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Introduction 1

The PRIMIS National Team 2

Your Local PRIMIS Scheme 7

The PRIMIS Training Agenda 13

Training Needs Assessment and Scheme Management 17

What is Primary Care? 21

Quality Data, Quality Outcomes 25

Clinical Coding 29

The MIQUEST Process 33

Data Analysis, Interpretation and Feedback 37

Facilitation Skills 39

Annual Review 43

CHART 47

Action Planning and Supporting Change 51

Information Governance 55

Path to Paperless 59

Data Quality and Patient Safety 63

Supporting Quality Outcomes 67

Supporting Quality Services 71

Supporting Quality Review 75

Primary Care Data Uses and Abuses 79

Glossary 83
http://0.0.0.0/http://0.0.0.0/


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The aim of the Primary Care Information Services (PRIMIS) Facilitator Handbookis to supportthe information facilitators individual learning portfolio by introducing each of the training topicsoffered as part of the PRIMIS training programme. The Handbook does not replace the need toattend the training, but serves to prepare the facilitator for the training and give references foradditional reading which facilitators can choose to pursue, either in preparation for the trainingday or for further information following the training. Detailed information on the setting up andrunning of a local PRIMIS schemeis contained within the PRIMIS Guidelines.

In addition to the Facilitator Handbookand PRIMIS Guidelinesthere are also workbooks tosupport the majority of the PRIMIS training modules. These workbooks, made available tothose attending the training, include background information and practical exercises andscenarios, and are designed to build up a full resource for future use. A manual for theMIQUEST data extraction software is made available separately to those attending theMIQUEST Process training module.

This Handbook is divided into sections that mirror the training modules offered by PRIMIS, asshown below:

PRIMIS Training Modules

Training Needs Analysis and Scheme Management

What Is Primary Care?

Quality Data, Quality Outcomes

Clinical Coding The MIQUEST Process

Data Analysis, Interpretation and Feedback

Facilitation Skills

Annual Review

CHART

Action Planning and Supporting Change

Information Governance

Path to Paperless

Data Quality and Patient Safety

Supporting Quality Outcomes

Supporting Quality Services

Supporting Quality Review

Primary Care Data Uses and Abuses

Introduction PRIMIS Facilitator Handbook

PRIMIS 1


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PRIMIS Facilitator Handbook Introduction

2 PRIMIS

Introduction

PRIMIS is a free training and support service to help GPs provide quality patient care bymaking the best use of their clinical computer systems and improving data quality andinformation management. Launched in April 2000, PRIMIS is currently managed by NHSConnecting for Health and is based in the Division of Primary Care at the University ofNottingham.

PRIMIS works with local information facilitators, employed by Primary Care Organisations(PCOs) or local Health Informatics Services across England, to provide GPs and practice staffwith:

training in information management skills

analysis of data quality and key clinical topics

feedback and interpretation of analyses

support in developing and delivering action plans to improve data quality.

The benefits to practices and PCOs of participating in a local PRIMIS scheme are outlinedbelow.

Benefits of participating in a local PRIMIS scheme

Training for local information facilitators whose role is to help GPs and

other members of primary health care teams assess and improve dataquality and information management, ultimately improving patient careand ensuring patient safety

Tools and techniques to assist PCOs in comparative analysis, which willprovide benchmarks as a basis for tackling inequality in access

Improved chronic disease registers. This facilitates the proactivemanagement, comprehensive treatment and monitoring of "at risk"patients

Assistance for practices in meeting clinical governance agendas and

national service framework requirements

Support in building and maintaining quality primary care electronicpatient records to support the information requirements of primary caremedical contracts

Support and advice for practices participating in the quality andoutcomes framework of the new GMS contract

Better use of clinical information systems to ensure patient safety

Support for large national information-dependent projects, such asElectronic Transmission of Prescriptions (ETP), Choose and Book and

GP to GP transfer of data, and data migration to the NHS Care RecordsService, ensuring that data uploaded follows uniform quality standards


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PRIMIS 3

Data quality has now been recognised as a crucial element of the ongoing development ofprimary care, as part of the wider NHS community. As quality payments in the new GMScontract are calculated on recorded clinical data, data quality is no longer just the domain oftechy GPs. Virtually all practices now have clinical computer systems, but the level andeffectiveness of their use is variable. PRIMIS helps practices to improve their informationmanagement skills and their use of technology to support improved patient care.

The PRIMIS Team

PRIMIS consists of the following teams:

Directors

The four Directors are responsible for aligning the service with national policy, the overallorganisation and delivery of the service, ensuring appropriate clinical input to the service, andoverseeing the technical resources used by the PRIMIS Team.

Clinical Advisers

The team of Clinical Advisers provides support to the Learning Consultants and facilitators ona cluster basis, as well as contributing to the development of queries and software through theClinical Advisory Group, under the chairmanship of the Clinical Director.

Training and Support Team

Training and support for facilitators are provided by a team of Learning Consultants basedacross the five clusters in England:

This team is responsible for the delivery of the training set out later in this Handbook, as well

as ongoing support for schemes through such means as scheme reviews and FacilitatorsForums.

North East

Eastern

North Westand WestMidlands

London

Southern

Cluster Map


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4 PRIMIS

Information Team

Based in Nottingham, the Information Team is responsible for:

provision of a data analysis service using carefully developed MIQUEST queries

the analysis and reporting of anonymised practice data submitted through the dataanalysis service

the provision of a comparative analysis service (CAS) to enable schemes tocompare their data on selected clinical topics with aggregated data from otherparticipating PRIMIS schemes

the provision of helpdesk support for facilitators

the development and support of CHART (Care and Health Analysis in Real Time)software to support practices with their own data analysis.

Communications Team

The Communications Team is responsible for all internal and external communications aboutthe service.

Technical Support Team

The Technical Support Team is responsible for the provision of IT support to the PRIMIS Team.They are also responsible for facilitators access to the PRIMIS website.

Technical Consultants

The Technical Consultants are responsible for advice and support on MIQUEST software, andalso for the development and ongoing maintenance and support of a number of softwareapplications, including Rush, CHART and CHARTOnline. They work closely with theInformation and Technical Support Teams.


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PRIMIS 5

Useful PRIMIS contacts

PRIMISUniversity of Nottingham14th Floor Tower BuildingUniversity ParkNottinghamNG7 2RDwww.primis.nhs.uk

General enquiries

[email protected]: 0115 846 6420Fax: 0115 846 6432

Information Team enquiries

[email protected]: 0115 846 6320Fax: 0115 846 6432

Helpdesk enquiries

[email protected]: 0115 846 6320

Training enquiries

Individual Learning Consultants will give facilitators their mobile number and email address

Website access enquiries

[email protected]: 0115 846 6427
http://www.primis.nhs.uk/http://www.primis.nhs.uk/


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6 PRIMIS


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Your Local PRIMIS Scheme PRIMIS Facilitator Handbook

PRIMIS 7

A local project or scheme wishing to improve the use of primary care clinical systems may beorganised in various ways and at different organisational levels, such as a PCO or local HealthInformatics Service.

Before PRIMIS is able to begin training or data quality analysis work with a PCO, a projectplan must have been approved and a facilitator or team of facilitators employed.

The role of the facilitator

Depending on how much work has been already achieved by the scheme, facilitators mayneed to be proactive in setting up or finalising the project plan. Alternatively, facilitators may berecruited to an established scheme. Either way, training and support are provided by PRIMIS.

For new schemes, following initialtraining by PRIMIS, facilitators willbegin to work directly with practices.For each one, this involves getting toknow the practice team, evaluatingtraining and development needs, andexamining current use of the clinicalsystem. Data quality may be assessedby running sets of MIQUEST queriesand feeding back the analysed resultswith suitable interpretation. Actionplans can then be formulated andagreed, which may include identifyingtraining needs, changes in the way thesystem is used and indicators ofprogress.

Once the initial quality improvementwork has been started, the localscheme can consider incorporatingother PRIMIS activities, such asjoining the comparative analysisservice or using the CHART software.

By this stage, schemes tend to moveaway from a standard pattern in orderto support local needs. The variety ofwork carried out by PRIMIS facilitatorsacross England can be seen on theSchemes Showcase pages of thePRIMIS website.

The role of the facilitator is discussed in detail during the Scheme Management trainingmodule. Also, more information is available in the Introducing PRIMIS booklet available fromPRIMIS.

Keys to Successful

Planning for Data Quality

Primary care organisations that havesuccessfully implemented PRIMIS projectshave capitalised on the following key factors:

Clear vision and objectives

Activity plan with targets

Adequate resources

Management commitment and support

Clinical ownership

Recruiting the right people

Realistic expectations

Control and risk management

Linking in with other activities andinitiatives

Clearly defined reporting structures Commitment to monitor progress


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Other key factors identified as important for project success by PRIMIS schemes:

Good communication

Clear and realistic project milestones

Willingness to change

Training

Understanding the importance of data quality

Adopting an educational approach, not performance management

The first year

The plan shown in the box below outlines a suggested initial timetable for a new facilitatorstarting with a new PRIMIS scheme. In addition to the core training modules listed, facilitators

may access other PRIMIS training as required (see page 1).

PRIMIS Facilitator Handbook Your Local PRIMIS Scheme

8 PRIMIS

Apr May Jun Jul Aug Sep Oct Nov

Facilitator induction with PCO

PRIMIS Training - Training Needs Analysisand Scheme Management, Quality Data,Quality Outcomes, Clinical Coding

Develop Baseline

Recruit/first visit to Practices

Report to PCO - baseline findings

Review/develop recording processes

PRIMIS Training - The MIQUEST Process

Data extraction - PDQ and RPDQ queries

PRIMIS Training - Data Analysis, Interpretationand Feedback, Facilitation Skills

Feedback to practices

Develop/deliver training for practices

Extract from a typical facilitators plan for the first year of a new PRIMIS project


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PRIMIS 9

Information Governance issues and the PRIMIS process

Information about patients held by a general practice is confidential. Under certaincircumstances, data can be released to a PCO or other external enquirer. Scheme managersand practices need to be clear about their respective responsibilities.

There are several issues to be addressed, as follows:

Confidentiality of patients

Data by which any patient could be identified must not be extracted from a practice system byor for the use of an external enquirer. This clearly rules out such items as the names ofpatients or their addresses. It also rules out combinations of data items such as age, sex andpostcode which, if considered together, could identify a patient.

The MIQUEST Protocols

The MIQUEST protocols contain full data security and confidentiality safeguards as outlined inthe box below.

The PRIMIS Guidelines contains extensive recommendations about steps that must be takento protect the confidentiality of individual patients and of practices. Where anonymisedinformation is sufficient for a purpose, information that would enable the patients identity to betraced must be omitted.

After a query has run, the practice has:

the opportunity to scrutinise theresponse

to authorise the response before it isreleased to an enquirer

Before a query is run, the practice has:

the opportunity to scrutinise the query

to authorise the query before it can be

run

the safeguard that an externalenquirer may not access any strongpatient identifiers, such as name,address, full date of birth, fullpostcode, etc.

Data security and confidentiality safeguards built into the MIQUEST protocols


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There are purposes, other than for delivering personal care and treatment, for which it islegitimate to use personal information about patients, provided that patients in general aremade aware that personal information may be used to prepare statistics to support suchpurposes. These purposes include:

assuring and improving the quality of care and treatment (e.g. through clinical audit)

monitoring and improving public health

managing and planning services

statistical analysis and medical or health services research to support any of theabove.

Although the data extracted will not in itself identify individual patients, it will still be necessaryto avoid ill-considered aggregation of data which may threaten the confidentiality of theindividual. This is especially important with rare conditions involving small numbers of patients,or conditions associated with recognisable characteristics, or where patients with combinationsof conditions are being selected. Both participating GPs and the data quality improvementscheme must be alert to these potential problems and seek to prevent them.

Aggregating selective information about a small number of patients may not always safeguardconfidentiality adequately. Those with control of the information must make a judgement, takinginto account clinical and other relevant considerations, as to the point at which there is noperceptible risk of patient identities being discovered from the aggregated material, either byitself or in combination with other information available to, or potentially accessible by,recipients of the information.

Confidentiality is an essential component of the clinical consultation in the provision of healthcare. The clinical professions have stringent requirements with regard to confidentiality in theircodes of ethics. The NHS Confidentiality Code of Practice is a guide to required practice, forthose who work within or under contract to NHS organisations concerning confidentiality andpatients consent to using their health records.

A copy of the NHS Confidentiality Code of Practice or further information about the ways inwhich patient information is used in the NHS, and the need to ensure confidentiality, can beobtained from:

www.dh.gov.uk/PolicyAndGuidance/InformationPolicy/PatientConfidentialityAndCaldicottGuardians/fs/en

Agreements between the data quality improvement scheme and each practice

The responsibilities of the practices and the managers of the data quality improvement schemeneed to be clarified by a formal agreement. A skeleton agreement is provided in the PRIMISGuidelines. Such agreements are necessary for a variety of reasons, including the need tofulfil the requirements of confidentiality.

Data must not be extracted which go beyond the terms of the agreement between thepractices and the scheme managers, nor must data be used for purposes outside the formalagreement. Any new uses may need special agreements and due consideration of the

confidentiality aspects. In the scenario where a practice contributes to a national data qualityimprovement scheme, such as the PRIMIS Comparative Analysis Service, but is also part of a


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local scheme (PCO, MAAG, research network, etc.), the practice would have several datacollection agreements.

Scheme managers are advised to review and, where necessary, update agreement terms on aregular basis.

Confidentiality of practices

Practices must be anonymised in feedback or other reports that present analyses of data in acomparative fashion. This implies that each practice must have a code number or nameassigned to it, and that the key to the code is itself kept securely. Different data qualityimprovement schemes may require different anonymised codes. If all practices in a schemeagree, then practice identities may be disclosed. However, preservation of anonymity shouldbe the starting point.

Even when using an anonymised code to identify practices, schemes must still take extra carewhen presenting analyses showing a small number of practices that share certain

characteristics. For example, if a scheme produced a graph highlighting results for a subset ofpractices in a small geographical area that contained only two or three practices, it might bepossible to infer the identity of those practices.

Security of IT systems

The possibility of unauthorised access to data held in the schemes computer systems must beconsidered. Although any data extract may, in itself, conform to the requirements of patientconfidentiality, linking or otherwise cross-referencing it to other data sets may make it possibleto identify patients.

Anti-virus softwareIf the scheme is receiving any data directly from practices using MIQUEST, then as with thereceipt of any external disks arrangements will need to be made to ensure thorough andcomprehensive use of anti-virus software. The scheme will require virus-scanning software thatis regularly updated. It will also need internal security policies and procedures to be reviewedand revised appropriately. This issue also needs to be discussed with practices.

Practices will need to review their own internal security arrangements and ensure that goodquality and updated anti-virus software is in place to scan disks received from their localfacilitator. Internal procedures may have to be reviewed and revised to ensure that theseissues are dealt with comprehensively. See the latest version of the PRIMIS Guidelines for

further details.

Personal integrity

During the course of their work, the staff of data quality improvement schemes will encounterconfidential information, perhaps in the form of documents or letters in practice offices.Absolute personal integrity is essential. The subject is complex and reference should be madeto the section on confidentiality in the PRIMIS Guidelines.

Data Protection Act 1998

Practices involved in the scheme must be appropriately registered for the Data Protection Actand ensure that registration is kept in order. Seewww.hmso.gov.uk/acts/acts1998/19980029.htm#aofs for more information.


PRIMIS 11
http://www.hmso.gov.uk/acts/acts1998/19980029.htm#aofshttp://www.hmso.gov.uk/acts/acts1998/19980029.htm#aofs


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Records management

As part of a data quality improvement scheme, the facilitator and/or scheme manager may wellbe creating and storing a number of documents, such as practice-based reports and actionplans, data quality audits, minutes of meetings, progress reports, guidance, newsletters and soon.

It is recommended that records management systems are in place that meet the needs of thescheme and the requirements of the organisations records management policy. The Freedomof Information Act 2000 gives a general right of access to information held by public bodies,including GP practices and PCTs, and has also established a code of practice on recordsmanagement. Further information regarding the Freedom of Information Act 2000 and the NHScan be found atwww.foi.nhs.uk/

The following issues should be considered:

records should be easily located and retrieved

information should be recorded legibly and jargon-free

data should be stored with suitable anonymisation and security.

Facilitators and/or scheme managers are advised to follow their organisations recordsmanagement policy when creating, storing and disposing of information.


12 PRIMIS
http://www.foi.nhs.uk/http://www.foi.nhs.uk/http://www.foi.nhs.uk/


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The PRIMIS Training Agenda PRIMIS Facilitator Handbook

PRIMIS 13

PRIMIS training is based on the adult learning approach developed by influential Americanadult educator, Malcolm Knowles, who put forward the theory of andragogy where studentsare guided by tutors, rather than taught. This approach takes account of prior knowledge andexperience and involves learners in planning their own training programmes.

PRIMIS training is tailored to the needs of individual facilitators, determined by a TrainingNeeds Assessment (TNA) carried out by the PRIMIS Learning Consultant at the beginning ofthe training. The complete learning process is a cyclical one as shown below, andincorporates:

acquiring new skills

applying those skills

reviewing the effects of those skills.

David A. Kolb

ConcreteExperiencePutting it into practice

ReflectiveObservation

Objectively analyse theoutcome

Abstract

ConceptualisationReviewing your conceptualunderstanding

ActiveExperimentationExperimenting to findsolutions


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Reflecting on what has been learned and how it can be applied is a very important part of thelearning process. By using a learning diary, the learner can take control of this learning cycleand use it to their best advantage. Learners are recommended to record:

the learning that has taken place

the learners feelings, reactions and judgements about the learning or training

the learners assessment of the relevance of that learning

the learners application of what has been learned

The PRIMIS Training Modules

PRIMIS offers a complete programme of training, education and support for informationfacilitators working in primary care. PRIMIS training equips facilitators with the knowledge andexpertise needed to help GP practices improve and maintain data quality and information

management skills.

Training topics are taught by different methods, including individual scheme training sessionsand group workshops, depending on the nature of the subject and the facilitators needs. Thetraining programme is made up of a number of days, allocated according to the needs of theindividual facilitator, from the following modules. Each module is explained in some detail inlater chapters within this Handbook.

Training Needs Assessment and Scheme Management

PRIMIS helps facilitators assess their existing skills and knowledge, taking thelearners prior knowledge and experience into account and involving them inplanning their own training. PRIMIS provides guidance on scheme management,obtaining resources and equipment and networking within organisations, as well asrecruiting and carrying out baseline assessments with practices and coveringissues of security and confidentiality.

What is Primary Care?

In this module, facilitators are introduced to the complexities of primary care,including practice structure, funding and the new GMS contract.

What is PRIMIS?

This module provides facilitators with an understanding of what PRIMIS is and whyit is needed. The PRIMIS training, data quality analysis and comparative analysisservices are described in detail. Facilitators gain an understanding of their role inimproving data quality and the critical factors that can impact on the success of aPRIMIS scheme.


This module provides facilitators with an understanding of the importance of dataquality. Actual practice scenarios are used to demonstrate situations that mightconfront practices in achieving good data quality.

PRIMIS Facilitator Handbook The PRIMIS Training Agenda

14 PRIMIS


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Clinical Coding

In this module, facilitators are given a basic understanding of the history, principlesand structure of clinical codes, together with an understanding of the benefits ofusing clinical codes for recording in primary care.

The MIQUEST Process

This two-day module provides facilitators with an understanding of the functions ofthe MIQUEST Query Manager and Response Manager, including configuring setsof queries, importing response files and aggregating and anonymising responsefiles.


This module provides PRIMIS facilitators with the skills to understand analyseddata, identify questions raised by the data, and feed back to practices in asupportive way. It also guides facilitators in how to help practices design actionplans to improve data quality.

CHART

Facilitators are trained to use CHART (Care and Health Analysis in Real Time), aclinical information feedback tool developed by PRIMIS. CHART enables practicesto analyse and view their data using a number of different query libraries, includingone for the new GMS contract.

The following modules are more generic than the above scheme-based modules. For many ofthe topics, it would benefit the facilitator to have undertaken the above modules to provide a

rounded understanding of information management in primary care before undertaking thesetraining sessions, although this is not a necessity.

Facilitation Skills

This module is run on a group basis and gives tools and techniques for identifyingdifferent behaviours and learning styles, managing different situations, andpreparing for and managing meetings. It also provides guidance on otherfacilitation skills, like listening and negotiating.

Annual Review

A regular review with PRIMIS enables both the facilitator and their organisation tocontinually evaluate their aims and objectives, and to be responsive and proactivein making suitable changes.


Facilitators are given an understanding of change management theory andtechniques, enabling them to support the development, implementation and reviewof practice-based action plans.

The PRIMIS Training Agenda PRIMIS Facilitator Handbook

PRIMIS 15


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With increasing emphasis on confidentiality and security in health care, this moduleis based on the policy and legal context of Caldicott, the Data Protection Act,BS7799 and the Freedom of Information Act. Facilitators gain an understanding ofrisk management and information governance, and how these interact with the

PRIMIS process and agreements.

Path to Paperless

This module provides facilitators with guidance on the legal considerations andprotocols required to be able to support their practices through the transition frompaper to electronic patient records.


Facilitators learn about the role of the National Patient Safety Agency and thesafety features inherent in GP clinical computer systems, as well as the impact ofdata quality on patient safety.


This module helps facilitators to guide practices in implementing the quality andoutcomes framework of the new GMS contract. The training provides anunderstanding of the structure, process and outcomes for each of the clinicalindicators and the ten disease areas in the clinical domain.

Supporting Quality Services

This training session looks at changes to the provision of primary health careservices in the new GMS contract. It focuses on particular issues around DirectedEnhanced Services and National Enhanced Services so that facilitators can helppractices with data recording.

Supporting Quality Review

Facilitators are given an overview of the recording and review arrangements for thenew GMS contract and an awareness of the data needed to support the reportingand verification process.

Primary Care Data Uses and AbusesThis module helps facilitators and others in their PCO to understand how to useaggregated primary care data to support their work, as well as becoming aware ofsome of the pitfalls to avoid.

PRIMIS Facilitator Handbook The PRIMIS Training Agenda

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Training Needs Assessment and Scheme Management PRIMIS Facilitator Handbook

PRIMIS 17

Background

There are many factors that determine how successful a project is in meeting its objectives.Setting up a project to improve information management skills and data quality in primary careis no easy task. Many of the existing PRIMIS schemes have taken different approaches to theirscheme management. For example, in Cambridgeshire the emphasis was put on:

having a clear vision of what wasexpected from the initiative

recruiting the right people

management support

clinical ownership

Management support, recruiting the right people,having clear objectives and a detailed activityplan are common themes across many schemes.

The aim of this training module is to provide guidance on project management, obtainingresources and equipment, networking within organisations, and recruiting and carrying outbaseline assessments with practices, including issues of security and confidentiality.Facilitators are also provided with an awareness of the MIQUEST process, an understandingof issues surrounding data confidentiality, and an understanding of how to construct an action

plan. The training includes the development of an individual action plan for the first few monthsof the facilitators work, based on their own training needs. Also covered are the skills andtechniques required for the facilitator to assess the information training needs of the practicesthat they will be supporting.

The Training

The training takes place over a half or full day, and is run on an individual scheme basis. Thetraining session starts with the facilitator completing a Training Needs Assessment (TNA) toenable the Learning Consultant to tailor the PRIMIS training package to their individual needs.The exact format of the training will then depend on the previous experience of the facilitator

and the current status of the project, but is likely to include discussion around some or all ofthe following topics:

reasons for setting up a data quality improvement scheme

how a data quality improvement scheme is organised

managing the scheme and maintaining enthusiasm

the role of the local project board and who should be involved

information governance issues

the role of the facilitator

recruiting practices

"The whole emphasis has been onactually setting up the process andmaking sure that there is ownership of theproblems within the practice. We need toput in place a process that keeps it goingwhen we walk away as facilitators."

Cambridgeshire PRIMIS


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PRIMIS Facilitator Handbook Training Needs Assessment and Scheme Management

18 PRIMIS

an overview of general practice computer systems

how to carry out a baseline assessment

By the end of the session, the facilitator will have developed their own short term activity plan.

Learning Objectives

The training will provide information facilitators with:

an understanding of what a TNA is and why one is needed

a training plan based on their own needs

an understanding of how the results of a TNA can be used to develop an action planto help a practice team improve their ability to record high-quality patient data byidentifying gaps in training and understanding of roles

an understanding of the different stages in the management of a scheme and how toplan each stage

an understanding of how to conduct a baseline assessment of practices computerusage and recruit practices to participate in the scheme

an awareness of the MIQUEST process and an understanding of the issues ofconfidentiality

an understanding of how to compile an action plan and the completion of a short-term action plan for their individual scheme

an understanding of their role and the critical factors that can impact on the successof a scheme

Further Reading

PRIMIS Guidelineswww.primis.nhs.uk

Roth J. Needs and Needs Assessment Process. Evaluation Practice. 1990; 11:141-3.

Department of Health: Patient Confidentiality and Access to Health Recordswww.dh.gov.uk/PolicyAndGuidance/InformationPolicy/PatientConfidentialityAndCaldicottGuardians/fs/en

Data Protection Actwww.hmso.gov.uk/acts/acts1998/19980029.htm#aofs
http://www.primis.nhs.uk/pages/publications.asphttp://www.dh.gov.uk/PolicyAndGuidance/InformationPolicy/PatientConfidentialityAndCaldicottGuardians/fs/enhttp://www.hmso.gov.uk/acts/acts1998/19980029.htm#aofshttp://www.hmso.gov.uk/acts/acts1998/19980029.htm#aofshttp://www.hmso.gov.uk/acts/acts1998/19980029.htm#aofshttp://www.dh.gov.uk/PolicyAndGuidance/InformationPolicy/PatientConfidentialityAndCaldicottGuardians/fs/enhttp://www.primis.nhs.uk/pages/publications.asp


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Training Needs Assessment and Scheme Management PRIMIS Facilitator Handbook

PRIMIS 19

Training Plan - Links to other PRIMIS training

Facilitators attending the Scheme Management training module would also find thefollowing training modules of interest:


What is PRIMIS?

Clinical Coding

The MIQUEST Process


Facilitation Skills


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PRIMIS Facilitator Handbook Training Needs Assessment and Scheme Management

20 PRIMIS


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Background

What does it all mean? In a period when primarycare has seen some of the largest structuralchanges in decades, with new contracts for GPsand new organisations cropping up virtuallyweekly, how does someone new to primary carefind their way around?

One thing that has been consistent throughoutall the changes is the need for good quality data.Facilitators working in information managementwithin primary care are now more in demand

than ever.

The Training

This training module is intended for thosefacilitators who are new to the NHS or havenever worked within a primary care organisation before. It may also prove to be a usefulsource of information for those who require a refresher on what is happening in and aroundprimary care. The main aim is to introduce the facilitator to topics and sources of informationwhat they will need to be familiar with in order to fulfil their role successfully.

This training is delivered via an electronic program which the facilitator can obtain from his orher Learning Consultant. The facilitator can then individually run the program and determinetheir own pace and route through the module and can re-run the program again at any time inthe future. Use is made of web hyperlinks in the program to take the reader to the home webpage of various organisations for further in-depth reading as required. This can be followed upby a half or full day session as required.

The main sections of the training course are:


What is it and how is it defined? What is a General Medical Practitioner? Using links to variousNHS organisations websites, answers to the above questions and more are provided.

Relationship between primary care and other NHS agencies

An organisational diagram is used to chart the NHS from the Department of Health through toStrategic Health Authorities and then down to the providers of local services, such as acuteand community care trusts. Each organisations responsibilities are documented.

Relationship between different organisations in primary care

The responsibilities and links between Primary Care Organisations, Out of Hours, doctors

surgeries, dentists, opticians and pharmacists are outlined. NHS walk-in centres and NHSDirect are also covered in the analysis. A pen picture of PRIMIS itself is also included.

What Is Primary Care? PRIMIS Facilitator Handbook

PRIMIS 21

What Does it All Mean?

PCO

SHA

DoH

NPfIT

NHS Connecting for Health

Clusters

nGMS

QOF

LDP


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Structure of General Practice

The organisation of general practice is dissected in detail, with the emphasis on the newworking arrangements since the arrival of the new GMS contract in April 2004. The servicesoffered by general practice now under nGMS are outlined along with the funding available. Abackground to the workings of the quality and outcomes framework (QOF) and the differences

between GMS and PMS (Personal Medical Services) practices are detailed.

Primary Health Care Team (PHCT)

A comprehensive insight is provided into the roles operating within the PHCT, from differenttypes of GPs, including GPs with Special Interests (GPwSI) to other clinical roles such as thePractice Nurse and the Health Care Assistant. The managerial and clinical roles within apractice are also discussed, with numerous web links to professional bodies representing eachprofession.

Computerisation and General Practice

The history of the background and use of computers in general practice since 1970 is traced.Important landmarks such as the background of Requirements for Accreditation (RFA), theNHS Plan, the 1990 GP Contract and the Wanless Report are included. More recently, NHSConnecting for Health and its stated aims are documented.

Abbreviations used in Primary Care

A simple listing is collected together in one place of a number of organisations operating in theNHS and their acronyms. Where available, a web link to each organisations home web pageis made available for further reading.

Learning Objectives


understanding of what primary care is

awareness of the relationships between primary care and other NHS agencies

understanding of the relationships between the different organisations in primarycare

understanding of the structure of, and relationships within, general practice

awareness of events that have brought primary care to its present position

understanding of internal and external forces that can have an impact on dataquality in primary care

understanding of how PRIMIS can support primary care in improving data quality

PRIMIS Facilitator Handbook What Is Primary Care?

22 PRIMIS


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Further Reading

PRIMIS Guidelineswww.primis.nhs.uk

Department of Healthhttp://www.dh.gov.uk

National Association of Primary Carewww.primarycare.co.uk

National Primary Care Development Teamwww.npdt.org

Primary Health Care Specialist Group of the British Computer Societywww.phcsg.org.uk

National PCT Databasewww.primary-care-db.org.uk

What Is Primary Care? PRIMIS Facilitator Handbook

PRIMIS 23


Facilitators completing the What is Primary Care? training module would also find thefollowing training modules of interest:

Scheme Management


Clinical Coding

Facilitation Skills



Path to Paperless

Supporting Quality Services Supporting Quality Review

http://www.primis.nhs.uk/pages/publications.asphttp://www.dh.gov.uk/http://www.dh.gov.uk/http://www.primarycare.co.uk/http://www.primarycare.co.uk/http://www.npdt.org/http://www.npdt.org/http://www.phcsg.org.uk/http://www.phcsg.org.uk/http://www.primary-care-db.org.uk/http://www.primary-care-db.org.uk/http://www.primary-care-db.org.uk/http://www.phcsg.org.uk/http://www.npdt.org/http://www.primarycare.co.uk/http://www.dh.gov.uk/http://www.primis.nhs.uk/pages/publications.asp


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PRIMIS Facilitator Handbook What Is Primary Care?

24 PRIMIS


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Background

The effective use of informationmanagement and technology is at theheart of the strategy to modernise theNHS, with quality information seen asthe key to improving patient care andpublic health.

The new GMS contract puts an emphasis on data quality for measuring achievement.

However, the primary care clinical system is more than just a data repository, being used as anintegral part of the GPs decision-making process during the consultation. Data quality istherefore essential at many levels.

In 2000, electronic records were granted medico-legal status. Although provision is made fornon-computerised practices, the expectation is that complete and accurate data will berecorded on a GP clinical system. There are certain areas of the patients medical historyunder the new GMS contract where there is consensus on how data should be entered.However, this is not always the case, especially in general practice where patients oftenpresent with problems which are not necessarily clear-cut and easy to record, are seen bydifferent professionals and in different places. It is, therefore, essential to understand theprocesses involved in capturing data from the various sources within and outside of thepractice in an accurate format.

Data which are not accurate, complete, relevant, up-to-date and accessible may be dangerousto patients. For example, if a repeat prescription is not recorded accurately, severe harm to the

patient could ensue; if an allergy is not entered, the record is not complete suchinadequacies could lead to medico-legal problems for the clinician and the practice.

The Quality Data, Quality Outcomes training module provides new PRIMIS facilitators withknowledge and understanding of the importance of data quality and the recording of data forthe quality and outcomes indicators of the new GMS contract. It will raise an awareness of theissues around the flow of data in and around a general practice and the difficulties in recordingdata and validating the quality of the data when they are entered and when they are laterretrieved.

The information facilitator will be able to encourage practices to use their GP clinical systems

for recording data for quality outcomes, and apply change management theory to generalpractice.

Quality Data, Quality Outcomes PRIMIS Facilitator Handbook

PRIMIS 25

"The most valuable repository about the currenthealth of the population may well be GP records."

Information for Health, NHS Executive, 1998

In order to measure achievement, practices will have to enter and retrieve high qualityinformation from their practice clinical systems. To qualify for payment, quality framework

data will be recordable, repeatable, reliable, consistent and auditable. IM&T systems arerequired in order to deliver such requirements. Education and training of practice staff willbe supported through funded national programmes.

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The Training

The training takes place over a full day and is run on an individual scheme basis covering thefollowing topics:

why data quality is important

how data quality is defined

the baseline essential elements of a patient record and how they are created

the importance of capturing data from home visits and other locations outside ofthe GP surgery

mapping data flows from secondary care into a practice to eventual entry onto theclinical system

the differences and similarities between the NSFs, National Institute for Clinical

Excellence (NICE) guidelines and Quality and Outcomes Framework (QOF)indicators and the essential data recording requirements for each

practical knowledge of clinical coding structures

problems faced by many practices with consistency in methods of data capture andentry between all practice staff

methods of entering and capturing data onto a clinical system

how to raise the issue of data quality and help practices to address any problemsand share best practice.

Learning Objectives


an awareness of what is meant by the patients story and their contact with thehealthcare professionals in a GP practice, including what data recording is requiredat each step

an awareness of the importance of data quality and its relevance to recordingissues pertaining to the patients story

an understanding of the necessity to identify all relevant information coming intothe practice

an awareness of what is required to collect all the relevant information in thecorrect format

an awareness of the range of options for storing the data

an understanding of the knowledge required to retrieve the data in an accurateformat

knowledge and understanding of data quality theory and its application to thepatients story

an understanding of future issues that may affect primary care data.

PRIMIS Facilitator Handbook Quality Data, Quality Outcomes

26 PRIMIS


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Further Reading

PRIMIS Guidelineswww.primis.nhs.uk/pages/download_template.asp?r=Guidelines_Sept01.pdf

Good Practice Guidelines for General Practice Electronic Patient Records. 2000. GMC GPsCommittee and the RCGP on behalf of the NHS Executive. London: GMC.www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4008657&chk=rr8fQT

Maintaining Good Medical Practice 2. London: GMC; 1998.

Medical Records. London: Medical Protection Society; 1999.

Morris D. Acquiring computer literacy. British Medical Journal. 1998; 317:2.

Roscoe T. Paper vs electronic medical records (special paper). Wisdom website; 2000http://wisdomnet.co.uk/paper.html

Report on the Review of Patient-identifiable Information. The Caldicott Committee. London:Department of Health; 1997.

Play IT Safe a practical guide to IT Security for everyone working in General Practicewww.connectingforhealth.nhs.uk/publications/comms_tkjune05/NHSnumberarticleforsyndication.pdf/view?searchterm=Play%20IT%20safe

Pringle M. Using a computer in the consultation. In: Sheldon M, Stoddart N, eds. Trends inGeneral Practice computing. London: Royal College of General Practitioners; 1985.

Waring N. To what extent are practices paperless and what are the constraints to thembecoming more so? British Journal of General Practice. 2000; 50: 46-7.

Watkins C et al. General practitioners use of computers during the consultation. British JournalGeneral Practice. 1999; 49:481-3.

Quality Data, Quality Outcomes PRIMIS Facilitator Handbook

PRIMIS 27


Facilitators attending the Quality Data Quality Outcomes training module wouldalso find the following training modules of interest:

Clinical Coding


Facilitation Skills


Path to Paperless


http://www.primis.nhs.uk/pages/download_template.asp?r=Guidelines_Sept01.pdfhttp://www.primis.nhs.uk/pages/download_template.asp?r=Guidelines_Sept01.pdfhttp://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4008657&chk=rr8fQThttp://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4008657&chk=rr8fQThttp://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4008657&chk=rr8fQThttp://wisdomnet.co.uk/paper.htmlhttp://wisdomnet.co.uk/paper.htmlhttp://www.connectingforhealth.nhs.uk/publications/comms_tkjune05/NHSnumberarticleforsyndication.pdf/view?searchterm=Play%20IT%20safehttp://www.connectingforhealth.nhs.uk/publications/comms_tkjune05/NHSnumberarticleforsyndication.pdf/view?searchterm=Play%20IT%20safehttp://www.connectingforhealth.nhs.uk/publications/comms_tkjune05/NHSnumberarticleforsyndication.pdf/view?searchterm=Play%20IT%20safehttp://www.connectingforhealth.nhs.uk/publications/comms_tkjune05/NHSnumberarticleforsyndication.pdf/view?searchterm=Play%20IT%20safehttp://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4008657&chk=rr8fQThttp://www.primis.nhs.uk/pages/download_template.asp?r=Guidelines_Sept01.pdfhttp://wisdomnet.co.uk/paper.html


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PRIMIS Facilitator Handbook Quality Data, Quality Outcomes

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Background

General practice systems use clinical coding to store data. To record data, the user enters amedical term or concept. The computer system then presents a set of terms or rubrics,together with codes. Assisted by the rubric, a choice is made and the data item is therebyrecorded. An important part of setting recording guidelines is to ensure that appropriate codesare assigned for the items in the data set and that these codes are used for entering data inthe patients record at the appropriate stage in the cycle of care.

In the early 1980s, Dr James Read developed a coding system for general practice for thepurpose of maintaining a computerised patient record. It allowed for increased efficiency andimproved preventative procedures. This coding system became known as the Read Code andremains as the accepted standard for British general practice. The coding system copyright

was purchased by the Secretary of State for Health in 1990 and the Read Code becameCrown Copyright. It has been subsequently developed in later versions to include terminologycontent appropriate for a wider range of health care specialities and professional groups. Allversions of the Read Code are maintained and developed by NHS Connecting for Health.

There are three versions of the Read Code currently in use as shown in the box below:

The GP 4 byte set was developed for use in GP systems and the codes are four characterslong, allowing four levels of detail. The GP 5 byte set extended the codes to five characters -and thus a fifth level of detail - and included cross reference to the International Classificationof Diseases tenth revision ICD-10. Clinical Terms version 3 (CTV3) incorporatescomprehensive codes for the acute sector, as well as general practice, allowing for storage,retrieval, cross-mapping and analysis of patient information. The mostly widely used set withinGP clinical systems at present is the GP 5 byte set.

The important point to be aware of is the hierarchical nature of Read codes, as demonstratedin the example shown below. As the diagnosis becomes more specific, so the appropriateRead code carries more significant characters to reflect the greater level of detail. The codingscheme is a structured collection of terms with each clinical entity, known as a concept, beingrepresented by a preferred term. Each concept has a unique alphanumeric code, known as theRead code.

Clinical Coding PRIMIS Facilitator Handbook

PRIMIS 29

The current three versions of Read Code in general practice

GP 4 byte set (referred to as Version 0)

GP 5 byte set (referred to as Version 2)

Clinical Terms Version 3 (referred to as CTV3)


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PRIMIS Facilitator Handbook Clinical Coding

30 PRIMIS

The NHS Executive and the College of American Pathologists (CAP) have developed a newcollaborative work, SNOMED Clinical Terms. This coding system combines CAPs SNOMEDRT with the Clinical Terms Version 3 (Read Codes) and is called SNOMED CT. This singleunified terminology will underpin the development of the integrated electronic patient recordand is a pivotal part of the National Programme for Information Technology National CareRecord Service. PRIMIS is currently developing a training module on SNOMED CT.

The Training

The training takes place over a half day and is run on an individual scheme basis.

It covers the advantages and disadvantages of coding, the different coding schemes in useacross health care and a detailed overview of Read codes, including the structure, thehierarchy and the Read code chapters. The training also provides practical techniques andexercises for searching for Read codes within a browser.

Further information on the background and subject matter included in this training is availablein the form of a workbook. This is provided to facilitators during the training.

Learning Objectives


an understanding of the history, principles and structure of the Read codes in thevarious versions

skills in finding and selecting appropriate codes for specified conditions/investigations/procedures, etc., using a variety of Read Code browsers (includingGP systems, CLUE and NHS Connecting for Health)

an understanding of the limitations of Read codes when grouped for analysis

skills to enable them to teach practice team members how to find and select the

appropriate Read code using the Read code browser available to them

Level Term Read 4-byte Read Version 2

1 Circulatory system disease G G....

2 Ischaemic heart disease G4.. G3...

3 Acute myocardial infarction G41. G30..

4 Anterior myocardial infarction G301.

5 Acute anteroseptal infarction G3011


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Further Reading


NHS Connecting for Healthwww.connectingforhealth.nhs.uk

Clinical Coding PRIMIS Facilitator Handbook

PRIMIS 31


Facilitators attending the Clinical Coding training module would also find the followingtraining modules of interest:

The MIQUEST Process


CHART


http://www.primis.nhs.uk/pages/download_template.asp?r=Guidelines_Sept01.pdfhttp://www.primis.nhs.uk/pages/download_template.asp?r=Guidelines_Sept01.pdfhttp://www.connectingforhealth.nhs.uk/http://www.connectingforhealth.nhs.uk/http://www.connectingforhealth.nhs.uk/http://www.primis.nhs.uk/pages/download_template.asp?r=Guidelines_Sept01.pdf


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PRIMIS Facilitator Handbook Clinical Coding

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Background

MIQUEST stands for: Morbidity Information Query and Export Syntax and is a software tool toextract and aggregate comparable data from disparate GP systems. It is a method forextracting data in a computer-readable form that uses a common query language for healthknown as Health Query Language (HQL) and can therefore be used with a variety of differentGP clinical computer systems, using the systems own MIQUEST interpreter. Both MIQUESTand the system interpreters incorporate various security and confidentiality safeguards whichenforce security constraints to prevent unauthorised extraction of patient-identifiable data.MIQUEST has been endorsed by the NHS as the recommended method of expressing queriesand extracting data from different types of practice systems and it has therefore been adoptedas the standard method for PRIMIS.

MIQUEST in itself is not a data quality improvement method, but is one of the many tools thatan information facilitator will use when working with a practice to improve their data quality.

MIQUEST Enquirer software is Crown Copyright, for use only by authorised personnel withinthe NHS. Technical maintenance and development support for MIQUEST Enquirer is providedby NHS Connecting for Health, but the suppliers of each GP computer system are responsiblefor support and maintenance of their systems own MIQUEST interpreter.

MIQUEST is available on the majority of GP clinical computer systems that are in use today.This is because it is part of the General Medical Practice Computer Systems Requirementsfor Accreditation (RFA99) scheme. Where MIQUEST is available for a particular GP clinicalsystem, it should be used as the preferred method of extraction of data from that system forPRIMIS purposes.

MIQUEST Enquirer software includes a Query Manager to facilitate the distribution of queriesand a Response Manager to organise and aggregate the responses received from participantsin a local or national data collection scheme. An HQL Editor is also available to facilitate thewriting of queries. However, it should be noted that the construction of a MIQUEST query setand the coding required for it can be complex and often time consuming, requiring both clinicaland technical input.

The responses from a MIQUEST-generated query are created as Comma Separated Value(CSV) files. Analytical tools such as PRIMIS Rushand CHART use these files to create easy-to-view graphs, summary sheets and spreadsheets, enabling trained information facilitators tointerpret and make sense of the data extracted.

The Training

The training takes place over two full days and is run on an individual scheme basis.

Prior to training, information facilitators will be required to install the MIQUEST software ontheir PC or laptop. This is available from Connecting for Health on a CD-ROM. Contact theConnecting for Health helpdesk on 01392 251289, or email [email protected] or visit

www.nhsia.nhs.uk/nhais/pages/products/vaprod/miquest/ to fill out an online request form.

The MIQUEST Process PRIMIS Facilitator Handbook

PRIMIS 33
http://www.nhsia.nhs.uk/nhais/pages/products/vaprod/miquest/http://www.nhsia.nhs.uk/nhais/pages/products/vaprod/miquest/http://www.nhsia.nhs.uk/nhais/pages/products/vaprod/miquest/http://www.nhsia.nhs.uk/nhais/pages/products/vaprod/miquest/


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PRIMIS Facilitator Handbook The MIQUEST Process

34 PRIMIS

The first day concentrates on the benefits and process of using MIQUEST as part of a dataquality improvement scheme. It will provide an understanding of Query structure and the useof the MIQUEST Query Manager. An overview is given on how the data extraction processworks, as shown in the box below, once the preliminary steps of agreeing objectives andsetting up the scheme have been implemented.

The training shows the information facilitator how to download Data Quality query sets, how topopulate the Query Manager with their allocated practice details and how to prepare thepractice query disk using the Query Manager.

The second days training focuses on the MIQUEST Interpreters. It includes on-site visits tolocal GP practices in order to run a set of training MIQUEST queries. This is then followed bytraining on the use of the Response Manager to aggregate and anonymise the data extracted.Finally information facilitators are shown how to submit their data extraction to PRIMIS foranalysis.

Further information on the background and subject matter included in this training is available

in the PRIMIS MIQUEST Manual. This is provided to facilitators during the training.

Learning Objectives

The first days training (MIQUEST Overview and Query Manager) will provide informationfacilitators with an understanding of:

the functions of MIQUEST Query Manager

how to set up scheme details (Remote and Local), practices, agreements, etc.

how to add new practices, new agreements, etc. how to configure sets of queries for their scheme/PCO/practices

Confidentiality Agreement

Query Manager

MIQUEST Interpreter (Clinical System)

Response Manager

Analysis Package (PRIMIS Rush)


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The second days training (MIQUEST System Interpreters and Response Manager) willprovide information facilitators with an understanding of:

the functions of MIQUEST interpreters on clinical systems

how to import and run queries from different enquirers with appropriate security

safeguards

how to export response files to disk or to transmit on a network when this option isavailable

how to work with volunteer practices and the PRIMIS Learning Consultant to teachpractice staff the appropriate use of their MIQUEST interpreter

functions of MIQUEST Response Manager and how to aggregate anonymised datafor analysis.

Further Reading

PRIMIS Guidelineswww.primis.nhs.ukpages/download_template.asp?r=Guidelines_Sept01.pdf

PRIMIS MIQUEST Manual

The MIQUEST Process PRIMIS Facilitator Handbook

PRIMIS 35


Facilitators attending the MIQUEST training module would also find the following trainingmodules of interest:

Scheme Management


Clinical Coding


Project Review

Information Governance CHART
http://www.primis.nhs.uk/pages/download_template.asp?r=Guidelines_Sept01.pdfhttp://www.primis.nhs.uk/pages/download_template.asp?r=Guidelines_Sept01.pdfhttp://www.primis.nhs.uk/pages/download_template.asp?r=Guidelines_Sept01.pdf


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PRIMIS Facilitator Handbook The MIQUEST Process

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Data Analysis, Interpretation and Feedback PRIMIS Facilitator Handbook

PRIMIS 37

Background

The use of MIQUEST in the PRIMIS process is twofold. Firstly, it provides a mechanism for theeasy extraction of data recorded on a practices clinical system, enabling the practice toexamine and improve data recording techniques. This method can be supplemented by usingvarious analysis software tools such as CHART, the use of which is covered in a later module.Secondly, it enables practices to compare their data recording to that of other practices oragainst their own recording over time. In order to enable the effective use of MIQUEST,PRIMIS has developed several query sets. Each set has a different focus and is designed tomeet a variety of needs.

A key query set, and the one used mostfrequently, is the PRIMIS Data Quality set.

This set has been designed to enablefacilitators and participating practices tobegin to identify areas where the datarecorded on the clinical system is not ofgood quality: that is, it does not have thefive characteristics of good quality listed inthe box to the right.

The PRIMIS Data Quality query set is one of the most valuable sets in supporting informationfacilitators in their role. Facilitators run this set with all new practices joining the scheme, andrepeat the run at regular intervals. Once a practice has identified the strengths andweaknesses of their data capture methods, they are then in a position to make improvements.The queries are intended to provide a basis for discussion and debate from which an actionplan can be derived. By repeating data extractions at regular intervals, the practice will be ableto demonstrate improvements over time and see the effectiveness of actions taken.

The Training

The training takes place over a half or full day and is run on an individual scheme basis. Dataextracted from practices and submitted to PRIMIS by a scheme are analysed and reportedback to the facilitator in an Excel format known as Rush. This format enables the facilitator toview the data in a variety of ways. Throughout the training, the facilitator is taken through theirown practices data and shown how to use the analyses listed in the box below to identifywhere there are potential data quality issues.

Five characteristics of good quality data

Completeness Accessibility

Accuracy Timeliness

Relevance

Analyses used in the PRIMIS Data Quality

query set to highlight potential quality issues

Baseline prevalence Risk factor recording

Apparent prevalence Screening data recording

Comparison with proxy indicators Data validity checks


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The training also covers techniques for feeding data back to practices and other appropriatebodies, such as the PCT or employing organisation, and the steps to be taken in developingan action plan for tackling changes that need to be made. An important part of the training isthe management of confidentiality issues.

On completion of the training, facilitators will be able to submit further data to the PRIMISInformation Team and receive the analysed data back via the PRIMIS secure website.

Learning Objectives


an understanding of how to download feedback and configure Rush

an understanding of Rushgraph construction including the difference betweenmorbidity, mortality, prevalence and incidence

an understanding of data quality issues that contribute to feedback results

an understanding of limitations and use of aggregated feedback data

an awareness of confidentiality issues relating to aggregated data

an awareness of additional methods, including clinical systems own searchengines, to complement feedback.

Further Reading

PRIMIS Guidelines

www.primis.nhs.uk/pages/download_template.asp?r=Guidelines_Sept01.pdf

PRIMIS Facilitator Handbook Data Analysis, Interpretation and Feedback

38 PRIMIS


Before attending the Data Analysis, Interpretation and Feedback module, facilitatorsshould already have attended the following PRIMIS training modules:


Clinical Coding

The MIQUEST Process

Facilitators attending this training module would also find the following training modulesof interest:

Facilitation Skills



Path to Paperless

http://www.primis.nhs.uk/pages/download_template.asp?r=Guidelines_Sept01.pdfhttp://www.primis.nhs.uk/pages/download_template.asp?r=Guidelines_Sept01.pdfhttp://www.primis.nhs.uk/pages/download_template.asp?r=Guidelines_Sept01.pdf


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PRIMIS Facilitator Handbook Facilitation Skills

40 PRIMIS

The Training

The training takes place over a half or full day and is run as a group session. The aim of thetraining is to equip participants with the skills to effectively facilitate teams, particularly generalpractice teams. The training comprises interactive exercises using tools and techniques in

facilitation based on the following topics:

definition of facilitation and the attributes that make an effective facilitator

understanding the core competencies needed in the process of facilitation

listening skills

communication styles

managing and making meetings effective

dealing with difficult behaviours

agreeing priorities

the importance of review

tools and techniques used in facilitation

Further information on the background and subject matter included in this training is availablein the form of a workbook. This is provided to facilitators during the training.

Learning Objectives


a knowledge of the definition of a facilitator

an awareness of a selection of communication styles and skills

an understanding of how to deal with differing behavioural styles and how to facilitatemeetings

an understanding of team working and negotiation skills

Further Reading

Bray T. Training Sessions for Effective Meeting. Aldershot: Gower Publishing; 1995.

Dobson A. Managing Meetings. Plymouth: How to Books; 1999.

Duffy M, Griffin E. Facilitating Groups in Primary Care. Abingdon: Radcliffe Medical Press;2000.

Hart L. The Faultless Facilitator. London: Kogan Page; 1992.

Hunter D, Bailey A, Taylor B. The Facilitation of Groups. Aldershot: Gower Publishing; 1996.


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Johnson D, Johnson F. Joining Together: group theory and group skills. New Jersey: Prentice-Hall; 1991.

Sharman D. The Perfect Meeting. London: Century Business Books; 1992.

Primary Care Facilitation: what is it and what is the evidence of its effectiveness? Oxford: TheNational Primary Care Facilitation Programme; 1998.

Middleton J. The Team Guide to Communication. Abingdon: Radcliffe Medical Press; 2000.

Elwyn G, Greenhalgh T, Macfarlane F, Groups: a guide to small group work in healthcare,management, education and research. Abingdon: Radcliffe Medical Press; 2001.

King J. Effective Facilitation. British Medical Journal2002; 324:S36.

Facilitation Skills PRIMIS Facilitator Handbook

PRIMIS 41


Facilitators attending the Facilitation Skills training module would also find the followingtraining modules of interest:





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PRIMIS Facilitator Handbook Facilitation Skills

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Annual Review PRIMIS Facilitator Handbook

PRIMIS 43

Background

Since April 2000 PRIMIS has been working, through local PCOs, to help GPs to make the bestuse of their clinical computer systems, both in meeting their organisational needs and insupporting good quality patient care as part of an ongoing programme of development.However, as with any work programme, regular progress reviews are essential.

Many project and change management theories extol the virtue of ongoing review to ensurethat projects remain on course, identify and address any issues as they arise, and constantlystrive towards achieving the original aims and objectives of the project. A local PRIMIS projector scheme is no exception.

The PRIMIS approach to training and working with an information facilitator is adaptive and theprinciples of the scheme review follow the broader principles of PRINCE 2 (PRojects INControlled Environments) methodology, a structured method for effective project managementused extensively by UK Government organisations.

The Training

The training takes place over a half or full day and is run on an individual scheme basis,involving the information facilitator and preferably their line manager. It is usually held at theend of the first year of the project. Subsequent reviews may be conducted by correspondence.

The training will be introduced with a presentation and discussion on what an annual reviewshould include, what steps are involved and an explanation as to why it is an essential

process. The various methods of conducting an annual review are also discussed.

The aim of this training is twofold: to carry out a review of the local scheme and to equip theinformation facilitator with the skills to facilitate their practices to carry out reviews.

The review itself will involve a guided discussion around key stages and events as outlined inthe box on the following page. The experiences and the reflections from the facilitator will bedocumented.

The underlying objective for a project review is to improve the overall outcome. To achievethis, the review must be forward looking, constantly seeking to identify how current lessonscan be exploited for future advantage. For a review to add real value, it must go beyondthe superficial and drill down to the underlying capabilities. By doing this it can identifyfundamental improvements that are the key to consistently improved performance in thefuture.

www.amtec.co.uk/private-sector-consulting/foundation/project_review/project_rev_overview.xhtml
http://www.amtec.co.uk/consulting/practices/overview/change_and_programme_management.xhtmlhttp://www.amtec.co.uk/consulting/practices/overview/change_and_programme_management.xhtml


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PRIMIS Facilitator Handbook Annual Review

44 PRIMIS

The information facilitator may also be encouraged to conduct a self-evaluation SWOT(strengths, weaknesses, opportunities and threats) exercise to help highlight any areas ofachievement or strengths that could be utilised further. The SWOT analysis will also helpidentify any areas that may be causing concern for the facilitator. The SWOT analysis processmay be held in confidence between the facilitator and the Learning Consultant.

Learning Objectives

The training should provide the information facilitator with an understanding of:

what an annual review should include

why an scheme review is needed

what steps are required when conducting an annual review

what methods can be used in an annual review

The training will also help the information facilitator identify:

how the results of an annual review can be used to develop an action plan to improvetheir ability to project manage their PRIMIS programme

any gaps in training and missed milestones and the reasons for these

where the project has succeeded and any lessons that could be shared.

Typical key stages and events for discussion at a project review

The specific objectives for the scheme

Progress against objectives

Reasons for non-achievement

Encountered problems and how they were resolved

Changes in direction

Unexpected benefits

Collaboration with other projects

Overall satisfaction

Funding, and further requirements

Action plan for the way forward


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Further reading


PRINCE 2www.prince2.com/whatisp2.html

Annual Review PRIMIS Facilitator Handbook

PRIMIS 45


Before attending the Scheme Review training module, facilitators should have attended thefollowing PRIMIS training modules and have completed a whole cycle of data flow mapping,data extraction and feedback:

Scheme Management


Clinical Coding

The MIQUEST Process


Facilitators attending this training module would also find the following training modules of

interest:

Facilitation Skills


http://www.primis.nhs.uk/pages/download_template.asp?r=Guidelines_Sept01.pdfhttp://www.primis.nhs.uk/pages/download_template.asp?r=Guidelines_Sept01.pdfhttp://www.prince2.com/whatisp2.htmlhttp://www.prince2.com/whatisp2.htmlhttp://www.prince2.com/whatisp2.htmlhttp://www.primis.nhs.uk/pages/download_template.asp?r=Guidelines_Sept01.pdf


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PRIMIS Facilitator Handbook Annual Review

46 PRIMIS


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Background

CHART stands for Care and Health Analysis in Real Time. It is a software program based onExcel that enables the quick and easy viewing of data from clinical queries. The software,which has been developed by PRIMIS as an upgraded alternative to Rush for Practices, isdesigned to be used within practices allowing the practice staff or PRIMIS facilitator to producehealth query language (HQL) queries, taken from a library, which are then run on their clinicalsystem. The query responses are imported back into CHART. Results are displayed either aseasy-to-read graphs, summary sheets or a spreadsheet. CHART gives a practice the option torun local, patient-identifiable queries or, if preferred, anonymised queries should they wish toshare data confidentially.

CHART can be used in conjunction with any RFA accredited clinical system with a functioning

MIQUEST interpreter. As the responses are converted into Excel format, the software retainsmuch of the original Excel functionality, including the ability to sort or filter the extracted dataand drill down through graphical displays to quickly identify groups of patients by type ofrecording. Responses take the form of a spreadsheet with one line for each patient included inthe cohort. Each column represents an indicator included in the query, giving a whole patientpicture for that specific clinical area. Viewing the clinical data in this way enables gaps in thepatients data relating to the specific query topic to be highlighted and, by using multi-factorfiltering, complex data and/or clinical quality issues can be picked up: for example, identifyingpatients with a recorded diabetes diagnosis who have a raised HbA1c and a BMI greater than25. By archiving results and comparing them with later extractions, any changes orimprovements can be identified.

CHART PRIMIS Facilitator Handbook

PRIMIS 47


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PRIMIS Facilitator Handbook CHART

48 PRIMIS

The CHART queries

Each clinical topic is arranged into groups of queries known as query libraries. The librariescurrently available are shown in the box below. Each query library can be downloadedseparately and used as and when needed. Date ranges within queries are controlled by theuser and are automatically updated through the use of a reference date. New query libraries

can be installed directly into existing CHART software.

The CHART query sets have beendeveloped by the PRIMIS Team, withsignificant clinical input from thePRIMIS Clinical Advisory Group. Theyhave then undergone a process of betatesting before release.

At the time of writing, the PRIMIS Teamis currently working on a data quality

library which will allow practices toidentify gaps and errors in their patientrecords.

Using CHART as a Data Quality Improvement Tool

One of the big advantages of CHART is that it remains in the practice and is relatively simplefor practice staff to use, following training provided by the facilitator. This gives practice staffthe ability to look at their own data quality and patient care whenever they need to, forexample in relation to the New GMS Contract. Responses are displayed in a format that allowsthe user to analyse the patient record, using filters to review various criteria. This can be done

either through the datasheet, or by drilling down through the various graphical displays.

The Training

The CHART training module takes place over a half or full day and is run on an individualscheme basis. During the training, facilitators will be shown how to download the software andquery libraries and how to use the software to customise HQL queries. Analysis of responsesand how to use the CHART display functionality to identify data quality issues is also coveredin some detail, as is how to train practice staff to use the software. On completion of thetraining, facilitators will have access to the CHART software and CHART query libraries on thePRIMIS secure website.

Further information on the subject matter included in this training is available in the form ofprinted CHART instructions and a computer-based tutorial. These are provided to facilitatorsduring the training.

CHART query libraries available (April 2005)

the nGMS query library - focusing on thenew contract

the Flu query library - looking at influenzavaccinations

the original Rushquery library - focusing onthe Quality and Outcomes Framework


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CHART PRIMIS Facilitator Handbook

PRIMIS 49

Learning Objectives

The training will provide facilitators with:

the skills to download and install CHART software and query libraries

an understanding of the functionality of the software

the skills to analyse and interpret the query responses when viewed using CHARTsoftware

the ability to train practice staff in the use of the software

an understanding of the confidentiality aspects of the software.


Before attending the CHART training module, facilitators should have attended thefollowing PRIMIS training and have completed some data quality improvement work withtheir local practices:


Clinical Coding

The MIQUEST Process


Facilitators attending this training module would also find the following training modules ofinterest:





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PRIMIS Facilitator Handbook CHART

50 PRIMIS


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Background

The NHS is constantly changing due to the political agenda. Recent changes to the GPcontract and the increased priority for use of information technology in the NHS are affectingthe culture of primary care, with emphasis on recording data on the computer as opposed topaper-based records.

This training module follows on from the Data Analysis, Interpretation and Feedback moduleand is designed to assist the information facilitator in helping practices to manage change, anddevelop and implement action plans. Following on from the facilitators initial feedback session,the practice can identify areas where data quality issues have been highlighted. It gives aplatform to start from in deciding:

where are they now? where do they want to get to?

how are they going to get there?

One method for instigating change is to raise dissatisfaction with the current situation, in thiscase in the quality of the practices data. This should be a whole practice process with allmembers of staff involved. There are various techniques that a facilitator may use with apractice. Some examples are given in the box below:

The Training

The training takes place over a full day and is run on either an individual scheme or groupbasis. The training consists of a presentation about the stages of change management andseveral exercises to be undertaken by the participants during the training; it covers thefollowing topics:

reducing resistance to change

knowing what causes change

raising dissatisfaction with the current way of doing things

reaching agreement on a common way forward

identifying who is involved in the change process

Action Planning and Supporting Change PRIMIS Facilitator Handbook

PRIMIS 51

Suggested Information Management tasks for practice use

Planning data collection and storage processes

Understanding how members of the practice team use data

Developing data entry policies and procedures

Monitoring information handling systems


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building confidence that the target is achievable

implementing the change and the new ways of working

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