Background
The Investment and Impact Fund (IIF) includes a number of indicators which require a change to the GPES data model. These are detailed below:
Indicator SMR-01
Primary Care Networks (PCNs) have been delivering Structured Medication Reviews (SMRs) as a contractual requirement via the Network Contract Directed Enhanced Service (DES) since October 2020. In 2023/24, the SMR-01 indicator will reward PCNs for high rates of SMR delivery to the Patient cohorts (outlined under ‘live 2022/23 indicators’ in DES).
Currently, the GPES Data Model does not allow identification of distinct medications, or medications to be filtered based on the prescription being acute or repeat. To allow for accurate measurement of medication prescribed and identification of the correct Patient cohort, attribute ‘T2A19A - VALUE3 (Virtual Therapeutic Moiety (VTM))' has been added as mandatory in the Journals Table Attribute List.
Indicators RESP-01 and RESP-02
RESP-01 and RESP-02 are indicators focused on improving outcomes for Patients with asthma. These indicators will increase the use of Inhaled Corticosteroids (ICS) inhalers for appropriate asthma Patients, this will improve disease management and reduce unnecessary Short-Acting Beta-Agonists (SABA) inhaler usage.
Currently, the GPES Data Model states attribute ‘T2A18 - VALUE1 (Medication Quantity)' as an optional attribute. To allow accurate measurement of medication prescribed and identification of the correct Patient cohort, 'T2A18 - VALUE1 (Medication Quantity)’ attribute has been made mandatory in the Journals Table Attribute List.
Index of Multiple Deprivation
Tackling neighbourhood health inequalities, informed by the Core20Plus5 approach, is a major focus of the Network Contract DES. The Core20Plus5 is focused on the 20% of most deprived neighbourhoods, as well as on five clinical areas particularly important for health inequalities. The Indices of Deprivation are used to define the level of deprivation of neighbourhoods across England and hence enable comparison of care provision across deprived and non-deprived areas.
Currently, the GPES Data Model does not allow data collection of least deprived quintile and most deprived quintile for health inequalities. In order to resolve this, three mandatory fields have been added in the Patients Table Attribute List:
‘Lower Layer Super Output Area (LSOA)’ - (mapped from Patient postcode)
‘Index of Multiple Deprivation Rank’ – (mapped from LSOA)
‘Index of Multiple Deprivation Decile’ – (mapped from LSOA)
To determine the deprivation of the area in which a Patient lives, their postcode is mapped up to LSOA level. These LSOAs are ranked from most to least deprived (IMD Rank) and are also allocated a decile (a value 1 to 10). In indicator construction, the Patients within the 20% most deprived areas would be identified as those with an IMD Decile of 1 or 2. IMD Rank can be used to identify percentages, not a factor of 10, e.g. 15% most deprived.
Mapping files:
LSOA to IMD - English indices of deprivation 2019
Patient postcode to LSOA - Office for National Statistics data
Outline Plan
Suppliers to be compliant after 3 months of the Roadmap Item Publication date. Suppliers are to create indicators (as specified by the GP Specification and Extraction Service) based on the new fields:
Build functionality to count the number of items included on a prescription in order to identify a Patient cohort who are prescribed (e.g. a particular number of inhalers). Field T2A18 has been updated from optional to mandatory to facilitate this
Build functionality using new field T2A19A to identify a Patient cohort who are prescribed multiple (e.g. 10+) VTMs, with the option to filter out acute or repeat prescriptions
Build functionality using new fields T1A30, T1A31 and T1A32 to create a Patient cohort based on the deprivation level of the area in which they live (e.g. Patients living in the 20% least deprived areas)
Summary of Change
GPES Data Extraction: GPES Interoperability Standard requirements introduction and document updated to v7.0.0 |
The GPES-I requirements |
GPES Interoperability Standard document: Requirements T2A18 updated to mandatory and T1A19A added to the Journals Table |
Ref | Item - JOURNALS | User view | Technical notes | Code list | Data type | M/O |
T2A18 | VALUE1 (In a record with CODE for prescribable item) | Amount prescribed as number of tablets, capsules, etc. or vol. Of liquid in ml. | Report as null string "" if this cannot be ascertained from the prescription data. | N/A | NUMERIC |
|
T2A19A | VALUE3 (In a record with CODE for prescribable item) | VTM | Return VTM, mapped from AMP/VMP code of prescribable medicine | CV | M |
GPES Interoperability Standard document: Requirements T1A30, T1A31 and T1A32 added to the Patients Table |
Ref | Item - PATIENTS | User view | Technical notes | Code list | Data type | M/O |
T1A30 | LSOA | Lower Layer Super Output Area of residence | Return LSOA mapped from T1A6 patient postcode | CV | M | |
T1A31 | IMD_RANK | Index of Multiple Deprivation Rank of LSOA of residence | Return Index of Multiple Deprivation Rank mapped from T1A30 LSOA | CV | M | |
T1A32 | IMD_DECILE | Index of Multiple Deprivation Decile of LSOA of residence | Return Index of Multiple Deprivation Decile (a value 1 to 10) mapped from T1A30 LSOA | CV | M |
Full Specification
Assurance Approach
Suppliers will be asked to demonstrate their mitigations against the pre-identified risks through completion of the NHS England Solution Assurance Risk log submission, supported with the requested messaging based test evidence and online demonstration by the Supplier to a group of NHS England representatives.
The successful conclusion of the NHS England assurance for the risk mitigations implemented by the Supplier in relation to these requirements will be required before the changes can be deployed in the production environment.