General Practice Alert State (GPAS) FAQs

The following questions have been developed to support the introduction of the General Practice Alert State or GPAS and is based on feedback obtained through one-to-one interviews and other general discussions with Practices that have been involved in the pilot programmes coordinated by the Kent and Medway LMC

Rationale

1.  What is the purpose of GPAS and why are we doing it now?

GPAS has been designed to allow general practice to report the state of pressure and resilience in local areas.

All other parts of the healthcare system can signal when they are at capacity, except for general practice. Hospital trusts use Operating Pressures Escalation Level (OPEL) to communicate demand and capacity issues, but general practice has not until now, had a similar system. The new system is being rolled nationally and will be known as GPAS. The LMC is encouraging all Practices to submit data on a regular basis, to build a robust evidence base that will provide system leaders with better visibility of the pressures being experienced by general practice at Health and Care Partnership (HCP) level.

It will also enable comparison with pressures in secondary care as the Integrated Care Board is established. This way we will be able to demonstrate to other provider groups the sheer scale of what general practice does, and to demonstrate the case for extra support and investment.

2.  How can I be sure that the data I’m providing is consistent with the data others are providing?

We have developed simple instructions you can follow to extract appointment data from EMIS. We want you to provide all appointments delivered by all members of your clinical team under your GP and supplementary contracts (e.g., PCN DES; Primary Care Quality Standard contracts) where this is simple for you to do. Where extracting PCN activity is too complicated reporting practice level data only is fine.

We recognise there will be variation between what practices do due to, for example, the makeup of your clinical teams and what services you are commissioned to provide. This variation is not something you should be concerned about and reflects how practices have evolved to meet the needs of the diverse communities they serve.

You can minimise the variation by increasing the accuracy with which your appointments are mapped. This is not a requirement for GPAS but is a contractual requirement around General Practice Appointment Data (GPAD). You can find more details on this here.

3.  What are the criteria against which the Alert State rating has been designed?

You will be asked to consider two main criteria when selecting your Alert State: Patient Flow and Staffing Levels.

When thinking about patient flow there are a number of factors you can consider. The most important will be how long your patients wait for an appointment. However, you can also consider other factors such as, how long patients wait on the phone to speak to someone, or the volume of eConsults that need processing. You can consider any one or combination of these when deciding your Alert State.

Staffing levels is simply whether you are experiencing any staff shortages. This could be for any reason including carrying vacancies; annual leave; or staff sickness.

You could move up the Alert State scale for either or both factors. For instance, demand for appointments may be within normal parameters, but if you have had a covid outbreak and 1/3 of your staff are off sick you will be experiencing acute pressure.

4.  How will the data I provide be used?

The most important thing to note is that the collection of this data is not intended to be punitive in any way. It is about building an evidence base that the LMC can use to demonstrate the breadth and depth of general practice services and the demands being made on it.

Each week the LMC will produce a report to inform system leaders about the Alert State in general practice across all 4 Kent and Medway HCPs and will monitor how it is changing over time. The report will also be shared with practices so that you can see what is happening too and explore how issues might be addressed through PCNs.

5.  Is the data I provide totally anonymous from the outset?

Yes. The LMC does not collect the names of Practices that submit data. We do collect your list size, and the HCP and PCN within which you operate. In combination this could make your practice identifiable however, this information is only visible to LMC officers. We will not share individual responses with system partners and the report we produce will contain aggregate data at Health and Care Partnerships (HCPs) and Integrated Care Board (ICB) levels only.

6.  How confident is the LMC that the data it supplies will be used by system leaders?

The new ICB and HCPs are being given explicit responsibilities to strengthen partnerships between NHS organisations, local authorities and other local partners including civil society. Specifically, the Fuller Stocktake report recognises the critical role general practice plays in the healthcare system. The intention is that this collaboration will support a change of culture towards greater integration and joint working. Our discussions about GPAS with the ICB, HCPs, and other system leaders to date have been very positive. We anticipate therefore, that the evidence we collect through GPAS will evidence the pressure within general practice and become an important source of intelligence to support resource allocation and improvement initiatives across Kent and Medway.

7.  Will the data be shared across local practices to support local improvement?

With the data being aggregated at HCP level, Practices may find it more useful to discuss the individual data they submit with other Practices in their local community or with PCNs.

8.  How can the LMC assure me that the data I provide will not be used for performance management?

The system which the LMC uses to collect and analyse the data submitted by Practices is independent from any NHS systems and is not being collected for performance management. The LMC will not be sharing practice level submissions with the ICB, HCPs or CQC.

9.  Do I have to take part in GPAS?

Your participation is optional but the more Practices that submit data the more robust our evidence base becomes. We require at least 50% of practices to participate to create data that is valid.

We strongly encourage you to take part as GPAS will provide general practice the opportunity to demonstrate to the rest of the system the tremendous contribution it makes. It will also help to build the case for additional investment and support and to understand how pressures differ across the different HCP areas.

Completing the forms

1.  How do I submit Monday Appointments data each week?

On Tuesday each week we will send an email to the nominated practice contact that contains a link to an online form through which data can be submitted. The process, including extracting appointment data, should take between 5 and 7 minutes.

The link does not change so you are able to bookmark it, but the timing of the submission is important so that the system can accurately allocate the data to the correct week.

2.  What appointment data should I be reporting? Should we just be reporting appointments with GPs?

We are interested in all appointments held by the GPWT, delivered by all members of your clinical team. However, we recognise it may not be possible for all practices to extract appointment data attributed to PCN staff due to the way these appointments are organised.

3.  How do I know if my practice is ‘green’?

This implies low level of pressure; the practice is appropriately staffed and there is sufficient capacity to meet patient demand and expectations. GPs in the practice are working to BMA recommended safe working limits.

4.  How do I know if my practice is ‘amber’?

This indicates the practice is under moderate pressure. The practice is unable to fully meet patient demand or expectations. GPs in the practice are likely to be working beyond BMA recommended safe working limits meaning some patient demand cannot be met by the practice. This is unsustainable in the long term without action.

5.  How do I know if my practice is ‘red’?

This indicates the practice is under severe pressure and although it may be able to run safely for a very limited period, immediate action is required to mitigate the situation. The GPs in the practice are continuously working beyond BMA recommended safe working limits and significant levels of patient demand cannot be met by the practice.

6.  How do I know if my practice is ‘black’?

The practice is unable to provide safe care and there is a risk of service failure. Without intervention, it is likely the practice will be forced to close. The practice would be expected to declare this state to the commissioner and seek guidance from the LMC.

7.  What do you do with the open narrative in the form?

This is an opportunity for you to provide context behind your rating and appointment data. For example, whether your practice has experienced a covid outbreaks or whether significant numbers of patients are enquiring about secondary care referrals. This provides a richness to the information we receive that the numbers do not and if you are looking for any specific support it provides a way of letting the LMC know. We can then consider whether there is anything that we can do to provide help and support.