symptoms and signs, but when combining GP and practice nurse data, hypertension is the most common reason for a consultation. The most common activity for practice nurses is taking blood samples.
  • Contacts for QOF-related conditions represent nearly a quarter of all GP and practice nurse contacts. Practice nurses are increasingly involved in managing chronic conditions, and more than 30% of their contacts are for QOF-related conditons. However, these figures also illustrate that whilst the management of the chronic conditions included in the QOF accounts for a substantial part of the practice workload, the QOF by no means covers all conditions encountered in general practice.
  • For many of the individual conditions for which data are presented, the estimated number of contacts for GPs and Practice Nurses combined decreased between 2003/04 and 2006/07. This may be a result of improvements in treatments and risk factor levels or changes in the natural history of some of these conditions. Where conditions have been included in the QOF, clinicians may have become more precise in their coding; for example if patients with suspected angina used to be coded as having angina, now they would only get an angina code once the diagnosis has been confirmed.
  • In contrast to the above, estimated numbers of GP contacts for dementia, although falling from 33,500 in 2003/04 to 20,650 in 2005/06, increased for 2006/07 to 28,150. This observation is likely due to the inclusion of dementia as a QOF condition from 2006/07 onwards. Under QOF guidance, practices are required to record, using clinical codes, which of their patients have dementia, and also to record in a systematic way whether patients have had their care reviewed within a given time period. This is likely to have resulted in improved clinical coding and thus identification of this condition in the PTI data set. Whilst practice nurses continue to have relatively few contacts specifically for dementia, the increase for GPs is very apparent. In addition, information available for district nurses for 2003/04 to 2005/06 indicates that they too clearly provide dementia-related care, in accordance with the typically older age profile of the patients served by this professional group.

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MAIN CONTACTS:

Annemarie van Heelsum
Lead analyst - Practice Team Information
0131 275 7099
Annemarie.vanHeelsum@isd.csa.scot.nhs.uk

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GLOSSARY:

PTI = Practice Team Information
GP - General medical practitioner
QOF - Quality and Outcomes Framework

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PRE-RELEASE ACCESS TO THIS PUBLICATION WAS GIVEN TO:

Scottish Government Health Department (Analytical Services Division)

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HISTORY OF THIS PUBLICATION:

Last Published: 27 March 2007
Next Due: 31 March 2009 (provisionally)
Data Avaliable Since:  November 2003

 


Main contact: Email Annemarie van Heelsum