Just as price comparison websites have made shopping around for the best price the norm in 2014, comparing activity between GPs is now much more common.
Data is often attractively presented, accessible and more accurate that it has been before making it possible to look in detail at aspects such as referral rates between partners or between neighbouring practices.
But are GPs motivated to turn on their computers or tablets and take a look at how many patients they referred to ENT last month or which patients have been attending A&E?
Dr Peter Von Eichstorff, a GP in Plymouth, says they are. When working as a GP in Oxfordshire he helped developed the county’s ReferralPoint system which allows GPs to check their referral rates for the top ten specialties standardised against their own consultation rates.
Data is only available within practices and means partners are able to look at their own referral rate compared to practice colleagues, identifying if they are an outlier for any specialty and then being able to act on the results.
A practice manager or GP in each practice needs to upload their consultation numbers and sessions for the previous month and Dr Von Eichstorff says ‘the proof is in the pudding’ as far as popularity of the scheme goes with 426 GPs - about three quarters of practices - returning data each month.
He adds: ‘You can’t help but be interested in what you’re doing and nobody wants to be an outlier.’
Unplanned admissions DES
In addition to potentially saving the NHS thousands of pounds in referral costs, the benefit of such data to GPs is payments from local and national incentive schemes for managing referrals and admissions and data for appraisals.
Dr Van Eichstorff adds: ‘NHS appraisers ask for information on referral rates and will want to see that you have looked at that and written something reflective on it.’
Dr Mark Davies, European medical director of business intelligence firm MedeAnalytics and a GP in Hebden Bridge, West Yorkshire, says GPs' clinical IT systems have given them good ‘introspective’ information for years but there is now a demand for information about the impact of decisions made in the practice on the whole health economy.
He points out that schemes like the 2014/15 DES on unplanned admissions, worth a potential £20,340 to the average practice with a list size of 7,087 patients, require information about who has previous admissions and therefore is likely to be at increased risk of another inpatient stay.
‘GPs in Hertfordshire are starting to use this information to create mature predictive data and things like the DES will affect profitability which is going to be of significant interest to practices,’ he explains.
Dr Davies says MedeAnalytics sees interest from individual practices as a growth area and believes the future addition of social data together with secondary care data will provide GPs with a much better picture of what happens to their patients.
‘There’s genuine frustration, and I might even say anger among the GP population, that they have only been able to look introspectively at their activity until now.’
Supporting GP federations
Dr Dan Bunstone, a GP in Warrington, says a key benefit of the availability of more data is that it has brought his practice together with other local surgeries. Warrington is divided into four federations and each federation of about four practices meets to discuss data such as referral or prescribing information.
He says: ‘We get together with our local practices far more than we ever did, in fact before we probably never did, and that also really helps to exchange ideas and information about running your own GP business.’
However Dr Bunstone says data is still not always accurate and this is also the experience of Peterborough GP Dr Jeremy Phipps. ‘Up-to-date information would be very helpful but often it isn’t, which undermines our confidence in it,’ he says.
GPs in some areas are being provided with more accurate data and responding by taking up the offer. Helen Deevy, information solutions lead for North of England CSU which developed RAIDR, a business intelligence solution used by 850 practices from 23 CCGs, says most of those practices access the system on a daily basis.
RAIDR has nine dashboards and the three most commonly accessed by GPs are those covering primary care, secondary care and urgent care. The primary care dashboard includes functionality covering data quality which means GPs can identify missing NHS numbers in their clinical system or where, for example, weight and height information may have been entered incorrectly, impacting QOF scores.
Other dashboards allow them to identify patients according to a range of risks such as admission, fracture or COPD and to examine data on inpatient attendances, urgent care admissions and so on.
Ms Deevy adds: ‘We generally get really positive feedback from practices and all the developments are things that have been suggested by users.’
For GPs throughout the UK, it seems likely that the availability of such tools will continue to expand as well as the functionality they can offer, providing practices with information that provide insight into workload, profitability and the wider planning and delivery of local health services.
Case study: Using a business intelligence tool in practice
A live data feed brings a new feel to practice meetings for Newcastle GP Dr David Grainger (pictured above) and his partners. With the use of the RAIDR business intelligence tool developed by their local commissioners, the GPs are able to call up the database in meetings and see almost instantly how their practice is performing on a range of activities and work on schemes such as this year’s DES for unplanned admissions, worth up to £2.87 per patient.
Dr Grainger says: ‘We have a surgery projector in our meeting room and, for example, for the DES on high risk patients we are able to look at those patients live with other members of the practice and see a lot of information on them which RAIDR has.’
Dr Grainger is also an executive member of Newcastle West CCG and uses the tool for a range of activities such as reviewing the suitability of outpatient procedures for different specialties and in-hours A&E attendances and identifying possible areas for savings. He adds: ‘I probably use it more than most because of my CCG role but we have never had information in this easy format before and all GPs are interested in what their practice is doing and how they compare with their local peers.’