Hampshire data accreditation case study

Hampshire 2008

PRIMIS+ is pleased to have been able to support facilitators and PCT staff, practices and assessors throughout their data accreditation preparations with a full range of training, resources, materials, analysis tools and queries sets.

PCTs have been putting their own stamp on the IM&T DES process by tailoring their approach to their specific demographic and geographic needs.

In this case study, Hampshire PCT explains its unique experiences, situations and approaches to helping practices become accredited under Component Two of the Information Management and Technology Directed Enhanced Service (IM&T DES), so they can upload summary patient records to the Spine.

As the largest PCT in England, Hampshire’s size and sheer number of practices prompted its facilitators to be quick off the mark - both in preparation and the number of practices put through for early accreditation. With a population of around 1,250,000 people, Hampshire PCT covers 550 GPs in 147 surgeries and was formed by the merger of seven PCTS on 1st October 2006.

The Primary Care Information Service Team in Hampshire – Caroline Sims, Julia Warner, Cheryl Mair and Emma Goss - are all PRIMIS+ facilitators. The team found that when overall data quality is good within practices, it has been more likely that they are ready – and eager – to be accredited. The first practice assessment took place in Hampshire on 1st November 2007, and by the 7th April 2008, 139 practices had been assessed.

Every practice assessed since February 2008 has passed. The vast majority were accredited for the maximum three years, with around 18% of the practices passed for one year (with an action plan of issues they need to work on). Because Hampshire put through those practices with the best data quality first, facilitators and assessors could concentrate on the process and learn from it, while minimising the chances of any practice being turned down for accreditation.

Julia Warner explained that the preparation for the DES had been ‘massively hard work’ for everyone involved. In Hampshire, as with other geographically large PCTs, journey distances have exacerbated the problem of managing this many practices in a short space of time.

Hampshire has been fortunate to have had access to a clinical assessor dedicated to the concept of the DES. Dr Tim Cotton took a three month sabbatical from his Winchester practice to work on the IM&T DES. While preparing for and undertaking practice assessments, he has also worked with Hampshire’s other clinical assessors; producing assessor guidance and streamlining the assessment process and documentation.

Initially, Hampshire assessors gathered CHART Online data for practices themselves, which added hours to the total time spent on assessments. Now facilitators prepare this information for assessors, as it is a more sensible division of tasks.

Another area that Tim has worked on is his marking methodology. He conceded that his assessment marking was somewhat inconsistent to begin with but, over time, he has worked on this so as to be as fair as possible to the practices. Consistency may be an issue for other PCTs with several assessors, but this can be resolved with clear guidelines on marking, such as those produced by Tim.

A full time partner at his practice for 16 years, Tim has always considered himself to be IT-literate and inquisitive about new healthcare technologies and sits on the implementation panel for NHS Connecting for Health's GP Systems of Choice (GPSoC). After becoming a clinical assessor, he opted to work on the IM&T DES full time for 'the experience and privilege of doing it'.

As part of the changes to the GMS contract in April 2006, a Directed Enhanced Service (DES) was developed to facilitate the use of Information Management and Technology (IM&T), in supporting the delivery of the National Programme for IT.

A key objective of this DES is to support practices in achieving accredited data quality standards that are acceptable for sharing data in the NHS Care Records Service. Once practices have achieved accreditation, they will be able to upload patient summary records to the Spine.

The PRIMIS+ team of Clinical Advisers – all working GPs – put together a specification and query set which was designed to test the quality of patient data within general practice in relation to the needs of the IM&T DES, called the e-audit toolkit. This toolkit provides a snapshot of data recording in a practice, and can help IM&T DES assessors, as well as practices, in their preparation for the data accreditation assessment. The toolkit was developed for use with the MIQUEST interpreter found on all clinical systems and the PRIMIS+ CHART software, which displays data in a user-friendly format allowing in-depth analysis.

PRIMIS+ has produced a web-based comparative analysis tool, CHART Online, which is the only tool mandated by NHS Connecting for Health to support the IM&T DES data accreditation process. With CHART Online, data can be viewed in a variety of graphs, and practices can benchmark their progress against other practices within their PCT, Strategic Health Authority or nationally.

Dr Dai Evans, PRIMIS+ Clinical Director, who helped with the development of the e-audit toolkit, uses CHART Online within his own practice. "It’s an invaluable tool to mark a practice’s progress towards high data quality," he commented. "It’s particularly useful as the queries it contains relate to records that will be looked at during the data accreditation assessments - records which have not been looked at before under QOF or any other assessment."