Primary care: national monitoring and evaluation strategy

Monitoring Improvements with Statistics

It is vital that we underpin the story of primary care reform with high quality, comprehensive quantitative data, collected, analysed and disseminated in an efficient and robust way. Such data will provide up to date information on the progress of primary care reform, and will identify areas where more detailed additional statistical data, follow-up analysis, improvement activity, policy intervention or other actions may be required.

The data needed for monitoring and evaluation at the national macro level will often be different in nature to that which is needed at a local level. For example, ready access to up-to-date, detailed and accurate information from SPIRE and other local systems is essential at a practice and cluster level to drive quality improvement. Some of this information will also be required to monitor progress nationally, but this will be needed on a less frequent basis and generally in a more summative form. All of these data needs are important, however this strategy focuses on national level statistics.

At present, data relating to primary care is limited. Existing (but incomplete) data for national monitoring relates to:

• the primary care workforce
• GP practice level information (such as list sizes)
• some activity data (e.g. Out of Hours, previous QOF data collection)

In addition, some patient reported outcome measures are available from the Scottish Government’s Health and Care Experience Survey.^[27]

The lack of data and an inadequate data infrastructure are substantial challenges to developing the effective policies required to address increasing demand across the health and social care system. This includes, for instance, questions about the efficiency and economy of primary care spending and difficulties in attributing the role of policy to improved outcomes. It is also important to develop better data for understanding the impact of primary care reform on inequalities and better approaches to address these. 

The Scottish Government’s workforce plan notes (chapter 7) key developments already underway to improve the primary care data landscape.^[28] This includes the roll-out of SPIRE, improved general practice workforce data under the terms of the GMS Contract, and a platform NHS National Education for Scotland (NES) are developing to bring together and align relevant workforce data to inform workforce planning.

Historically, the availability of data from primary care to support research has been limited and has often involved bespoke data collections. In time, the roll-out of SPIRE to all practices in Scotland should provide an unprecedented source of accessible primary care information to support research and evaluation.

Currently, primary care data is available to different groups of stakeholders in a number of different locations and formats. To facilitate synthesis of these data, and to identify continued data gaps, we will work with the national boards to create an online resource which draws together data sources, analyses and other relevant evidence.

National Level Indicators for Primary Care Reform

There is a recognised need for a small number of national measures that track system-level progress. To address this we have developed a set of high level (predominantly national level) indicators across the six primary care outcomes. This is included at Annex 2 and will be further discussed with stakeholders over the coming months. The development of this indicator set follows the model in the Institute for Healthcare Improvement whole system measures white paper,^[29] which describes the importance of having a balanced set of system level measures which provide:

• A conceptual framework for organising measures of care quality
• A specific set of quality metrics (that can contribute to the Scottish Government’s broader set of strategic performance measures)
• A relatively small number of “big dot” measures which track system level change within primary care at a high level
• A balance among structures, processes, and outcomes measures.

The current proposed set of national indicators are not intended to cover all of these aspects of primary care, at least initially, and process measures will initially predominate for some topics. It remains a longer-term ambition to broaden the scope of the indicators as the data availability and quality improve and we gradually incorporate and aggregate data from sub-national sources. We will also take account of the framework that the Scottish Government and COSLA are committed to develop for community-based integrated services.

Who will use the indicators and why?

The table below describes the main groups who will have an interest and stake in the national indicators and why. Not all of these groups will require the same levels of detail, or be interested in all of the proposed indicators.

Table 1: Users and purpose of primary care indicator data