PLEASE NOTE:
We are currently in the process of updating this chapter and we appreciate your patience whilst this is being completed.
Identifying patients to the system: The Exeter system records every registration of a patient to a GP practice.
https://digital.nhs.uk/data-and-information/publications/statistical/patients-registered-at-a-gp-practice [accessed 23/08/2018]
Data include patient's full name and address, including postcode, date of birth, sex, date of registration, place of birth (free text), and some data on date of entry to the UK. Data are partitioned so that CCGs are given access to their resident patients, plus aggregate data for their registered patients who live outside the CCG area. CCGs can set up mutual exchange arrangements to enable each other to have full details. The Exeter system was originally intended to enable GPs to be paid, when the main determinant of the pay was a capitation fee.
Derived from the NHS Central Register, in theory a patient can only be recorded once. In practice, ‘List inflation’ is due to patients who transfer to another General Practice or die, and are not removed from the original Practice list. On average, perhaps, an estimated 5.6% inflation is encountered. However, list inflation varies greatly in various places and can be much higher.
GP activity: GP systems vary, but as most GPs are now on contracts where their remuneration depends on recording activity performed for patients, their current systems reflect this. The systems record appointments, tests requested (with results when these are available), physiological measurements, prescriptions and referrals. In general, without special arrangements, GPs' data at patient level are not available to CCGs, but nationally analysed data in terms of the Quality and Outcomes Framework (QOF) contract data are available at practice level. The QOF itemises those data items thought by the Department of health to be sufficiently important to affect GP's fees. These include blood pressure measurement, smoking, body mass index, diabetic lab results, proportions of children immunised, and various other items that may change from year to year. However, the recording by general practices of their QOF data varies widely – See Chapter 3b section Quality and Outcomes Framework in UK General Practice.
Getting patients into the secondary care (hospital) system: A main plank of the former Connecting for Health strategy
(https://en.wikipedia.org/wiki/NHS_Connecting_for_Health [accessed 23/08/2018] was 'Choose and Book', intended to allow patients choice of potential hospital providers and to book appointments directly on line rather than relying on the hospital to prioritise and allocate a slot. This was replaced by a new NHS e-referral system around 2014 https://www.england.nhs.uk/2014/05/choose-and-book/ [accessed 23/08/2018]
See https://digital.nhs.uk/services/nhs-e-referral-service/
And https://www.nhs.uk/using-the-nhs/nhs-services/hospitals/nhs-e-referral-service/
[accessed 24/08/2018]
Hospital Activity:
- Accident and Emergency: A&E systems track patients from first arrival through encounters with NHS staff, through diagnosis and (possibly) intervention to outcome (discharge, admission, etc.). A&E systems have risen in prominence since major political emphasis was placed on quick attention and maximum time spent in A&E. Diagnostic codes are limited to one or two per visit, so underlying issue such as substance abuse may be under-counted.
- Patient Administration Systems (PAS): the hospital's master system for recording what happens to their patients. Administers outpatient clinics, capacity, list sizes, appointments and attendance, level of medical staff per appointment. Administers Elective Admission Lists (waiting lists), recording date on list, urgency, intended treatment and management, specialty, consultant, any periods of suspension. Tracks admitted patients through hospital, including specialty, consultant, dates, intended management, ward admissions and transfers, discharges; after discharge data are clinically coded for diagnostics (using ICD10 codes) and surgical interventions (using OPCS4 codes), and assigned an HRG (Healthcare Resource Group) for payment. Extracts from PAS admitted patients’ data and (recently) outpatients data go to the national Secondary User Service, where the data are partitioned for registered and resident CCG, and certain fields are taken off to the Hospital Episode Statistics (HES) database, which is used by the Department of Health for NHS planning purposes. These partitioned files enable CCGs to analyse their patients' care wherever they are treated within the NHS, and allow for benchmarking (using appropriate age/sex standardisation) against national or selected counterpart organisations.
- Clinical Audit/Research Systems: can be part of a central hospital database or locally run by a department, or as part of a national audit process. These record clinical aspects in more detail than PAS. The National Service Framework for Cardiovascular disease is recorded on a national standard system, MINAP.
https://www.ucl.ac.uk/nicor/audits/minap [accessed 23/08/2018]
- Laboratory Systems: These record requests for and results of laboratory tests.
Community Health Care: Systems vary, but CCGs run systems to manage children's health (recording immunisation, health visitors, birth weights, etc.) and some para-medical activity such as physiotherapy and podiatry, also sexual health and teenage pregnancy data.
Genito-Urinary Clinics: record patient data at catchment level, and are not permitted to report at other levels. This data are subject to certain extra statutory protection.
Public Health:
Vital Statistics: Public Health departments are allowed full details of the births and death registration relevant to their areas. Although these data are in the public domain (via the public registry office) users are required to treat them as personal data that should not be disclosed.
Geographic Information Systems (GIS): Most NHS data has geographic data indirectly attached, usually as the postcode of the patient. The Office of National Statistics, working with the Post Office, produces the NHS Postcodes file, which includes mapping coordinates for the centroid of each postcode polygon to the nearest 100 metres, and for a fee a version accurate to 1 metre can be obtained. The file is updated four time per year. This file also allocates the postcode to every possible level, current and obsolete, of administrative geography, including CCG, Local Authority, ward, Super Output Area, and others. In combination with software that is designed to display maps, these data can be presented in ways that cast a great deal of light on the health issues faced by a CCG, or SHA. http://www.healthgis.nhs.uk/ [accessed 23/08/2018]
© M Goodyear 2008, D Lawrence 2018
[1] Lawrence D Health Services Planning. Chr 5.1, in Guest C, et al, Eds Oxford Handbook of Public Health Practice 3rd Edition 2015
https://global.oup.com/academic/product/oxford-handbook-of-public-healt… [accessed 22/08/2018] (a 4th Edition should be available in 2019)
[2] Logan RFL., et al. Dynamics of Medical Care. Memoir No. 14 London School of Hygiene and Tropical Medicine, London, 1972
[3] https://www.cl.cam.ac.uk/~rja14/Papers/npfit-mpp-2014-case-history.pdf