‘Hard to quantify’ primary and community care has been overlooked for too long. That could be about to change, thanks to moves to standardise the codes for encounters, activities and job roles, writes Nilesh Bharakhada
A recent report from the King’s Fund, Making care closer to home a reality, shines a light on the failure of successive governments to shift the focus away from hospital care to primary and community services. This is despite the wealth of evidence that investing in primary and community services is key to delivering a sea change in the NHS from a demand-led urgent and emergency service to one that is more personalised, focused on improving the health of the population and preventing illness.
Why is this such an enduring problem? According to the King’s Fund, primary and community care services are “hard to quantify, easy to overlook” and as a result, financial and workforce growth plans have concentrated on acute trusts far more than primary and community care.
A new vision for health and care services would require structural changes and investment in primary and community care; a crucial element of this is effective data management.
The way care is delivered in general practice has changed – there is a new workforce and new ways of accessing care. There are challenges around existing and future primary care estates which invariably have inadequate space to accommodate new and existing staff. Remote access and remote working, as well as roles shared across organisations are being used as temporary workarounds.
Currently, general practices do not have good quality data to understand who is doing what, where and how, making it difficult to understand whether the changes are working, plan workflow, and inform workforce and local estates planning to drive better outcomes for people and communities.
Data enables integration
Data is key to delivering integrated care. Dr Claire Fuller’s Stocktake from 2022 identifies data as one of the three enablers to fulfil the vision for integrating primary care services, resulting in better access to care and advice, providing more proactive and personalised care, and helping people to stay well for longer through primary prevention.
Primary Care Networks and wider neighbourhood teams need to be able to access real-time data on service demand, service activity and service capacity. At present, it is not easy to accurately, consistently and unambiguously record consultation types, their modes and types of care-related activity in systems. By improving the consistency and accuracy in recording who carried out what activity (a consultation, review of test results, etc) and how they did it (telephone, online, face-to-face), activity carried out in general practice can be better understood and used to draw insights for planning purposes. Funding can be better aligned to workforce requirements and how they deliver care.
There are many challenges in obtaining good quality, consistent primary care data in this area. To date, there has been no systematic approach to standardising the coding of encounter types and care-related activity in general practice. Doing so would undoubtedly improve data quality leading to powerful insights about people’s needs, which could drive better demand and capacity management leading to improved access and care for all. Fortunately, work to do just that is currently underway.
National work on standardisation
The PRSB is working with the NHS England to build on the work of North-East London Integrated Care Board by reviewing the approach they took to define the codes and terms for encounters, activities and job roles. It involves broadening engagement to the four nations and IT system suppliers and determining what could be done nationally to support the implementation of those terms. The project supports the Delivery plan for recovering access to primary care which aims to help practices and primary care networks to better align capacity with demand, improve the working environment and improve people’s experience of care.
The PRSB has consulted widely with primary care professionals and IT system suppliers to agree the terms. At the time of writing this article, we are also preparing for our roundtable event to further debate the proposals and will be producing a report on our findings and recommendations.
Data is care, but only if it supports informed decision-making and can be utilised to deliver overarching goals. Enabling primary care to access and record robust data should be the starting point for any improvements.
Dr Nilesh Bharakhada is a GP partner and executive clinical director for health and care at the Professional Record Standards Body. He is also a PCN clinical director, chair of quality and clinical governance for Hillingdon Health and Care Partners and chair of the RCGP North and West London Faculty.