Overview of Practice Team Information

The Practice Team Information (PTI) programme collects information from a sample of Scottish general practices on contacts (face-to-face consultations in a surgery or the patient's home) between patients and any member of the Practice Team (general practitioners, practice nurses, district nurses and health visitors). It replaced the Continuous Morbidity Recording (CMR) scheme that previously collected data on General Practitioner (GP) contacts only.

Currently 44 practices contribute full Practice Team Information to PTI, covering around 5 per cent of the Scottish population. The population in the sample is a good reflection of the Scottish population with regards to age, gender and deprivation, and small imbalances due to these factors are addressed through a process of direct standardisation. Prevalence and incidence estimates based on PTI data are thought to be a better estimate of prevalence and incidence in the Scottish population compared to GP-only estimates, because any patient who had a consultation with a member of the practice team other than a GP would previously have been missed.

Contacts are recorded by every doctor (including locums) and by practice and community nurses. Up to ten signs, symptoms or diagnoses can be recorded for each contact with a doctor and four for nursing staff. Clinicians are asked to describe the signs, symptoms or diagnoses as specifically as possible. The signs, symptoms or diagnoses are given a Read code along with an appropriate modifier indicating whether the condition is the first episode, a recurrence or a persisting problem. The data are entered onto the practice GPASS system. Monthly extractions are sent to ISD for analysis. Each practice receives regular quarterly feedback.

Strengths

• PTI allows national estimates of primary care activity, prevalence and incidence and numbers of contacts for the full range of clinical problems presenting in primary care, while alternative sources, such as the Quality and Outcomes Framework (QOF) of the new GMS contract, provide information only on selected conditions
  
• PTI provides individual level data, which allow adjustment for age, sex and level of deprivation. This is easily achieved using the aggregated data currently provided by the QOF. More information on comparisons with the QOF is available on the PTI web pages.

Limitations

• PTI estimates for a given condition are based on patients consulting a member of the practice team because of a specific condition at some point during the year of interest. PTI measures active problems; a lifelong or previous condition will not be recorded unless the patient had a contact with the practice that was directly related to that condition. PTI figures are therefore likely to underestimate the true Scottish prevalence of some conditions.
  
• As PTI is based on a small sample of practices, it is not suitable for estimating the prevalence of rare conditions.
  
• Patient and contact rates are derived using population estimates based on the number of people registered with a general medical practice at the midway point of the year (30th September). Any person not registered with a practice at the time of the population extract is not be included in the population totals. As a result the population size is likely to be slightly overestimated, resulting in a slight underestimation of patient and contact rates.
  
• In common with many other health data sets, standardisation within PTI can take account only of measured factors that influence health status. Although standardisation can take account of differences in the distribution of age, gender and deprivation between the PTI sample and Scotland, there might well be other factors that influence the number of patients and contacts recorded for certain health conditions. Examples could be NHS Board (e.g. the way that services are configured) or other geographical factors.

The PTI website contains more information about PTI and how the information is collected.