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Here is a fun story about NHSE and NHS Digital where the right hand doesn't seem to know what the left hand is doing...
A few years back NHS Digital wisely decided it would be useful to know what was happening in GPs. This should have been done many years ago as managing primary care with no idea of the activity trends is non-trivial to say the least...
But there were both trust problems (GPs resist being managed and hate bureaucracy) and technical problems (GP systems don't play nice with others and getting useful data from them is painful)...
But, eventually, NHS Digital started collecting data from the clinical systems. And they published it monthly. This consisted of monthly counts of appointments, telephone consultations and metrics like the DNA rate...
WOOT! we now have a public datasource that we can all use to test ideas about GP activity and monitor it over time. Ish. The published data is aggregated to CCG level so we can't compare practices...
But–and here things get really annoying: CCGs keep merging at a frantic pace. So any analyst who wants to track regional activity over time has a huge problem: many time series are interrupted by boundary changes...
I've done public analysis on this data ( https://public.tableau.com/views/gpapptanalysisv1_2pub/insightsfromGPappointmentdata?:language=en&:display_count=y&:origin=viz_share_link) and there are some fascinating and provocative insights in it...
But I gave up trying to update it because it was simply impossible to handle long time series in a consistent way given the frequent boundary changes...
But at least we had a consistent national time series about most of the activity done by GPs. And, presumably NHSE could look at the practice level data for insight in a way that non-NHS people like me can do...
But then #covid happened and the last thing NHSE wanted GPs to do was to see all their patients in person as that would lead to a catastrophic risk of spreading the virus...
So the excellent primary care team in NHSE issued advice to avoid f-to-f appointments wherever possible. And supported this by demanding a much faster roll-out of online total-triage tools like @askmygp and @econsult_thinks ...
And this was done very rapidly and effectively with a radical and rapid rollout of online tools and a big shift to dealing with patients online (though those who went online early did it faster: https://www.health.org.uk/news-and-comment/charts-and-infographics/how-has-covid-19-affected-service-delivery-in-gp-practices) ...
So far so good. GPs were moving from seeing most patients f-to-f to dealing with them by phone video or message. Across the country perhaps moving from 85% f-to-f to <10%. And this was good...
Some practices saw major improvements in their service to patients with faster, more appropriate responses to their needs and patients liked it (certainly at @askmygp where we get ~20k pieces of patient feedback per month)...
But the problem with handling patients online is that there are very few f-to-f appointments any more. And GP clinical systems were never very reliable at recording phone calls never mind online activity...
So that NHSE national collection (which extracts activity from clinical system appointment books) now shows very low levels of activity...
Never mind. NHSE had established a daily collection early in the pandemic so every provider of online services sends daily online reports describing how many requests each of their GPs has handled...
So they have a data source that tells them what GPs are doing that counts activity not well recorded by the clinical systems. So they can hold up a middle finger to dumb journalists who claim GPs are not doing much right now...
But some other branch of NHSE don't seem to have got the memo. Many practices have recently been approached by their CCGs because the (original) national dataset makes it look like they have very low activity...
(which it would since most activity is online and not getting into the clinical appointment books). And someone in NHSE has decided that they don't know what is happening in their GPs...
So they are now demanding from their practices that they explain their apparent lack of activity. For those with good online systems they can do this easily by showing the total volume of requests using their system's analytics...
So practice can send their CCG that data to keep some part of NHSE happy. But NHSE already have all that data as all the suppliers have been feeding it to them daily since April...
So we now have a situation where one part of NHSE is pressuring CCGs to get data from GP practices to explain why the national activity dataset doesn't report activity properly when NHSE already have the complete dataset!...
And this is my (incredibly long winded) point: why does one branch of NHSE not seem to know what another branch of NHSE is doing? Doesn't NHS Digital share all the collections across the people who need to have it?...
