Chris Netherton, M.D.

The vital role of appointments data in enabling positive change in healthcare

This week, Microtest took part in an important NHS workshop held in London – a meeting attended by 35 influential representatives from NHS England, NHS Digital, BMA, RCGP, CSUs as well as clinical suppliers. 

The workshop was set up to look at the challenges and opportunities associated with GP appointments data. Appointments data has a vital role to play in helping inform and steer the current transformation of the NHS. Workload management is of course a key challenge for overstretched GPs. However, in order to fully understand the issues and identify improvements, it is vital to obtain accurate management statistics of appointments.

NHS England and NHS Digital are working together to establish a collection of appointments data in support of planning for winter and other periods of high demand in order to inform local management of appointments capacity and wider NHS strategy.

The collection of appointments data will help to improve understanding of appointments capacity and utilisation in general practice and inform more effective planning and management of capacity at local and regional levels. It will aid the understanding of seasonal pressures at a national level which will be used to inform wider strategy on the provision of services across primary and secondary care to help improve patient access to general practice.

The collection of this data will bring direct benefits to patients as NHS England will be able to more appropriately design services at local, regional and national level to meet demand.

Accurate front line statistical data is fundamental in order to analyse what is currently happening and implement change for the better. Accurate data collection allows us all to compare demand vs capacity, evidence initiatives to test alternative ways of working and share best practice, with an overall aim of streamlining workload and improving patient care.

All four clinical suppliers have a GP Workload Tool for practice staff to view their data.  EMIS and Vision will deploy their tools by end of August 2018, whilst the tools from Microtest and TPP are already available to their practices. However, there is an issue to do with accuracy of the data provided by these tools, across all system suppliers.

Work is currently being undertaken by NHS Digital to explore issues relating to the use of these tools. For example, an indicative study of EMIS data that has been undertaken has highlighted that there are issues to do with the accuracy of the data generated. This inaccuracy was caused by a wide number of factors. Here are just a few examples – this list is not exhaustive.

  • Hidden workload through dealing with workflow processes such as urgent issues and prescription requests where patients are not always added to a clinic list
  • Not labelling the clinics and appointments properly
  • Recording cancellations and patients who do not attend
  • Adding text in bookable and free appointment slots e.g. tea break
  • Visits not added or documented correctly
  • Using free appointment slots as messaging lists e.g. questions about acute medication
  • Every surgery manages their appointment books and protocols for dealing with demand differently
  • Extended access software solutions are generally outside of the clinical system which are not currently involved in the data collection tools.

It was interesting to note that all system suppliers face similar problems with the data. A root problem is that most practices are not making the most of their GP Workload Tool and of course, practices will only get out of the tool what they put in.

The key reason why practices are not fully engaging with their GP Workload Tool and taking steps to improve their data is that there is a low level of understanding of the importance and value of this data as well as how they should interpret the data gathered – and all of this in the face of a busy working day!  The irony is that improving the use of the GP Workload Tool and other performance management tools will start to bring about change that will reduce pressure on practices and enable benefits for patients and practices alike.

If real change is to happen, there needs to be a step change in mindset about performance management data.

One way that this can be achieved is through improved collaboration with practices sharing their results, so benchmarks can be identified and gold standards can be emulated across the country.

As a leading clinical IT system supplier, Microtest is totally committed to helping bring about positive change in the NHS as well as help GPs overcome the challenges of rising workloads whilst improving patient care.  So to help raise awareness of the importance and value of accurate workload data, Microtest is taking steps to raise awareness within our own customer base and provide training on how to get the most out of the GP Workload Tool.

This workshop is a salutary reminder that developing clinical IT systems and tools is only one part of the whole. Most IT tools are used in a way that does not fully maximise their potential. The more we can ensure that IT tools are supported by ongoing awareness building and practical training, the greater the benefits that technology can bring.

When it comes to appointments data, this is fundamental to the performance management of GP practices and its widespread analysis is an essential springboard to create a more effective NHS for all.