Before an IT project begins, it can be as useful to know what you do not what to achieve as what you do. The information team at NHS South of Tyne and Wear had this in mind when they set out to create an information system for GPs.
“We did not want to push information out to GPs that was of little interest or clinical value. Instead we wanted develop a ‘pull culture’ for GP management information, “says Bob Gaffney, assistant business information manager at the trust.
The end result was the creation of a system called GPC+ which so impressed the judges at the EHI Awards 2011 in association with BT that it scooped the prize for ‘most promising IT for GP-led commissioning’.
Building on the urgent care dashboard
GPC+ provides GPs and clinical commissioners with ‘real time’ information on primary care, admissions, accident and emergency attendances and use of community services.
Within 24 hours, GPs can see which patients have been admitted to hospital or attended A&E, while community contact data is available even faster – it appears on GPC+ as soon as the information is logged on the community system.
GPC+ also includes risk stratification models and disease register profiles and key business information such as financial reports, Quality and Outcomes Framework analysis and benchmarking data.
Gaffney says: “The tool is all about getting information from a range of providers and integrating it to provide a holistic picture of healthcare across the locality. For the first time, GPs and other stakeholders have access to timely, clinically meaningful management information.”
The development of GPC+ was part of a formal project launched as part of the PCT’s urgent care and long term conditions work stream.
It was driven by two sets of motivators – a desire to tackle health inequalities and an interest in the work NHS Bolton had done with its urgent care dashboard.
The first module builds on the work done in Bolton, which provides GPs with information on A&E attendances, emergency admissions and discharges, walk-in centre attendances and calls on the out-of-hours service.
Gaffney says the information team found it “surprisingly easy” to get information from the three foundation trusts on its patch, which all allow the PCT daily access to their data on admissions, discharges and A&E attendances.
“It was somewhere where we thought we would have problems and we didn’t,” he adds.
Gaffney says the PCT also realised it could go one step further than Bolton in adding community contact data, thanks to its close working relationship with the community trust, which until recently was part of the same team.
Gaffney adds: “They were happy to feedback the data, and we gave them access to the same tools so that community matrons can have the same view of their patients. That was another big incentive for the community team.”
Gaffney says including the community data was a benefit for GP practices because communication had previously been poor, with GPs sometimes not knowing if their patients had a community matron. The dashboard means that information is now readily accessible.
More modules deliver more information
The information team built the system using nationally and locally defined datasets and was prescriptive in ensuring that all providers used the same nomenclature, definitions and data types, using established NHS terms and data definitions wherever possible.
This means it can rapidly include additional provider information without having to undertake any major system changes.
The second module developed for GPC+ delivers risk stratification information using the King’s Fund’s Combined Predictive Model.
The CPM categorises patients in every GP practice according to their risk of having an unplanned admission in the next 12 months, with a view to targeting interventions at those in the highest risk groups.
The information team has integrated the data with its first module so that, for example, a practice can see whether a patient who has attended A&E is in a high risk category.
Gaffney adds: “I think the CPM is the best algorithm that’s out there at the moment and in my view one of the good things is the way we present the data.”
GPC+’s third module aims to provide support on health inequalities work in the PCT. Health and lifestyles in NHS South of Tyne and Wear are significantly worse than the national average and life expectancy is shorter.
Gaffney says the information team and public health specialists were keen to work together to investigate how they could use IT to back up the eight interventions that were being targeted locally.
The result is a module that highlights performance on indictors that make the biggest difference to life expectancy.
It draws on QOF, prescribing and local enhanced services’ data and allows comparison within clusters and across practices with similar levels of need as well as helping service improvement planning.
Gaffney says the team was keen to avoid “death by benchmarks” while providing information that would be useful to practices and clinical commissioning groups.
Working with change
The PCT piloted GPC+ in six practices and then implemented a phased roll-out across the NHS South of Tyne and Wear patch of 117 GP practices.
The software is web-based, uses standard operating systems and can be managed without the need for on-site installation. Training is also available online; although the PCT found training in practices was more effective in engaging users.
Gaffney adds: “We learned a lot about the range of skills in practices and their ability to understand the data and changed our approach from big training sessions to individual work to help people get going.”
Gaffney says feedback from practices has also been generally good as the tool was seen as not something imposed by the PCT but developed with public health doctors and local GPs.
All three clinical commissioning groups in NHS South of Tyne and Wear have adopted the GPC+ tools as part of their authorisation work. Some keen to use the tools to focus on health inequality targets while others want to use GPC+ to help manage their budget and drive down referral rates.
Plans are in place for CCGs across the north east to be provided with commissioning support from one large commissioning support organisation. For NHS South of Tyne and Wear, this means GPC+ tool will have to be considered as part of the wider support offering.
Gaffney adds: “There are four clusters within the north east and three systems so at some point we will need to bring them all together. Our mindset is that we will probably cherry pick the best bits to make a better system.”
For now, though the focus in NHS South of Tyne and Wear is on getting everyone to use and get the most from this award-winning system.
Gaffney adds: “Now we are not really talking about the tool but about practices within primary care and their way of working. Tools have to be there but it just gives you the right information to adapt your way of working.”
To enter an award category, reserve a table, or for more information on the EHI Awards 2012 in association with BT please visit the Awards section of the website.