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Background
The 2022/23 Investment and Impact Fund (IIF) includes an indicator for 'Percentage of Patients who waited two weeks or less for an Appointment in General Practice' (ACC-08). The intention of this indicator is to recognise Primary Care Networks (PCN) for reducing the percentage of Patients who have to wait a long time for an Appointment. However, the indicator currently has a limitation where it is unable to distinguish between the following situations:
- The Patient wanted the first available Appointment but had to wait more than two weeks to be seen
- The Patient actively requested an Appointment more than two weeks into the future
- There was a clinically indicated interval between Appointments more than two weeks
To address this limitation, NHS England (NHSE) proposes in 2023/24, to add the facility 'Appointment Exception Reporting' to the ACC-08 indicator. This facility will enable Practice Users to record when a time from booking to Appointment of more than two weeks was by Patient choice or clinically indicated. The intention is that Exception Reported Appointments will be removed from the denominator of the ACC-08 indicator, ensuring that PCNs are not at a disadvantage when the wait time was by Patient choice or clinically indicated.
The National Slot Type Appointment Categories will be used to define which Appointments are in scope of the IIF waiting time indicator ACC-08 and which Appointments are subject to Exception Reporting. The National Slot Type Appointment Categories have been divided into three groups:
- Group 1: Categories of Appointments that will typically be scheduled in advance (e.g. planned clinics and planned procedures). These are out of scope of the IIF waiting time indicator and exception reporting should not be available for them
- Group 2: Categories for which it is reasonable to assume that the Patient will always request the first available Appointment (e.g. 'general consultation acute', 'unplanned clinical', 'walk in', 'clinical triage'). These Appointments are in scope of the indicator, but Exception Reporting should not be available for them, as time from booking to Appointment can be taken as a proxy for 'true' waiting time
- Group 3: Categories for which Patients will sometimes request the first available Appointment, while at other times there may be a clinically indicated interval between appointments or the Patient may request an Appointment in the future or express a preference that has the same effect. These Appointments are in scope of the indicator, and Exception Reporting should be available for them, to enable Practice Users to flag when a time from booking to Appointment of two weeks or more was by Patient choice or clinically indicated
Information on which National Slot Type Appointment Categories are in which groups: GP Appointment Exception Reporting - Category Group Table
Outline Plan
When Roadmap status is Published (week 1):
1. Suppliers start development:
The GPAD programme team are able to work with Suppliers, answer any questions and advise on the implementation approach
Development Period (up to 3 months, including week 1):
2. Suppliers carry out their development including addressing any items raised during Solution Assurance (see below)
3. Solution Assurance in relation to underlying Appointment Exception Reporting functionality:
Suppliers to provide Solution Assurance team with necessary inputs for system testing in relation to deployment of the underlying Appointment Exception Reporting functionality, and must demonstrate compliance with test requirements
4. Updates to GPAD Data Provision Notice (DPN) specification:
The GPAD programme team will update the DPN specification (not the DPN itself, as the Information Asset Owner (IAO) has confirmed this isn't necessary) to add details of the new data variables that are to be provided by Suppliers in the regular GPAD collection. The GPAD programme team will make Practices and Suppliers aware of this via existing communication channels (NHS England » Improving GP appointment data) related to the GPAD publication
When above activities (1-4) are completed:
5. Publishing User Guidance:
The GPAD programme team will write and provide content that can be published by Suppliers to Practice Users as helpful guidance. This will have information on the system change and explain how and when to use the new Exception Reporting Reasons
6. Deployment of underlying Appointment Exception Reporting functionality to Live Environments (on the next available release after the Development Period):
The sign-off of Suppliers as compliant (i.e. as operationally ready for go-live) is dependent on the successful completion of Solution Assurance in relation to the underlying Appointment Exception Reporting functionality
Each Supplier can go live on different dates once they have been signed-off as compliant as part of the GPIT Futures compliance process in relation to the underlying Appointment Exception Reporting functionality
The underlying functionality can be deployed before assurance of the Data Management approach has taken place by the GPAD programme team. However, Suppliers should not start to flow Appointment Exception Reporting data as part of the GPAD collection until assurance of the Data Management approach has taken place
When above activities (5-6) are completed:
7. Solution assurance in relation to the Data Management approach:
After release to live environments, Suppliers are to provide sample data outputs to the GPAD programme team, who will then check that these meet data requirements. Sample files will then be assigned to a Data Management services team, who will conduct data review, loading, re-development, and testing work
Suppliers should not start to flow Appointment Exception Reporting data as part of the GPAD collection until assurance of the Data Management approach has taken place
Summary of Change
Two Additional Requirements added to General Practice Appointments Data Reporting Standard:
| Requirement ID | Data Item | Requirement Text | Level |
WPAD-DI-030 | Exception Reason | The Exception Reason(s) why an Appointment Slot was booked more than 14 calendar days after the booked date where an Exception Reason applies. Exception Reason(s) will only be provided for applicable Appointments, not all Appointments. These are applicable if the National Slot Type Category is either 2, 8, 9, or 17, and the time between the Appointment booked date and Appointment Date is over 14 calendar days. Group 3 National Slot Type Categories are;
Selection of Exception Reasons is optional and Practice Users may update their selection at any time. One or more Exception Reasons may be selected by Practice Users. Exception Reasons are to be ordered in the character string as: 1. Patient preferred an Appointment on a future date or at a specific time Suppliers are to report a character string to indicate Exception Reasons selected by a Practice User. Suppliers may return a 'N' to denote that no Exception Reason has been chosen, whilst 'Y' would denote the opposite. This would form a string of four characters; 'NNNN' would indicate no selection, 'YNNN' would indicate selection of the first Exception Reason, 'YNYN' would indicate multiple reasons selected and 'YYYY' would indicate that all Exception Reasons have been selected. Where there are multiple Exception Reasons to be returned for an Appointment, it will be clearly indicated that they relate to the same Appointment Slot. NB: Suppliers can engage with NHS Digital to ensure that the correct information is returned for this data item. Where the Exception Reason associated with the Appointment changes prior to the Appointment being carried out, then this change will be reflected in the delta of data to be returned. If this changes multiple times, it is not necessary to return the full history unless this is available. | MUST |
| WPAD-DI-031 | Self-booking identifier | The flag which identifies an Appointment Slot as Patient-booked (e.g., via the NHS app). Format: Suppliers will return: NB: Suppliers can engage with NHS Digital to ensure that the correct information is returned for this data item. Where the Self-booking identifier associated with the Appointment changes prior to the Appointment being carried out, then this change will be reflected in the delta of data to be returned. If this changes multiple times, it is not necessary to return the full history unless this is available. | MUST |
Amendment to Requirement WPAD-TS3-002 in General Practice Appointments Data Reporting:
The csv file 'Appointment Data Collection Preferred Format' associated with requirement WPAD-TS3-002 has been updated to include the two additional requirements: Exception Reason and Self-booking identifier
| Requirement ID | Data Item | Requirement Text | Level |
WPAD-TS3-002 | Suppliers will agree with NHS Digital the exact format and structure of the csv file(s) to be submitted ahead of the first submission of data and provide copies of these as file templates. NHS Digital will make these templates available via SEFT each week. The initial format is shown in the linked Excel file below. This is to ensure consistency in the way the data is returned. | MUST |
Added sentence in the description of the Standard:
"NHS services come under significant additional pressure over winter and holiday periods. There is already data available to aid understanding of these pressures for secondary care, but currently there are no routine measures of activity levels in General Practice. Therefore, this specification sets out the requirements for a weekly collection of data on all General Practice Appointments. Currently, this is a Practice specification but the plan is to collect this information from Primary Care Network Hubs in the future."
Full Specification
Assurance Approach
- This Roadmap Item is specifically addressing exception reporting within the data collection, based on the outlined selection criteria. As such, embedded within the Traceability Matrix (TM) will be a requirement specific risk log outlining the associated risks
- All Suppliers are to provide either a new or updated 'General Practice Appointments Data Reporting Standard' compliance TM with their compliance evidence. The TM will indicate the level of risk mitigation evidence required for each requirement
- Suppliers will be asked to demonstrate against the identified risks and the mitigations to a group of NHS Digital representatives. The acceptance of appropriate risk mitigation in relation to this requirement will form part of the overall GP Appointment Data Standard assurance