Chapter Seven: A Data and Intelligence Led Primary Care
- Enhanced workforce data across 3 broad GMS contract areas: workforce, GP income and expenses, and quality improvement and sustainability/clinical activity.
- Improvements underway in collection of AHP, pharmacy and optometry workforce and activity data.
- Roll out of the Scottish Primary Care Information Resource ( SPIRE), enabling health professionals and GP clusters to work more effectively together to improve the quality of care.
- Expansion of the successful Local Intelligence Support Team ( LIST) programme into primary care to support GP Clusters deliver quality improvement.
- Development of the NES workforce data platform and supply modelling.
- The Primary Care Digital Services Development Fund, 2016-2018 delivering a wide range of systems enhancements, infrastructure improvements and innovative trials of new tools and technologies.
- Development of a 10 year Primary Care Monitoring and Evaluation Strategy to understand and share learning, including progress in delivering the commitments set out in this plan.
The importance of good quality and timely data and the capacity to use it to drive the reform of primary care and quality improvement cannot be under-estimated. We are aware of the need to strengthen the primary care data we collect, and ensure the right healthcare professional has the right access to the right data at the right time to improve patient outcomes. We are currently rolling out a significant programme of work and investment to enable consistent, high quality and reliable data to be sourced, managed and utilised appropriately.
The Primary Care Workforce Survey is designed to capture aggregate workforce information from Scottish general practices and NHS Board-run GP Out of Hours services. The survey provides information on GPs, registered nurses (including nurse practitioners) and other clinical staff employed by Scottish general practices. It also collates data on vacancies, temporary cover for sessions / hours and out of hours commitments. The 2017 workforce survey was published in March 2018  .
In recognition of the importance of reliable workforce data we have agreed with the BMA as part of the new GMS contract that, from 2018-2019, practices will return data to NHS National Services Scotland. This will create a richer set of data to support local and national workforce planning and service improvement. Data is required across three broad areas:
- Workforce data for workforce planning and assessing practice sustainability. This is likely to be broadly in line with the information collected via the existing workforce survey but we will explore the potential of collecting these data on a quarterly basis;
- In order to prepare for Phase 2 of the GMS Contract we need to fully understand the current expenses of running a GP practice, the income of salaried GPs and the income of GP partners as well as the hours worked by individual GPs. The Scottish Government and the BMA have agreed that all GP practices will be required to provide this data (earnings, expenses, working hours/sessions) in a similar way to the data already provided for pension purposes;
- Clinical quality and activity data to support GP cluster quality improvement, planning and service re-design.
The need for robust data for ensuring continuity in high quality patient care applies equally to primary care services provided out-of-hours. This was acknowledged as one of the main recommendations in Sir Lewis Ritchie's National Review of Out-of-Hours Services report published in November 2015  . Since the Review's publication, work has been underway across all NHS Boards to improve the data collected and used within out-of-hours service, by upgrading the Adastra IT system. Once fully in place, this will ensure standardised use of the system across Scotland, allowing for consistent meaningful data to be collected.
The benefits of the system changes and the improved data collection are already being seen. NHS National Services Scotland is now reporting on primary care out-of-hours services data  . This data shows patient and workforce data for out-of-hours services, so allows Boards to plan and monitor how their service is delivered to ensure it is high quality and safe.
We are aware of the need to improve data on the AHP workforce. There is no national approach to the collection of all AHP activity data, or detailed information on where and how AHP services are delivered across all health and social care sectors (including in primary care). The AHP Operational Measures  project aims to address the activity data gap; paramedic data is collated separately. While ISD publish quarterly AHP workforce data  , more detail is needed to fully understand how AHP services are delivered across all health and social care sectors. The AHP Directors of Scotland Group ( ADSG) recognise the importance of understanding more about the AHP workforce and have begun a process of reviewing existing workforce and workload tools. This work is in its early stages but a report including recommendations will be produced in due course.
For optometry, the national listing of optometrists and dispensing opticians (a key recommendation of the Community Eyecare Services Review published in April 2017)  on a single system will deliver improvements in the provision of optometry workforce data and in workforce planning.
In recognition of the gap in robust baseline data on the number of pharmacists and pharmacy technicians working in our network of community pharmacies, in February 2018 NES Pharmacy undertook the first national community pharmacy workforce survey to gain a better understanding of staff numbers and skill mix within community pharmacy in Scotland. The survey was carried out in partnership with Community Pharmacy Scotland, Community Pharmacy Champions and health board staff, and the Company Chemists' Association.
The survey was designed to capture a snapshot  of the community pharmacy workforce including pharmacists, pre-registration trainee pharmacists, pharmacy technicians including trainees, and pharmacy support staff. The information obtained is being analysed and will help to inform future iterations of workforce planning, to help ensure we have the right workforce in place and to take action to meet future service models and demands.
NES Data Platform and supply modelling
As set out in the National Health and Social Care Workforce Plan: Part 1, NES is working with stakeholders to bring together and align relevant workforce data under a data platform to better inform workforce planning. As an initial step NES has led a process to develop a minimum standardised data set with potential to use across different sectors. NES is currently engaging with regional and national planners with the aim of finalising the minimum dataset shortly. These engagement sessions will help inform further development of the platform over the course of this year.
The platform will assist the development of more sophisticated workforce modelling, including the design of a 'pipeline' approach demonstrating how supply via training and recruitment numbers will meet estimated demand. This work will be progressed during 2018 with full implementation expected in 2019. These are significant development that will lead to more informed and better integrated workforce planning decisions at local and national level.
Scottish Primary Care Information Resource ( SPIRE)
SPIRE is an integral part of the reform of primary care and is a crucial tool in enabling the emerging model of more collaborative multi-disciplinary primary care  . By improving the management and usability of existing data within general practice records the introduction of SPIRE is an essential component of making GP clusters effective.
SPIRE is currently being rolled out across Scotland and will help practices provide patients with better care and services and help with the following:
- Analysing and streamlining practice workload, getting information on patient encounters, and analysing practice demographics;
- Analysing the number of patients that have certain illnesses or looking at the medicines they are prescribed;
- Monitoring and improving data quality;
- Enabling GP clusters to work together to improve the quality of care;
- Improve the provision of health and care to vulnerable or disadvantaged groups.
Local Intelligence Support Team ( LIST)
LIST analysts have been successfully working locally with Health and Social Care Partnerships and others, to help drive forward integration. The Scottish Government has provided additional funding from 2017-18, to expand the LIST service to work with primary care. This will support GP Clusters and their focus on improvement, following Improving Together: A National Framework for Quality and GP Clusters in Scotland  .
LIST, part of NHS National Services Scotland, mainly comprises information analysts with the aim of adding capacity and capability to local expertise. The increasingly multi-disciplinary nature of the LIST team, with its connection to the national level resources in ISD and the ability to use national and local data, will help deliver an intelligence-led service which is joined up across health and social care, including GP Clusters. As of April 2018, LIST has grown to around 65 whole time equivalent staff. The team supports cluster and partnership working across Scotland  .
We recognise the need to improve IT to help enable efficient and effective working. NHS Boards have commissioned a procurement competition to provide the next generation of GP clinical IT systems in Scotland. This is being undertaken by NHS National Services Scotland. The new systems will be more intuitive and user friendly. They will be quicker and more efficient, with increased functionality. They will be underpinned by strong service levels and performance management, with clear lines of responsibility and accountability, providing, overall, a more professional GP IT Service. All GP practices will transition to the new systems by 2020.
Increasing Digital Capacity
The Primary Care Digital Services Development Fund, 2016-2018 has enabled general practices to benefit from a wide range of systems enhancements, infrastructure improvements and innovative trials of new tools and technologies.
A number of the opportunities selected serve to increase the availability of, and access to, timely data. For example, the practical benefits of remote working tools to enable real time access out with the practice, dual monitors in consulting rooms to facilitate ease of working between information systems in real time and ultimately to support shared decision making with patients. A range of infrastructure improvements, including server replacements to increase speed of backups and connectivity and practice wi-fi to support multidisciplinary team working. Trials of new technologies include online consultations, decision support, mobile working software solutions and devices.
The impact of the fund is being measured using an outcomes framework developed with stakeholders which is aligned to the wider Primary Care Outcomes Framework (see below). A specific study on the use, spread and experiences of Mobile Working is being undertaken which encompasses the wider community and primary care workforce.
Monitoring and Evaluation
The continuing reform of primary care is challenging and will take time. We need to be realistic about what changes we expect to see and when, and be responsive to changing circumstances. The Scottish Government will publish a 10 year national monitoring and evaluating strategy for primary care, which has been developed in partnership with NHS Health Scotland, by summer 2018. We are also working with partners to develop a set of national indicators to track progress.
A Primary Care Evidence Collaborative ( PCEC) involving national organisations  has also been established to champion evidence-based practice and service delivery across the primary care sector and to identify and help to fill gaps in evidence through research. The collaborative helped to develop Primary Care Outcomes Framework which describes, at a high level, how the vision for primary care will be achieved  . The outcomes pathway for workforce (see Annex A) sets out the short to longer term outcomes the actions set out in this plan, and as part of the wider reform of primary care, are expected to deliver. We will work with our partners to further develop this pathway and to ensure robust monitoring of these workforce outcomes is established.
Local and national workforce planning needs to be informed by good quality and timely data on both the shape of the current workforce and intelligence on how the workforce needs to develop and expand to address a growing and increasing elderly population. We recognise that we are still some way off realising that ambition, but significant progress is now being made. Through the NES data platform and the enhanced general practice data that will be delivered via the GMS contract, supported by expanded local analytical support, we are moving towards our goal of evidence-led workforce planning. Further iterations of the National Health and Social Care Workforce Plan will set out how this work is developing.