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Top tips on data pitfalls

Not getting the right data can be a major barrier for PBC. Our expert panel tells you how to troubleshoot six common problems. By Emma Wilkinson

Not getting the right data can be a major barrier for PBC. Our expert panel tells you how to troubleshoot six common problems. By Emma Wilkinson

Problem 1 - My PCT is not committed to data.
Top tip: Get an agreement up front on what is expected from both parties.

Dr Shane Gordon (SG): The first thing to do is negotiate with the PCT on the specification of the data the commissioners will be given to work with. With our PCT, we have negotiated a schedule of data we expect them to produce and worked to define the format of the data with them, which helps the PCT produce the information in a meaningful manner.

The PCT needs to stick to the commitment to deliver the data on schedule and provide the manpower to do so.You need to make it worth the PCT's investment in time. It is essential to work out from the beginning the parameters under which you will work.

Dr James Kingsland (JK): You have to provide the evidence that what you're requesting is reasonable and, if you're still having problems, always put it in writing.

Be professional, formalise the process and be clear. If you're worried, don't forget PCTs are performance managed so you can copy the correspondence to the commissioning lead at the SHA.

Dr Mike Dixon (MD): You also need to make it clear that without the data, you are unable to look at resources and use of services and you can't help the PCT with demand management. If the PCT has concerns about the financial explanation then they need to realise it's money well spent.

Problem 2 - I can't get hold of any data.
Top tip: Remember the PCT is not the only data source.

SG: Having a data tool is certainly invaluable when it comes to making a business case – you need to be able to go in quickly and analyse the data. You need some way of accessing the data that doesn't require you to go through a third party – for example, if you had to go through your finance team every time you wanted a bit of data it would not be very productive.

One bit of data always throws up a load of extra questions and then you would have to wait a couple of weeks or a month every time. You need something you can interrogate directly.

There's a lot of information you can get on your own, independently of the PCT, such as that from NHS comparators – it's quite out of date, about nine months, but it can still be very helpful.

Dr Stewart Findlay (SF): Data is sometimes difficult to extract but there are managers in the PCT who can do this for you and people should be using them to get the information they need.

There are also other services out there – for example, GSK will put together data for you, it's just not as timely.

JK: The PCT is just one source of information – the NHS Information Centre is developing some fantastic data tools or you could invest in Dr Foster. But remember, just as we used to do with fundholding, you can use your own data.

MD: You can produce your own information and keep a tally of referrals – we managed to cut referrals without extra information, just by looking at the referrals in the practice each week.

But if you do need information from the PCT you need to find the person in charge of PBC – there should be one.

Problem 3 - The data I'm receiving is often out of date.
Top tip: Not all data needs to be bang up to date.

SG: One barrier is a long delay in getting hospital data – up to three months behind – which for practical purposes is pretty useless. So we've negotiated with the PCT that we use provisional data and at the end of each quarter we adjust the data and that's quite helpful.

But people complain too much about data that's out of date. You can do quite a lot with data that is old because some things don't change that quickly.

If you're looking at the beginning of the commissioning year at the problem specialities, you can use last year's data.

41218593In my own area, obstetrics still has an amazingly high number of attendances and that's not something that's going to change overnight so I don't really need up-to-date information.

But if you have a service level agreement on production of data and they're not sticking to it you need to start having some contract negotiations with the PCT.

JK: This problem has been around for a number of years but a lot of organisations are now trying to get more real-time data, including PCTs.

MD: This is a big problem because activity data does tend to be out of date. You can have a chat with the PCT and explain why you need it to be more timely.

It may be so out of date that you can't do anything with it. And it may be too late to have any comeback with the acute trust. Everyone should be negotiating with their PCT on how they will get more timely data than they do at present.

Problem 4 - I don't know what to do when things go wrong.
Top tip: Have an agreement to fall back on.

SF: The support people get is quite variable. In our PCT we have people who look specifically at information and we can ask for reports, but in other PCTs it's patchy.

What PCTs should be doing with practice-based commissioners is having a contract and saying we expect you to achieve financial balance and in return we promise to give you timely data and a proportion of savings.

That should be in place from the outset.

JK: The first thing we did as a PBC consortium was write an accountability agreement with the PCT. Hopefully, you won't have to refer to it but if you have one you can point out when something is not forthcoming.

MD: You should shout and stamp your feet but remember also there's safety in numbers. Talk to other PBC groups in your PCT and if there's a general problem you can stand in concert against the PCT.

If others don't have the problem then you can ask your PCT why if they can do it for someone else, they can't do it for you.

The SHA should be the last resort – on the whole PCTs are willing to listen and sometimes they just need a bit of encouragement. And it's very helpful to have an agreement at the outset as well as a cultural debate about what they expect from PBC.

Problem 5 - I can only just about follow what they're talking about.
Top tip: Don't be blinded by jargon.

SG: There are courses out there on how to use data, but if it was me I would spend a few weeks being the best friend of the guy who deals with data at the PCT, asking him lots of questions.

I'd put a lot of effort into making sure someone in my cluster had spent a lot of time looking at the data machinery at the PCT.

JK: There's a lot of jargon and it's a foreign language to many GPs. When people are talking at meetings, GPs may think they can't ask questions.

I'd be inclined to get the director of finance in from the PCT to go through the jargon and technology and how the system works – it should only take a couple of hours.

MD: We have to make them translate it into English. If the practice-based commissioner doesn't understand, then the practice managers or local GPs certainly aren't going to understand it either.

It has to be in a form that's both understandable and usable. It is important to go to other commissioners and find out what they're asking for. We at the NHS Alliance do MOTs for practice-based commissioners so they can work out exactly how they're doing.

Problem 6 - I'm concerned about data security risks
Top tip: Stick to the same data protection principles you have in the practice

SG: There is an issue of practices sharing data with each other and an agreement is needed. But most of the tools don't give you names or identifiable information – they'll use NHS numbers. You just need to be sure you're not passing anything on that's identifiable, such as names or date of birth.

JK: Just stick to the guiding principle of data protection. You should have procedures in the practice already and if you stick to those principles, it's very straightforward.

Emma Wilkinson is a freelance journalist

Our experts

Dr Shane Gordon chief executive of Colchester PBC group in Essex and national co-lead of the NHS Alliance PBC federation
Dr Stewart Findlay PBC chair, Durham Dales
Dr James Kingsland NAPC president
Dr Mike Dixon chair, NHS Alliance

If you have an agreement on production of data and the PCT is not sticking to it, you need to start talking How you can help your PCT to help you

The more detail the better when requesting data and a realistic deadline could make a big difference, says David Arrowsmith, head of information at Derbyshire County PCT.
Be very specific – on what you want and what format you want the information in.

Information people don't like someone coming fishing. But they do like people who are going to use the data – analysts can find themselves doing the work and then it's not used. If someone is really keen and is going to use the information, the analysts are only too happy to help them.
Find out who the head of data is at the PCT and also the head of the public health department as they will be very clued up in the use of data and will have a lot of information.

Be aware that some data, such as secondary care data, is very good but other things like data on community services or mental health is not as good.

A lot of problems come from late requests, which means that things don't get the attention they could have.
Remember analysts have things going on every week that are set by national deadlines so if you give them a week they will be able to spend more time on it.

There's an awful lot of information and comparative data available on websites down to practice level, PCT level or PBC level.

It's always worth going to look at those first and then the information team can help with any additional questions you might have.

And one really important point is, if you have a business plan, think about how you're going to measure your outcome and talk to the analyst about it.

PBC data requirements Dr Shane Gordon, chief executive of Colchester PBC group and national co-lead of the NHS Alliance PBC federation Dr Stuart Findlay, PBC chair, Durham Dales Dr James Kingsland, NAPC president Dr Mike Dixon, chair, NHS Alliance

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