This note is to update users on data submissions to NHS England for activity reporting.

You may know that practices are required to submit activity data from 30 June 2021 as outlined on their website here.

Many practices made representations that this would create extra work for no benefit, as many patient requests are completed with no need for an “appointment” record.

We have seen a copy of a post on the forum “FutureNHS” by “Digital First Primary Care”

We are raising this with system suppliers with the aim to gather that data directly from them. If a Practice has started / or is happy to map across both systems, this would ultimately create a better reporting data and Practices can continue to do this.

However, if this is not currently being recorded in the GP Clinical system appointment book, the current advice is not to double record in the GP Clinical System appointment book due to the extra burden on Practices.

When the data is published it will include a caveat highlighting that the GP appointment book is not the only tool which captures appointments and for those appointments captured elsewhere we have not got the means of capturing that data.

We have requested an official communication to this effect but have had no reply so far.

The message seems to be a positive one, there is no need to double enter and no further action is required.

We have enabled a feature in askmyGP which allows you to specify a role, compatible with GPAD reporting, for each staff member.  We suggest you state a suitable role from the drop down list in the staff record, which is done only once and would take a few minutes for the whole practice.  Any reporting needs should then automatically be covered.

In order to help you meet your GPAD obligations, and improve reporting in the practice, staff ‘profession’ needs to be recorded consistently.  This note explains the process, context and wider benefits.

English Practices have recently been asked to provide appointment data via their CCGs to NHS England. As you will know, we believe that a flexible triaged approach supports practices to utilise their time to best effect for themselves and their patients. This view appears to be reflected in NHS England’s guidance on ‘total triage’.

We remain in discussion with NHS England, because we feel that you are being asked to report data that may not accurately reflect the activities carried out in the practice. In addition, we have made some changes to resolve the immediate issue, which is to minimise the administrative burden for you in completing the reports.

To enable a report to be produced, consistent descriptions of ‘profession’ are needed to meet the GPAD requirements.  Pragmatically, this means that all staff professions need to match one of the exact descriptions recognised by NHS England.  The new ‘Professional Group’ list allows you to select the best match for each staff member.  This is accessed via Staff > Edit, or Settings > My Profile. There is a short note available: https://askmygp.zendesk.com/hc/en-gb/articles/360006981297

Although this work is in response to GPAD, there are some more general benefits. By using consistent descriptions of profession, we will be able to provide you with better reporting in relation to staff groups – for instance allowing capacity planning by profession, or better understanding the activity of groups within the practice.

As always, the quality of any reports produced are dependent on the quality of the input data. Obvious limitations of reports from askmyGP, besides data quality include:

• any activity not recorded via askmyGP will not be included e.g. Nursing or Clinic activity booked directly.
• We cannot report on data (such as profession) which has not been entered into the system.
• GPAD guidance permits some contacts to be counted twice. We will try to ensure that we include this, however it may not capture a small percentage of this double activity contact.

We will add a report to your system in the near future. Should you wish us to provide reports directly to your CCG please contact us via your Training Partner to discuss details.

The Department of Health and Social Care published on 19/2/2019 its Code of Conduct for data-driven health and care technology.

Our response to the ten principles follows:

1.  Understand users, their needs and the context.  askmyGP users are broadly two groups, patients and providers which includes all GP practice staff.  Our design principles are for simplicity and ease of use, a difficult task when appealing to patients of all ages and abilities, both in general education and familiarity with online tools.  We cater equally for proxies (parents and carers), all gender expressions, and keep language simple to help those with limited English.  To assess our effectiveness we monitor age specific adoption by patients in each practice, and feedback from patients informs our development process.
2. Define the outcome and how the technology will contribute to it.  Our mission is to make it easier for patients to get help from their own GP, and easier for GPs to provide that help.  We measure attainment against this outcome by volumes, response and completion times, and measures of efficiency through resolution mode by providers.  We also collect and monitor patient feedback and present all measures to the provider organisations.
3. Use data that is in line with appropriate guidelines for the purpose for which it is being used.  We comply with all relevant legislation including GDPR, Data Protection Act 2018 and collect data only for necessary purposes.  Personal data is processed on behalf of providers (the data controllers), stored and transmitted encrypted and over the secure N3/HSCN network.  Anonymous data may be used for research and marketing purposes as allowed under the same principles.
4. Be fair, transparent and accountable about what data is being used.  All data is used in accordance with Caldicott principles, and the conditions are agreed by patients and providers.
5. Make use of open standards.  We support the use of open standards and wherever technically possible provide open links to others for legitimate interoperability reasons.  We use standard NHS number coding for any authorised data transfers.
6. Be transparent about the limitations of the data used and algorithms deployed.  We collect and transmit plain text and other file formats between patients and providers, but we do not use algorithms to produce triage decisions or advice to patients.
7. Show what type of algorithm is being developed or deployed, the ethical examination of how the data is used, how its performance will be validated and how it will be integrated into health and care provision.  We do not develop algorithms.  We do offer a third party service with Isabel Healthcare, which uses a machine learning approach.  Our users may enter any number of symptoms, and be shown a range of possible conditions.
8. Generate evidence of effectiveness for the intended use and value for money.  Integral to our offer to all customers is standard reporting on usage, patient service, timeliness and efficiency through the use of askmyGP.  We provide an economic model (Loadmaster), configurable by each customer, which demonstrates their value for money.  We also conduct our own analysis of performance and value and may publish on this site and in other media from time to time.
9. Make security integral to the design.  From the outset of design, security has been built into askmyGP.  Key features include:
   • N3/HSCN access required for all live patient data by providers.
   • Encryption of all patient data in transit and at rest
   • Strength checked passwords required for all users.
   • Separate code and database for live and demo systems
   • Independent penetration testing and fulfillment of all comments raised.
10. Define the commercial strategy.  Our strategy is that self-funding customers should see a high rate of return from their investment, and do so from the date of launch (typically four weeks from engagement).  Growth is therefore not dependent on taxpayer funding, but on efficiency and financial savings generated through the use of our services.

Harry Longman, 21 February 2019

Looking out on the rain, memories quickly fade of, for once, that glorious bank holiday weekend.

In GP land you may have noticed a lighter week too, because demand is predictably sensitive to weather – whether warm sunshine or heavy snow.

We need to qualify the effect however, because if your system is book ahead and wait, lower demand only shows up as a smaller backlog and maybe less pressure on reception.  You will still see the same number of patients who have patiently waited whatever the urgency of their need, and it will feel like a treadmill.

The point of a demand-flow system is that there’s always plenty of capacity for the predicted demand, and if it comes in below prediction, you can enjoy the sunshine.  A colleague of mine visited one practice we work with on Thursday lunchtime and there were just no patients, time for chat.

Now with summer on the way it is of course the perfect time to put that demand-flow system in place but let me tell you about a real problem we are struggling with.

I can name three practices right now where they are very clear on the challenges they face, they can’t cope with the workload, they know the service is terrible, and their receptionists are getting abuse every single day.

They’ve done a thorough analysis, all the surveys, know exactly what to do, and four GP partners can hardly wait to get going.  But one, or perhaps two, partners have dug their heels in.

I’m a great fan of the partner model for a host of reasons, and I haven’t seen a better one, but it has its drawbacks.  One partner can veto any change.  They are condemning the others to live with the same or worsening situation.  Why isn’t there a veto on doing nothing?

Fundamentally I think this imbalance in favour of inaction is holding GPs back, perhaps the whole profession, even if a majority can see what needs to be done.

Are you in this situation or do you have any suggestions?

Meanwhile two north east practices launch on Monday and let’s hope they enjoy the summer.

Kind regards

Harry Longman

PS: One who did act was Dr Sue Arnott and she joins us for this Thursday’s webinar at 1pm.

Online consultations – what is working and why?

Some background on how she came to be running a 4,700 practice as a single hander here.

Many have asked for the first in the series recorded, so it’s here, 45 minutes, “Exploding the myths of online consultations”

NHS England has trialled four digital versions of NHS111 in an attempt to shift channel from telephone to online.

An internal report dated December 2017 and obtained through HSJ reveals the astonishingly low take up of these heavily marketed pilots.   Download the full report here:

111 Online Evaluation DRAFT_

Data contained within the report shows the four trials covered a population of 7.5m for the period February to June 2017.  The total completed digital triages came to 8671.

A separate chart shows NHS111 telephone volume at around 1 million per month, for a population of 50m.

The digital trials covered around 15% of the population, and over the 5 months of the trial would see pro rata around (15% x 1,000,000 x 5 months) = 750,000 calls.

Digital triages therefore accounted for 8671/750,000 = 1.2%

We know that the digital option was heavily marketed in the four pilot areas, in the public domain, GP surgeries and through IVR messages.   We have no idea of the costs incurred.

We can see by comparing the charts that conversions from “I registered or downloaded the digital solution” to “I completed a triage” range from about 60% for Babylon and Sensely to 30% for Pathways and 10% for Expert 24.

Figures given on dispositions are compared to 111 phone triage dispositions and what is striking is the similarity.  Much is made of the 18% advised to self-care.  However, it is very disturbing to see 20% advised to call 999 or go to emergency.  Compared with GP audits of their demand, which they rate at around 0.5% as emergency, these are astonishing numbers.  Work we have analysed with a GP led OOH service showed GP disposition to ambulance at 1.4%.

Following the advice of the algorithms would multiply use of emergency services by a factor of 10 to 20.

Worse than this, we suspect that the low take up means the diseases entered are highly unrepresentative of the overal disease burden, and are likely skewed to conditions which are “easy to triage” and therefore less acute.

Given the above analyses, and if you knew the eye-watering costs incurred, what would you do?

Harry Longman

PS The conclusion of the report’s author may surprise you, page 4:

The learning from these pilots supplemented with data from other health systems and from
other online services would continue to support the case for an online interface for urgent
care. This evaluation does not recommend one product over another but demonstrates that all
products have some similarities and differences but all products tend to support channel shift
and management of demand whilst providing patients with a good experience.

To gain further understanding of NHS111 Online and the impact on the health system, larger
data sets and linked data will need to be considered. Therefore, the expansion of pilots and
further analysis will enable a more robust evaluation.