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GP practice workload is under-reported, NHS England admits

by Costanza Pearce
17 August 2020

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Official GP appointment data is giving a ‘false picture’ of practice workload, NHS England has admitted.

NHS England has published new guidance for practices as part of a drive to improve the quality of its GP appointment data planned for 2020/21.

The new guidance, which is a ‘joint commitment’ with the BMA, said the improvements would show the ‘sheer scale of what general practice does for us all’ and ‘make the case for extra investment in general practice’.

It outlines an official appointment definition that practices must apply from now to mitigate ‘under-reporting’ in NHS Digital’s official GP appointment data (GPAD) during the pandemic.

The guidance said: ‘During the Covid-19 emergency, practices have had to rapidly change their working patterns. This has highlighted that not all clinical interactions with patients are recorded in the appointment book. 

‘This may result in an under-recording of the activity taking place in practices. In turn that may lead to underreporting in the NHS Digital GPAD data publication.’

It added: ‘This is potentially giving a false picture of overall activity and workload in general practice. It is in all our interests to capture accurately the full scale of activity that general practice is providing for patients.’

In information published alongside its GP appointment statistics, NHS Digital also cautioned against using the data ‘to infer a view of workload’ because it only reflects ‘planned and scheduled’ appointments – which have declined during the pandemic.

It said: ‘It is important to note that this decline does not necessarily imply that GPs are having fewer interactions with patients.

‘[Coronavirus] has led to a dramatic increase in telephone and video contacts including same-day clinical triage interactions to assess and prioritise patient need, and a decrease in the number of traditional face-to-face scheduled appointments reported.’

NHS England’s new guidance defines appointments as ‘discrete interactions between a health or care professional and a patient, or a patient’s representative’.

This includes ‘all relevant staff’ including additional roles employed in primary care networks, ‘all modes’ such as face-to-face, telephone, video or online and ‘all settings’ including home visits, care homes and extended access hubs, it said.

However, ‘purely administrative’ interactions are excluded, as well as ‘automated’ online triage that doesn’t involve interaction between the patient and a healthcare professional.

Further technical guidance on configuring appointment books with a new set of ‘standardised national categories’ of appointment types will be issued ‘during the year’, it added. 

NHS Digital’s most recent appointment data showed that the numbers of recorded GP appointments are continuing to rise to pre-lockdown levels, in spite of the inconsistencies in reporting.

And despite claims that general practice was closed to patients due to the pandemic, NHS England’s primary care lead acknowledged that GPs were seeing a ‘huge’ increase in workload.

Meanwhile, health secretary Matt Hancock last month said he wants all GP consultations to be carried out remotely going forward, unless there is a ‘compelling clinical reason’ to see a patient face to face.

A version of this story was first published by our sister title Pulse.