HSCIC primary care overview

General Practice Extraction Service (GPES) Implementation Update Dave Roberts Head of Primary Care Strategy, HSCIC EMIS National User Group Thursday 6 September 2012

GP practice data Patient access to medical records Prescribing data Pathology MIQUEST query service MIQUEST ownership and future Education, Training and Development GPES

1. GP practice data

Transparency Phase 1 On the 7 December 2011, as part of the Government’s commitment to ‘open up our public services’ DH in partnership with the Health and Social Care Information Centre released (IC) 260 data items, covering 8,300 GP Practices in England through the Indicator Portal. The data is structured under 5 key headings: - Demographics - Patient Experience - Quality Outcomes - Infrastructure - Impact on NHS Resources The portal provides a single source of comparable data, appearing in a flat file format, primarily for data intermediary usage. Currently the portal enables the technical audience to compare practices, make choices and hold local services to account, whilst the NHS Choices site aids the public and patients in making practice decisions and simple comparisons.

Transparency Phase 2 To further support the work the IC will develop a ‘tool’ enabling GPs and other stakeholders e.g. emerging CCGs or HWBs to compare practices’ performance, allowing them to see where they could perform better, leading to fresh, innovative ideas. The tool will also allow practices, emerging CCGs, current PCT clusters and (in future) the NHS Commissioning Board to link the data to wider information on healthcare need, activity and outcomes. Development of the GP practice comparative tool will be in 3 stages: - Stage 1 (June 2012), will enable practice data to be viewed in a time series format along with a number of chart styles and tabular forms. - Stage 2 (September 2012) will have greater functionality allowing users to ‘save’ data selections and customisation of ‘standard views’. - Stage 3 (delivery date to be confirmed) will permit correlation, multivariate or other statistical analysis of the indicator or underlying data.

Transparency The comparative tool, focuses on 2 areas: - continuing work to identify other relevant clinical data indicators - developing composite and aggregate data indicators New data items - Working to publish 25 new data indicators in June 2012, these include A & E and readmissions data, life expectancy, contract type and weighted patient list size. - Further indicator development will take place over the next 18 months with data indicators published on a quarterly basis and when ready. Composite indicators - Bring together individual indicators into a single index, allowing simpler and quicker comparisons to be drawn. - Expert groups have been formed to initially advise on 3 areas: Diabetes, Prescribing and Patient Experience. - Initial release of the Patient Experience will take place in June and cover 5 domains: accessing care, waiting to be seen, opening hours, consultations with a doctor and consultations with a nurse.

GP Patient data Expanding the offering Adding additional data to the Indicator Portal Launching a tool to accompany the Indicator Portal that will enable users to manipulate almost 300 different datasets Continuing to release new data into the systems Surfacing all the data in a single file to help 3rd parties use the data to build their own tools

2. NHS Operating Framework 2012/13 Indicator PHF10 Percentage of patients with electronic access to their medical records

The current collection – SRF14 % of patients with greater control of their medical records During 2011-12 NHS Connecting for Health collected data at PCT level for SRF14: % PCT’s providing patients access to booking appointments, repeat prescriptions and their medical records broken down by: no functionality available; functionality available but not in use; functionality available and being used.

The planned collection – PHF10: % of patients with electronic access to their medical records The new indicator PHF10 will require data to be collected at GP Practice level by the HSCIC: - GP practices providing patients access to booking appointments, repeat prescriptions and their medical records broken down by: no functionality in place; functionality available; functionality in place and being used: Number of times patients have accessed their records. Important to note that no data is patient identifiable at any stage in this process.

How? GP System suppliers collect data quarterly for a return to the HSCIC HSCIC transforms data to DH specifications Data is submitted to DH HSCIC / DH publish data relating to % patients by GP Practice with electronic access to their medical records.

When? 1st data collection by GP System suppliers for PHF10 30th June 2012 Data from system suppliers to HSCIC by 16th July 2012 Reports to DH by August 2012 Reports quarterly thereafter

3. Prescribing data

Why release the data? Plan for Growth: “ … will look to publish prescribing data at practice level, subject to an evaluation and impact assessment by the NHS Information Centre.” Transparency agenda: “Open data must become the organising principle of public services.” PM letter to Cabinet, July 2011, restated the commitment to make available "prescribing data by GP practice by December 2011".

….over 4 million lines of data…. What has been released? ….over 4 million lines of data…. For each practice in England, and for each dispensed medicine (by chemical name), dressings and appliances (at section level) … Total number of items that were prescribed and then dispensed. Net Ingredient Cost. Actual Cost. Supporting detail: FAQs, sample data, glossary

What has been released? Data for September 2011 released on 14 December 2011. One very large CSV file with practices identified only by national code. Supplementary file of practice codes, names and addresses. October 2011 released in January 2012, and so on …

4. Pathology

Background Every year GPs request 500m pathology tests (37 m reports) The results are all routed from laboratories via secure electronic messages to practices The results all pass through a central electronic ‘sorting office’ – the Data Transfer Service (DTS) The national Pathology Benchmarking project (Universities of Keele and Leeds) has taken a pseudonymised copy of the data for 2 weeks to analyse the quality of the data and to undertake a number of analyses, initially concerned with quality of Read coding and units of measurement used

What the HSCIC propose to do Examine the costs, benefits and security / confidentiality issues of creating a national pathology database for GP requested pathology by copying the data as it flows from laboratories through the DTS to practices Seek sponsorship and ethical approval to build such a database and make results available in a secure / pseudonymised manner Build the database and consider further applications e.g. hospital requested pathology data

Potential uses of pathology data Analyse patterns of GP use of pathology services; evidence from Keele has shown that if data is exposed, it can encourage laboratories to improve the data quality and GPs to modify their requesting behaviour. To support pathology modernisation (Turner report), and the commissioning and contracting for lab services by commissioners. Ensure that NICE guidelines are followed regarding the use of pathology testing. For example are tests ordered too late? Or ordered too early to be of any value?

5. MIQUEST query service

MIQUEST query service Required from 1st April 2012: to immediately be able to support the QOF pilot process to immediately be able to support the National Diabetes Audit To have the capacity to support other identified monitoring programmes as they are confirmed. DH in collaboration with the Health Protection Agency collects vaccine uptake data for various vaccines from GP practices, including Seasonal Influenza, Pandemic Influenza and Pneumococcal Polysaccharide Vaccine (PPV). These data are collected via the ImmForm website and are made available to the HSCIC for publication.

MIQUEST query service GPES is intended to replace the MIQUEST authoring service once fully operational in 2013/14. Anticipated that the MIQUEST authoring service will be required for 2 years from 1st April 2012, with option to extend for a further 12 months. HSCIC have informed the preferred bidder

6. MIQUEST ownership and future

MIQUEST components MIQUEST Standard Specification Enquirer software GP System Interpreters

MIQUEST Process MIQUEST OUTPUT Data extracted in standard format Code clusters and logical rules and write HQL query Run matching queries on n GP systems Define plain English data requirement Usually local enquirer but may be national OUTPUT Data extracted in standard format

Current and short-term landscape GPES meets the needs of national DH sponsored enquirers GP suppliers offer in house data supply to their customers, e.g. EMIS IQ (+/- GPES) Commercial third parties have extraction solutions working via system APIs (pre-configured queries) MIQUEST or replacement remains the only flexible, low cost, in-house mixed system option for small/local health (e.g. CCG) and academic organisations

Options for the future Kill off MIQUEST and do not replace Continue current development of MIQUEST Increase development of MIQUEST to meet future needs In parallel new development by the HSCIC may: Make use of and adapt new technology and systems developed for GPES and GP system suppliers to provide a system that meets the long term requirements Develop an entirely new data extraction system suitable for local data extractions

7. Education, Training and Development

Data Quality Assurance within the HSCIC Background Health & Social Care Act confirms the HSCIC role is to ‘provide an assessment of the quality of health and social care information and publish that assessment’

Data Quality Assurance Project Short to Medium Term Reporting – visible, transparent and published with an Interim Report published June 2012 Assurance Framework (identify, monitor, report, improve) to be consistently applied across activities within HSCIC Longer Term National developed framework which outlines expectations (Standards) for local data providers, measures compliance (Assurance) and incentivise change (Improvement) Over time, the HSCIC will seek to positively influence and raise data quality standards at the point of data recording by providers through the above. Needs co-operation of other organisations, local and national, to deliver framework (e.g. NHS CB will set standards and incentivise improvement through contracts)

Data Quality Assurance Project To ensure the Data Quality Framework is successfully implemented, we are engaging with: All key national stakeholders (e.g. NCB, Monitor, DH, CQC, CFH, NICE, PHE) NHS, social care professional, clinician and organisation consultation and involvement in developments Key business areas within the HSCIC who currently undertake DQA activities

Primary Care ETD The HSCIC is assessing the needs of primary care providers for the provision of data quality training Data Quality training for primary care was previously provided through the PRIMIS + contract with Nottingham University With the introduction of Clinical Commissioning Groups (CCGs) in the Health and Social Care Act the structure of the provision of data quality training in Primary Care needs to be revised to reflect the new NHS environment

8. GPES

GPES - background Centrally managed extraction and analysis service that will obtain information from NHS GP systems in England with the aim of improving patient care. GPES will be used by HSCIC to provide extracts of data from GP clinical systems on behalf of specified and approved organisations that have Department of Health sponsorship. Comprehensive and rigorous approval process for all requests for information . Only data needed to accomplish the approved purposes will be extracted.

GPES - update Currently in development . Potential GPES customers will be required to undergo an approvals process to use the service, demonstrating how they plan to use the data they have requested and how that data will be used to provide benefits and improved care and outcomes for patients. Information Governance Principles Independent Advisory Group

GPES Independent Advisory Group (GPES IAG) Chair GP (BMA) (RCGP) (PHCSG) Lay member Non-GP Academic Ethicist Secretariat (HSCIC) GPES IAG membership: HSCIC IG assessor The GPES IAG will: Consider the HSCIC’s IG assessment weigh risks and benefits to decide whether, in its view, the extraction is appropriate and in the public interest. Make a recommendation to the HSCIC HSIC prepares “IAG pack” for GPES IAG’s consideration, including: Customer requirement IG assessment Benefits plan GPES IAG can draw on advice from HSICIC Recommend further consideration or significant changes Recommend minor changes Recommendation to proceed (subject to further approvals)

GPES – GP Practice next steps including: Involvement in detailed design, testing and assurance of GP Practice related functions and screens Involvement in design and development of patient related communications materials Targeted communications - including GP Practice Bi-monthly Newsletter Training – GP Practice related material assurance, testing and delivery approach and timetable Deployment – GP Practice First of Type and rollout approach and timetable Live service readiness activities: GP Practice preparation and, Operational support processes

EMIS reporting Service EMIS’ Solution for GPES EMIS reporting Service GPES EMIS central hosting services C Extract server C C GPES IG Principles LV PCS C EMIS Fam/Web C 18

Thank you