How are we going to track national progress in new ways of working?

Lara Shemtob is an Academic Clinical Fellow in General Practice at Imperial College London

The Appointments in General Practice data available° on the NHS Digital website collects data on the activity recorded within appointment systems for much of general practice across England.

The April 2020 data° contain a disclaimer about the impact of COVID-19 on data quality, acknowledging the change in work patterns that may not be easily traceable given “there are no national standards for data entry into GP systems which are not primarily designed for data analysis purposes”. NHS Digital recommends we treat the April 2020 data as experimental statistics given these limitations. To what extent has the data captured the degree to which general practice has changed over the last few months, and what can be done to improve the data quality?

The practice that I have been working at since February has seen a drop in appointment activity over the last two months. We moved to a telephone first appointment system, where most patients are called back by a doctor the same day with options to convert to video/bring the patient in/organise a home visit/hot hub appointment. Like many practices, we went from offering no video appointments to video being the preferred mode of further assessment where possible and safe. Meanwhile, the nursing team have been doing the majority of their appointments face to face, but have significantly fewer appointments than before.

While the national data (Table 1) has captured some of the trends we have seen on the ground: reduced appointment activity, with more patients being offered same day appointments, more of these being telephone vs fewer face to face appointments, the data on the percentage of video consultations that took place do not reflect the impressive degree of rapid change we have seen over the last few months.

Table 1.

	April 2019°	April 2020°
Open active practices	6,974	6,775
Total count of appointments	22,829,868	15,835,467
Appointment status (Percentage of total)	Attended 89.8% Did not attend 4.9% Unknown 5.2%	Attended 87.3% Did not attend 3.0% Unknown 9.7%
Healthcare professional involved (Percentage of total)	GP 53.0% Other practice staff 44.3% Unknown 2.7%	GP 54.8% Other practice Staff 42.0% Unknown 3.2%
Percentage of total offered same day appointment	42.9	63.3
Appointment mode (Percentage of total)	Face-to-face  82.6% Home visit 1.0% Telephone 14.2% Video/online 0.5% Unknown 1.8%	Face-to-face  47.2% Home visit 0.6% Telephone 48.3% Video/online 0.3% Unknown 3.5%

 

We have been troubleshooting challenges with data entry at the practice level through the pandemic, setting up new ways to document different types of consultation to help audit the outcomes and effectiveness of these new ways of working.

High quality data entry and coding is something that seems to take considerable effort for me as a registrar. With the majority of my thinking consumed with the clinical problem solving of each patient, I find I have to push myself to use the records optimally and enter consultation data in the most useful way to allow continuity and audit.

The national report from April shows holes in our local data entry, and likely in the collection methods too. There needs to be more clarity on how these national data are gathered, and how to optimise our local data entry for this as well as for use at the practice/PCN level. We cannot rely on the experimental data that has been collected over the last two months, but now that we are catching up with the rapid changes in working since March and with talk of the new ways of working becoming permanent, when will the data quality catch up? Without recording and measuring activity properly, it is impossible to track change and progress.

 

Featured photo by Stephen Dawson on Unsplash