Release notes 2015

All four countries now have data on the site for the year 2014/15. The four countries have continued to diverge in their requirements and common ground is becoming smaller. Where indicators are broadly equivalent I have tried to make them comparable.

There are a couple of things worth noting below.

Wales

Wales was first to publish this year, about two weeks ahead of Scotland and a month ahead of England and Northern Ireland, which was impressive. There are no significant issues with their statistics. They have continued to publish data about local practices groups so I have used these on the site. I can't find any official codes for these so they have a "QDB" code which is entirely made up by me.

Scotland

Most of the Scottish data is fairly straightforward. There seems to have been a bit of muddle about the actual identifiers for indicators and I have used those in the final publication. QS002 was used last year and then for a completely different indicator this year so I have used QS002A for the new one.

England

English data imported fairly easily this year, much helped by a "raw data" publication. There is a new "sub-region" which was used in publication which adds another level to the hierarchy on the site with the exception of Wessex. On the spreadsheets Wessex CCG was listed as its own sub region and to avoid a horrible loop it simply skips the sub region stage.

Northern Ireland

As things stand there is no prevalence data for Northern Ireland where there is no other indicator in that disease area. This affects obesity, epilepsy and learning disability and there is not a lot of smoking data either. I will update this if more information becomes available.

There are now Local Commissioning Groups in Northern Ireland. I have used these in much the same way as the old boards although they cover different areas, most notably by having a separate group for Belfast.

2015 Data publication dates

All of the data from this site comes from the various governments around the UK. Some of the publication dates have been announced. It takes me a little bit of time to translate this onto the site but for interest here are the dates currently available.

• Scotland - 15th October by ISD Scotland
• England - 29th October by HSCIC
• Northern Ireland - No information available
• Wales - 30th September by Welsh Government

Release notes

2014 QOF data

The data for 2013/14 is now on the site. It proved a bit of a challenge this year as, for the first time, there were material differences between the QOF in the four countries. Many of these differences were around the areas of thresholds and timings although the gaps have widened in 2014/15 so need to be tackled.

I had to bite the bullet and have some sort of policy about this and how to present the data. For precision each indicator is reported at practice level as they have been published by the four countries. Indicators particular to Scotland have the (S) suffix, Wales uses the W suffix and Northern Irish indicators end NI. England has no suffix - the assumption seems to be that the other nations have opted out of the English QOF. Not all indicators have an equivalent in each country.

One of the strengths of this site has always been that fact that data from all four countries can be compared. I was quite keen that this could continued. In any case the indicators are often quite similar. We are not so much comparing apples and oranges but rather Cox's and Braeburn apples (again possibly a rather pointless comparison as Cox's knock Braeburns out of the park every time in my view but it will do as analogy).

The site has grouped similar indicators as they have changed over time. If you click on the calendar icon you may see several similar indicators being used over time. This is a rough approximation but pretty effective. I have used the same sort of grouping to compare indicators between countries. The figures for the UK are based on this grouping and use indicators without a suffix where there is an English equivalent.

This does mean that the centile figures are largely confined to each country (where there are country specific indicators) but remain UK wide where the indicators are the same across the UK. This mostly is the case in disease prevalence.

Currently there is a bug which means that practices outside England do not compare properly with the UK figures. I will correct this over the next few days.

Welsh Practice Groupings

The data for Wales was published with small practice grouping and I have taken these onto the site. The systems is pretty good at arbitrary hierarchies so manages these fairly easily. There is not much detail about these groupings other than names and I have made up some custom codes for them.

Depression Prevalence

For the last couple of years the depression prevalence figure has been based on the number of patients who had received a diagnosis after the first of April 2006. Prior to that it was based on the number of patients who had received a diagnosis ever. This caused a bit of a jump in the figures and this did stand out last year. There was also some muddle in the figures last year.

This prevalence was in the figures as "DEP PREV 2". I have changed this to reflect the new rules to "DEP PREV 3" although these two are linked and the historical trend will appear between them. I will tidy up last years figures to the same in the next couple of days.

Downloads

Some of these decisions may not be what you would have done. All of the figures will be available for download in about a week. These will be as CSV files and an MS Access file. With ten years of figures they are getting quite big now (the main database is now over a gigabyte of disk space). In particular the Access database tends to be quite large and I am open to suggestions about how to make this easier. Microsoft's solution seems to be a Sharepoint server but I don't have one of those. If you are a seller of MS Sharepoint or even if you are Microsoft and you want to show off your wares by distributing a large database please do get in touch!

Many thanks for your patience.

2012/13 QOF Data now on the site

All of the QOF data for 2012/13 is now on the main website and will be available for download in a few days. Due to the timings of it being published this year and the time I had available the data for all four countries is going on at the same time.

There are a few small changes this year. Firstly there were new smoking indicators which now applied to all patients who had reached their fifteenth birthday. As there is both an indicator showing how many people were asked, and a second indicator about giving advice to people who said that they smoked we can used the numerator of the first and the denominator of the second to give an idea of the proportion of patients who smoke. This is a little limited as it only applies to patients who were asked but may be useful or at least interesting. This appears at SMO PREV ALL in the numbers. It is entirely a pseudo indicator made up by myself.

I had an interesting email during the year about the prevalence figures on the site. In several disease areas, such as diabetes, osteoporosis or rheumatoid arthritis the register is restricted according to the age of patients. For instance diabetes is 17 or over and nobody goes on the osteoporosis register until they are fifty years old. At the moment the denominator on the site is the whole practice list, rather than just those patients who could possibly qualify for the register. This would tend to underestimate the prevalence in the qualifying population.

There are two sides to this. Using the adjusted denominator makes it easier to compare populations. It is a more realistic measure of disease prevalence although in many cases the actual disease is relatively rare outside these age groups. The vast majority of diabetes, for instance, occurs in later life. Osteoporotic fracture is rare before 50.

There are snags though. Only England produces the adjusted figures and they are listed on the spreadsheets as estimates. It is also easier to see the relative disease burden on practices from the whole list figures. Comparison with earlier years is also easier.

My compromise is to keep the main prevalence figures the same but to include the adjusted figures for English practices. If you click through on diabetes you will see DM 32 Adj which has the same numerator but the adjusted denominator. Not so much a compromise as a fudge - I do both things!

Downloads should be available in a few days. As always the Access version is a bit painful to set up but I will try and push my increasingly aged laptop through it! General QOF stuff (and some stuff that comes to mind but absolutely no pictures of my lunch) please do follow me on twitter. You can see recent tweets to the right of this post.

The year 2013/14 will, for the first time have different indicators in each of the four contries. I have a year to figure out how to deal with this! In the meantime I hope to get a better API up and running. Also we should get some idea of what a new DES for admissions avoidance in England. It may be possible to model some of this from QOF data, but we await the details.

2012 English data now on the site.

I am happy to be able to say that the English 2012 QOF data has now been uploaded to the QOF Database website. It joins the Scottish and Welsh data which has been there for a couple of weeks.
There is currently no indication when the data for Northern Ireland will become available.

I still have a couple of tweaks to do, mainly around the organisational area at PCT level and higher to give a good overview of how practices are doing. There is also quite limited data about QP3-5. In these the targets were different for each practice.

There will be one more update this year, when the Northern Ireland data is released and once that is done then I should get the data to download - subject to my copy of Access on the laptop coping with 14 million rows of data!

2012 Wales and Scotland data now online

I am delighted to be able to say that the 2012 data for Wales and Scotland is now on the site. Some of the virtual indicators and registers (mostly around depression incidence and smoking) have not yet been calculated. The site still defaults to 2011 until England data is on (it is 80% of the site) but 2012 is available in the left side menus.

So the English don't feel left out there is also a recalculation of the 2011 data at CCG level. In many cases the composition of the CCG is so similar to the PCT that it makes no difference but it may prove interesting. Either search for the CCG or drill down from England page or up from an English practice.

It is likely to be about three weeks before the English data is available on the site and I have no firm date for Northern Ireland.

Access Databases to download

The access databases are now available on the download page. These are actually version two. If you have downloaded before Saturday night (21st January) there were some errors in the indicator descriptions and some practice codes - basically a lack of 'N's due to over vigorous removal of null values.

You can download this years data or the data for all QOF years. The latter is a very large download and it makes Access run like an asthmatic sloth but that could all be the way I have set it up. I am no Access guru.

You may also have noticed the new timelines on the site. You can see how achievement for an indicator has changed over time. This is something that would not have been possible on the old site - the new database structure makes it much easier.

2011 Data online - and the new site

I am delighted to be able to say that the 2011 data is on the site, and the new version of the site is on line. This currently mirrors of the function of the old site with more detail at the SHA, country and UK level.

There is more functionality to come which is made easier by an entirely new data model in the background. The database will be able to cope with things such as comparisons between years.

There is also a new look which is hopefully easier to find your way around. Search is on pretty much every page. Please do let me know how you find it. Everything can change and this is rather more simple in the new site. I have used Django to build the site which has a very simple template system. I would update the look to this blog but Blogger templates are such horrible things that I really can't figure out at all.

The downloads should be available soon. I need to tidy the database a little first.

Update - and coming soon!

I have not written here for quite a while, at least partly due to there being little going on until the past couple of weeks. I have been writing for the GP Business magazine though in that time.

The data for all four countries has now been released and I am getting it onto the database currently. I am also giving the site a makeover from top to bottom which will increase what is possible and make the whole thing more maintainable. It will also have a new look, have less clutter and have graphs that work where there is no flash (ipods,pads and phones mainly)

This is a pretty big change so I will have to take the site down for 24 hours or so in the next week before it reappears with all the data. New features can be added after that.

Hope to see you there soon!

Ooops

Many thanks to the reader who pointed out that, in England, I had transposed the two depression prevalence figures. I have now corrected this on the site. If you have downloaded the data there is now an updated version on the download page.

If you don't fancy downloading it all again you can switch in Access with some queries. I have not worked how to export these. If you are using MySQL the code is

update `achievement` set area='' WHERE `practiceid`regexp '^[ABCDEFGHIJKMLMNOPQRSTUVXYZ][0-9][0-9][0-9][0-9][0-9]$' and area ='DEP Prev 1';
update `achievement` set area='Dep Prev 1' WHERE `practiceid`regexp '^[ABCDEFGHIJKMLMNOPQRSTUVXYZ][0-9][0-9][0-9][0-9][0-9]$' and area ='DEP Prev 2';
update `achievement` set area='Dep Prev 2' WHERE area ='';
update `pcoach` set area='' WHERE `pco`regexp '5[A-Z][A-Z]' and area ='DEP Prev 1';
update `pcoach` set area='DEP PREV 1' WHERE `pco`regexp '5[A-Z][A-Z]' and area ='DEP Prev 2';
update `pcoach` set area='DEP PREV 2' WHERE area ='';

I had also missed the reconfiguration of the PCT in Hertfordshire which is now corrected in the downloads also (there is not a simple patch for that).

Sorry!

CPD+ on QOF Database

I tend to have a few ideas for projects floating around at a time, most of which come to nothing. One of these was an improved method for saving all of the stuff that I read for appraisal. At the time all that was out there was the official Appraisal Toolkit that was too horrible to use. Thankfully this is, if not quite dead, certainly having the curtains pulled around it.

I never actually managed more than about 20 lines of code as a proof of concept on this one but am very excited to find that those good folks at Healthcarerepublic have actually put finger to keyboard and written something very much along the same lines with their CPD+ system. It is also free, which is nice.

It is pretty basic at the moment but crucially it does allow one click to enter data into the log. There are instructions on the CPD + site but to make things even easier you can click on the CPD+ logo after every blog post at at the bottom of every table on the site. There is also a button at the bottom of each blog posting which is a stupidly complex thing to actually get into a Blogger template. Feel free to use the code yourselves.

I hope you find this useful.

Site unavailability

I apologise for the unavailability of the main site. This is due to upgrade work by the hosting provider which is not going all that well! This blog moved to a different server a couple of days ago. Should be up again soon and we are promised better, faster stronger etc.

Update your address, possibly

I am delighted to announce a new feature on the site about which I am quite excited although I must admit may disappoint a lot of you.

Over the past couple of years I have received a steady trickle of emails about practices with incorrect details on the database. This can because practices have moved, merged, or changed hands. Commonly it is due to not terribly good details in the first place. It can be impossible to tell one practice from another within the same building in some cases.

Other emails have pointed out that this site appears rather higher in the rankings of search engines than their own website which caused confusion amongst users.

The answer is to allow practice to update their own details. This can be more easily said than done however. It required quite a bit of messing around in the entrails of the site although the same process has given a more intelligent search form.

The really difficult bit is trying to unsure that only practices can change their details. Somewhat to my surprise the NHS IT people have not yet provided a reliable way of making sure that a GP's identity on-line is who they say they are. The closest I can come is the old style email addresses in England which contained the practice id as part of the address. For many practices, even with nhs.net addresses this old address will still work. For practices outside England so such system has ever existed to my knowledge.

So please have a go if you can, and my apologies if you cannot. Suggestions for an on-line verification scheme for other practices gratefully received!

Square roots and cut offs

It has been announced that from next year the square root formula for calculating the cash due per point in the clinical areas is to be abandoned. In brief this meant that the cash per point rose as the square root of prevalence rather than linearly with it. The theory was that there would be an economy of scale enjoyed by practices. For more information on this use the search box above to search for square root. Over time thought has moved against this theory.

In the following year the 5% cut off will go. Previously practices with less than five percent of the maximum prevalence would be treated as if they had exactly five percent of the maximum. This could create some bizarre results.

I have been asked by many people over the past couple of weeks what the effect on practices would be. Well after having a short holiday I have looked at modeling these changes based on last year's data. Before I discuss the results a couple of warnings about all that is to follow. It is a model, not a prediction. It is based on applying next year's rules to last year's data. It assumes that all of the indicators will remain the same - which is simply not true. It assumes that practice behaviour is identical which is unlikely. I have also had to make estimates at the prevalences of smoking and depression screening which were not published for England this year. These are likely to be close but not exact. I am not using the Dep 2 indicator at all. This is a model and not a detailed estimate - but it should be close.

So on with some meat. The figures for each practice are available from the left hand menu of each practices page. These are expressed in terms of the equivalence number of points gained and lost. To get the overall picture you can see the spread of practices in the graph above (I have taken eight outlier practices off the top to make the rest of the histogram clear - they tend to be unusual practices and so have unusual patterns of prevalence).

We can also look at practices in groups. Perhaps the most obvious group to look at are University practices. Dealing with younger people they tend to have a lesser incidence of chronic disease - particular cardiovascular and pulmonary diseases which dominate QOF. A rather crude search shows 26 practices in the database with the string "Univ" in their address. On average these practices lose 234 points equivalent from their QOF payments. These were the practices that started from a very low base so to lose this amount is very significant. In fact after these changes their take home points from the entire clinical domain is an average of 93. Their clinical domain is less valuable to them than the patient experience domain. This is likely to have a very significant effect on these practices.

We can also look at the effect at PCT or Health Board level. You can see the PCT level changes online or download a (7k) csv file. The winners and losers are quite dramatic. London is hit hard with both Lambeth and Westminster losing the equivalent of over 100 "full price" points per practice. The clear winners are in the North of England or attractive seaside resorts or, in a couple of cases, both. Two PCTs gain over 100 points per practice. County Durham PCT is going to have to find another one and a half million pounds per year to cover the cost of these changes. Meanwhile in Lambeth eight hundred thousand will be taken from primary care. Of course both of these could be told, more optimistically, the other way around! The message here is that although this change may be cash neutral at the national level the same is not true at the PCT level.

As the graph above shows we have a normal distribution. These changes will be moderate for most, large for some and extreme for a few - a couple of practice gain over a thousand points although they are not large but small and specialist practices.

2007/8 QOF data (mostly) available now!

Another year has passed and there is a new set of QOF data to pore over. Northern Ireland published first this year about a fortnight ago whilst Scotland and England both published last Tuesday. All of the data for these countries is now online at the QOF Database. You can search for or browse the data.

I will publish the Welsh data when it becomes available. Database download will also be available soon as will overall prevalences.

Palliative care data is not visible yet either. This is due to differences in the way that this has been reported. England gives a prevalence, the other countries just give a yes or no to the presence of a register. This will take a couple of tweaks to display sensibly and I will do this soon. In any case the prevalence is difficult to make a lot of sense of. These tend to be small numbers which inevitably vary quite considerably over time.

In other site news I have removed the links to the QOF changes pages as these have become out of date as well as the extended hours calculator. In the latter case the national directed enhanced service is much less relevant as many local enhanced services filled the gap caused by its tardy arrival.

For the future I am working on ways of keeping practice data up to date, particularly addresses. I also hope to bring in links to practice websites. As I am a one man band and there are about ten thousand practices automation is going to be essential and this is taking a little time to code. It is likely to come in gradually.

Supporting Surgeries

If there is one thing that QOF has taught us it is that most GPs respond to a challenge. In the first year the government was surpised at the levels of achievement seen, although this was largely a repeat of the situation with Item of Service payments in the 1992 contract. GPs it seem, will do what is required to meet the contract.

We may have met our match, however. When the requirement is largely that you are not a GP but a large corporation it is an impossible target to meet. With hundreds of individual and different contracts it also become impossible to collect consistent statistics and monitor the performance of the corporate clinics - just when we seemed to be getting started on that problem.

We have seen this already with independent treatment centres. For years there was a persistent rumour of poor outcomes from these centres but no good figures to back these rumours up. There is some data now which suggests that there is little difference in outcome from NHS centres but nobody benefited from a five year delay in collecting the statistics.

We risk a distraction of GPs from the patient sitting in front of them and their needs by the central declaration of needs and solutions from central government. Anything else is a risk to the patients in primary care. This is why I support the Support Your Surgery campain.

Pretty Charts

Since the new indicators appeared on the site last September the chart of prevalence on the practices page has been pretty awful. It was almost impossible to read the key at the bottom. This was a major limitation of the charting app I was using.

Well now there is something new. Thanks to the rather wonderful Fusion Charts there are now simple and clear charts. The downside is that they do need flash. However the way they work means it will be much easier to add new charts to the site in the future without a huge amount of extra work for the server to do.

Enjoy.

QOF changes

A couple of weeks ago the BMA issued its guidance on the QOF changes for this year. Basically some organisational areas were cut and the points transferred to two new areas to be based on surveys of patients.

The survey questions seem likely to be very similar, if not identical, to those asked about appointment booking in the 2007 patient survey.

As we have some data to go on, for England at least, the effect of the changes can be modelled at practice level. In fact I have done this for all practices in the UK, simply the results are likely to be less reliable outside England. In particular the square rooting of the COPD prevalence is based on the English average - slightly overestimating losses outside England.

To find the data for individual practices just use the search or browse pages to find the practice and then select from the menu on the left side.

Surgery search improved

I have changed the search system slightly to (hopefully) give better results. Previously you could use wildcards e.g. Car* would give Carlisle and Cardiff. This was hardly ever used and the search tended to give very long lists of unhelpful results.

You now can't use wildcards but the results should be better. For more general QOF queries over many web sites the Google search is still there. It searches on selected QOF related sites without all of the stuff about GnuCash and Hebrew characters you tend to get on a full Google search.

Changes to Extended Hours DES

In the fast(ish) moving world of GP contract negotiations the finances of the extended hours DES have changed again. In his latest letter to the profession Lawrence Buckman has announce an increase in the rate of payment from £2.80 to £2.95 per patient for extended hours. It has also been clarified that the survey will be in QOF and not part of the extended hours DES

This is in general good news - there is more cash for providing extended hours under the DES although and this is surprisingly substantial for many practices. I have updated the extended hours calculator which can be accessed from left hand menu the practice pages.

I have also corrected a bug which overestimated the hours required for about one in six practices. Sorry about that and thanks to the eagle eyed reader who spotted it.

The contents of the DES are still far from fixed as you can see here and here.