The Improving GP Appointment Data (GPAD) Direct Enhanced Service (DES) is here, but what is it trying to achieve and what is the benefit for Practices?
You may already know that since 2018, NHS Digital has been collecting data from General Practice appointment systems (including TPP SystmOne, EMIS Web, Cegedim (InPS Vision), Microtest Evolution and Informatica) and publishing the data monthly by CCG area.
This data has been used to get a better picture of the demand for primary care appointments, and to back up the Secretary of State for Health’s commitment to increase appointment numbers with an additional 50 million extra GP appointments by 2024.
Why is this data collection needed?
During the COVID-19 emergency, Practices had to rapidly change their working patterns and this highlighted that not all clinical interactions with patients are recorded in the ‘appointment book’. As a result, there may be an under-recording of the activity taking place in Practices which potentially gives a false picture of the overall activity and workload in general practice. This is particularly the case for appointments conducted by the wider workforce under the Network Directed Enhanced Service (DES) Additional Roles Reimbursement Scheme (ARRS).
NHS Digital wants to reassure Practices that there’s nothing to fear about collating this data and that it’s not micromanaging GP appointment systems but emphasises it is vital to capture accurately the full scale of activity that General Practice is providing for patients.
It’s worth recognising that over 400 GP Practices took part in the GPAD trials before the DES was introduced. NHS Digital doesn’t want Practices changing the way they manage their appointment book but to pick out the corresponding appointment slot types based on current activity. They want good quality data, owned and trusted at local level which can be used better for appointment planning and tracking true planned capacity that has not been used.
What type of appointment data is collected and reported?
These reports include various figures such as the number of same day appointments, appointments by Health Care Professional type, and the appointment time between the booking date and the appointment start date. For example, 44.4% of appointments in March took place on the same day that they were booked, and 91.6% of all appointments were attended in March.
It’s important to note that data from December 2020 onwards contains appointments related to COVID-19 vaccinations, but the most recent report shows that the total number of appointments recorded in GP Practice systems was 23,538,474 in February 2021 and 28,377,307 in March 2021– an increase of 17%. This seems to accurately reflect the feelings of GP Practices about the increased demand they are facing, especially since the growth of online consultations during the COVID-19 pandemic.
What is the definition of an appointment?
NHS England produced accurate general practice appointment data guidance in August 2020 as a first step to improving data quality, which included an agreed definition of an appointment as “discrete interactions between a health or care professional and a patient, or a patient’s representative”. This includes:
- All relevant staff
- Discrete interactions carried out by any health or care professional, including all roles in the ARRS
- All modes
- Discrete interactions that are delivered by all modes such as face-to-face, by telephone, via video and online
- All settings
- Discrete interactions in any primary medical care setting (including the Practice premises, the patient’s home, in the community, in a care home, group consultations, local GP extended access hub, etc.)
As always, Did Not Attend (DNA) appointments should continue to be recorded, but the definition of an ‘appointment’ excludes administrative interactions between Practice staff and patients e.g. non-clinical triage or administrative signposting, the Practice Manager meeting a patient to complete a subject access request, or a receptionist answering a query about opening hours.
Appointment Mapping Exercise
Mapping locally defined appointment slot types to a standard set of GP Appointment Categories will allow local control over appointment system use whilst also providing a consistent view of combined GP Appointments. The deadline for this to be completed by Practices is by the end of Quarter 1 (30 June 2021).
Practices are asked to carry out a short one-off exercise (which typically takes 30 to 60 minutes) to map each slot type it currently uses to one of the National categories. Once this has been completed, Practices can continue to use their appointment book in the usual way. The difference will be whenever a completely new slot type is created, Practices will be asked to specify which appointment category it should be mapped to.
Health and Care Professional (HCP) Types
There is a need to record HCP Type and these include General Practitioner, Practice Nurse, Health Care Assistants, Social Prescribing Link Worker, Physician Associate, First Contact Practitioner, Community Paramedic, Pharmacist, Pharmacist Technician, Health and Wellbeing Coach, Care Co-ordinator, Occupational Therapist, Dietician, Podiatrist and all other registered clinical professionals such as Osteopaths and Counsellors. If HCP type is recorded as NULL / Missing Data it will be classified as Unknown.
Category Types
There are currently about 400,000 different appointment slots being used across the country, so the creation of National categories aims to condense them into 17 defined single clinical appointment category types, although there are a further 9 different categories which may be used if appropriate, and NHS Digital has recently introduced new ‘standard appointment categories’ to provide a consistent view of appointments.
It has also published guidance on how to get the best out of your existing appointment systems by using them to accurately record appointments.
The Network Contract Directed Enhanced Service (DES) — Standardised GP Appointment Categories
The GPAD DES was issued on 31 March 2021 and contains useful information such as a flowchart to map to the right GP appointment category, how to manage default slots and surplus appointments and gives examples of applying a GP appointment category to existing slot types, for example a long-term condition nurse clinic or a pre-booked flu clinic.
Top Tips for GP Practices
- Read the GPAD DES and become familiar with the National Categories
- Book to attend one of the NHS Digital national webinars available in May and June for GP Practices and PCNs to find out more about GPAD
- Watch one of the EMIS or TTP demos that guides Practices through the process
- Set aside an hour to carry out the data mapping exercise, sooner rather than later
- If setting up new appointment slots, think about what National category the appointment should be mapped to
- Review the categories regularly as part of data housekeeping e.g. quarterly to ensure that they accurately the HCP Types and appointment slot types
The NHS Digital website has lots of resources and guides to help Practices with the General Practice Appointments Data (GPAD) process.
