General Practice Extraction Service GPES

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General Practice Extraction Service (GPES)
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• DAVE ROBERTS
• Programme Head
• non-acute care
• NHS Information Centre
• GPES Project Director

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Overview

• Why?
• business requirements
• current situation and provision
• What?
• scope of the service
• business case options and conclusions
• How?
• progress to date
• next steps

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Background

• 8,500 GP practices in England and 30,000 GPs
• Each GP practice has a clinical system that holds
  patient records
• Conditions, prescribing, tests and procedures all
  coded ( 3 different coding systems )
• 12 types of clinical systems supplied by 4 main
  commercial system suppliers

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Why? Business requirements

• DH
• Primary Care Contracting
• GPES intended to replace the extraction facility
  for QOF data
• patient survey work
• QOF assessor toolkit (currently part of BT
  contract with NHS CFH)
• QOF development work
• Workload toolkit (pilot looking for roll out)

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Why? Business requirements

• Resource Allocation team at DH
• Review of resource allocation process has
  identified a need for patient level data to
  support allocations for
• practice based commissioning
• PCT unified allocation
• formulae required to reflect disease burden and
  facilitate addressing health inequalities
• global sum calculations

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Why? Business requirements

• Public Health
• Health Improvement Directorate (DH)
• public health indicator work around risk
  management, including issues such as alcohol
  abuse, obesity, smoking, CHD risk
• surveillance data required on vaccines, flu
  pandemic preparation etc (extraction required on
  a daily basis)
• Health Protection Agency
• surveillance data in particular on STIs

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Why? Business requirements

• Research and development
• Research Capability Programme
• Pharma companies statutory requirements for drug
  licensing
• adverse drug reaction reporting
• post marketing surveillance
• other research programmes

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Why? Business requirements

• NICE
• Developing guidelines
• Monitoring the impact of guidelines

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Why? Business requirements

• New commissioner of clinical audits
• clinical audits with primary care focus
• national diabetes audit
• other audits (e.g. cancer, renal)

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Why? Phase 2 requirements

• PRIMIS
• request for new extraction service to replace
  MIQUEST from CfH clinical leads to help policy
  objectives such as the IMT DES process to allow
  data from GP systems to enter the spine
• SHAs/PCTS/Practice based commissioners
• requirements for commissioning
• several PCTs and SHAs currently implementing and
  considering procurement of extraction facilities

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Why? Current situation

• Current situation
• GPs extract information from their own systems
  through proprietary systems developed by the
  relevant system supplier or through the
  nationally implemented MIQUEST software
• The QMAS system has been developed as part of a
  payments system for the Quality and Outcomes
  Framework however these data are restricted to
  the indicators negotiated as part of the GMS
  contract (which are subject to change each year)
  and the data collected are complete only at
  financial year end given that they are collected
  primarily for payment purposes. The NHS
  Information Centre publishes complete
  practice-level data

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Why? Current situation cont.

• commercial companies have the expertise and
  software capable of extracting data from GP
  systems if they have the cooperation of the
  system suppliers
• there are several research databases which
  contain anonymised patient records from samples
  of GP systems. National estimates can be made
  from these databases

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Why? Current provision

• The current provision of data
• those that require data to be extracted from the
  majority or all practices are restricted in the
  data they collect, are not coordinated and are
  expensive to run.
• other data collections that collect comprehensive
  data from practices are only available for
  samples of practices.
• considerable duplication of effort and cost
  currently exists collecting overlapping sets of
  data
• existing processes are not aligned to the current
  architecture and information governance
  requirements of the National Programme for
  Information Technology

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What? Total scope of service(Authority and
Contractor)

• GPES scope

Customers
All GP Practice systems
Extraction
Query
Analysis
Data management
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Phasing

• Phase 1
• Centrally coordinated service
• All customers come to IC to request data
• IC formulates the business queries
• Contractor facility runs extracts and presents
  data back to IC
• IC provides analyses for customers
• Phase 2
• Same tools made available to wide audience
  including GP practices, PCTs etc
• Scale of facilities greater than for option 2
• Functionality is the same
• Replacement for MIQUEST

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How? Progress to date

• CFH and IC board approval for joint IC/CFH
  project
• Downing Street and Ministerial approval
• Funding agreed by the Department of Health to
  deliver Phase 1
• GPES market soundings exercise x 40 suppliers
  completed to establish the feasibility of
  concept capability of suppliers maturity of
  market capacity to deliver scale and timescales
• Website launched - www.ic.nhs.uk/gpes
• Enquiry line launched enquiries_at_ic.nhs.uk
• Gateway Review completed successfully and
  received significant support
• Media coverage Pulse, e-health insider, Primary
  Care Today and HSJ article

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Progress continued

• Project Assurance Group documentation reviewed,
  recommendations submitted and amendments made
• 10th September, final approval of all
  documentation from the Project Board
• Final high level requirements gathering exercise
  completed yesterday.16 customers interviewed in
  total
• Stakeholder engagement initiated
• Series of information sharing events and the
  first GPES Communications Group meeting completed
  in September
• speeches at conferences/meetings (British
  Computer Society, Primary Care Consortium, Pan
  User Group, e-supplier forum)
• press and media coverage (e-health insider
  Pulse HSJ and Primary Care Today)
• Key stakeholders being consulted re
  communication requirements

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Principles

• Compliant with legislation
• Consistent with the Governments policy on use of
  data from patients records for purposes other
  than direct care.
• Patient Record Guarantee
• Care Record Development Board report on
  secondary uses
• Presumption that analysis will be undertaken
  using data which is anonymised or in which
  identifiers are replaced by pseudonyms
• Advice and guidance from NIGB
• Technical solutions comply with National
  Programme for IT standards (approved by the
  independent Information Standards Board)

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Requests for extracts

• Practices able to opt out of any specific extract
• Patient opt outs in principle subject to
  appropriate read codes
• Independent Advisory Board, which will
• scrutinise each business requirement in terms of
  prioritisation and improving patient care
• make recommendations as to which extract requests
  should be executed
• membership will include representatives from the
  relevant GP professional bodies
• Extracts only used for the purpose approved

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Benefits of GPES to Primary Care

• Access and availability of our clinical data
• Access to practices for nationally defined
  queries
• Less risk of disruption in doing extracts
• Less management required
• Better information governance and data security
• Supports GPSoC

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Benefits of GPES to the NHS

• Comparison between practices helping us to
  deliver better care
• Coverage and quality of clinical audits
• Understanding to support provision and world
  class commissioning
• Support for personalised services
• New models of care e.g. Federations

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Benefits of GPES to public health

• National and local public health surveillance
• Information for health improvements and
  addressing inequalities

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Benefits of GPES Others

• Support for research
• Hypothesis generation and testing
• Case control studies
• Follow up of consenting individuals
• Record linkage

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www.ic.nhs.uk/gpes Queries enquiries_at_ic.nhs.uk
quoting GPES