PRIMIS is delighted to be part of the British Society for Heart Failure (BSH) Strategic Partnership for the 25in25 Initiative, along with NHS Benchmarking Network and Strategic Intelligence Alliance in Healthcare.

The objective of the 25in25 initiative is to achieve the BSH led ambition to reduce deaths due to heart failure by 25% in the next 25 years. This collaborative of expert partners is working throughout 2024 as part of a ‘discover and develop phase’ to create a dashboard from GP practice data, with a national rollout planned during 2025.

The collaborative will develop the coding and tools necessary to collect the data. We will work alongside selected health systems to validate the search criteria and drive quality improvements that result in better and more equitable heart failure care.

PRIMIS’ work on the 25in25 initiative (pilot phase) is due to conclude in December 2024.

Please contact enquiries@primis.nottingham.ac.uk if you would like further information.

Further reading

British Society for Heart Failure 25in25

Axial spondyloarthritis (axSpA) is an inflammatory arthritis where the main symptom is back pain. Early recognition of the symptoms is difficult for GPs, with the current average delay to diagnosis from when symptoms start being 8.5 years.

PRIMIS, in collaboration with Dr Raj Sengupta, Consultant Rheumatologist at the Royal United Hospital Bath NHS Foundation Trust, and Novartis Pharmaceuticals UK Ltd, has developed a pop-up tool to support the early referral of patients presenting with signs and symptoms of axSpA, based on the Assessment of Spondyloarthritis international Society (ASAS) inflammatory back pain score (IBP).

Designed to be non-intrusive and carefully optimised to avoid alert fatigue, the axSpA alert and template are launched when a specific combination of existing codes combined with those entered in a consultation are detected. The toolkit includes a reporting tool that tracks trigger activity and identifies patients that meet the ASAS IBP referral threshold.

Dr Sengupta commented:
"The axSpA tool has already shown to be easy and effective during the original trial in GP practices, here in Bath. Because of low prevalence of AS it rarely triggers, but when it does the impact that the pop-up can have on patients getting a faster and more accurate diagnosis is profound."

Following additional funding by NASS, PRIMIS is delighted to work with the South West Axial Spondyloarthritis Group (SWAG)* on its SWAG AxSpA Programme.

The SWAG AxSpA Programme will utilise the axSpA tool's reporting outputs to:

• monitor the effectiveness of an in-consultation alert 
• assess potential caseload by inviting patients identified by the reporting tool to complete a self-assessment questionnaire
• proactively inviting relevant patients for further assessment

This project will also enable the previous early adopter programme cohort to maintain access to the axSpA tool.

*SWAG is a group of rheumatologists from across South West England with a special interest in axial spondyloarthritis.

External links

NASS is the National Axial Spondyloarthritis Society (a UK registered charity)

NASS Act On Axial SpA 

NASS site for health professionals

Diabetes is a common illness that is mainly managed by GPs in primary care. There are several kinds of diabetes namely Type1, Type 2 and a genetic form of diabetes called maturity onset diabetes of the young (MODY)¹. Getting the right diagnosis from the start is vital to ensure people get the most effective treatment.

Researchers from the University of Exeter have developed and tested two online calculators which can be used to improve diabetes classification in primary care. The calculators can determine how likely someone is to have Type 1 rather than Type 2 diabetes and how likely someone is to have MODY².

They are now looking to embed these calculators in GP practices to explore how they can be used to help GPs with diabetes classification (DePICtion study). PRIMIS is delighted to be collaborating with the research team on the DePICtion analytical tool which will enable practices to apply the algorithms to the patients in their practices who have been diagnosed with diabetes. The analytical tool comprises a set of clinical system searches to be run on study GP practices and a DePICtion Display tool to post-process data to enable participating practices to identify:

• clear misclassifications/miscodings in the data
• patients with a high probability of maturity-onset diabetes of the young (MODY)
• patients at greatest likelihood of Type1/Type2 misclassification.  

PRIMIS’ work on the study commenced in September 2023 and the study is due to conclude in January 2025.

References

1. Pang L, Colclough KC, Shepherd MH et al. Improvements in Awareness and Testing Have Led to a Threefold Increase Over 10 Years in the Identification of Monogenic Diabetes in the UK. Diabetes Care 2022;45:642–649 

2. Shields BM, McDonald TJ, Ellard S et al. The development and validation of a clinical prediction model to determine the probability of MODY in patients with young-onset diabetes. Diabetologia (2012) 55:1265–1272

As part of a growing collaboration with Leicester Diabetes Centre (a unique, collaborative partnership between the NHS and the University of Leicester), PRIMIS is pleased to be providing close support for the D-Med Study which aims to reduce the number of falls, hypoglycaemic events or death in frail and elderly patients with type 2 diabetes caused by over-prescribing.

This important research funded by NIHR ARC-EM will examine the efficacy of an intervention designed to support clinical prescribers within general practice to effectively reduce the proportion of potentially inappropriate diabetes medications prescribed to this specific population.  Over-prescribing of medication can lead to blood sugar dropping to dangerous levels which increases the likelihood of falls, emergency hospital admissions and death.

As part of a package of services provided to the research team, PRIMIS has developed a bespoke GP clinical system decision support tool to alert GPs to any patients eligible for de-prescribing and access to an embedded standardised data entry template to record any medication changes during review. 

The study involves the participation of 40 GP practices across England.  Data will be extracted on multiple occasions from the participating practices over an 18-month period to allow the efficacy of the intervention to be assessed.

Findings expected to be made available by the Leicester Diabetes Centre by the end of 2023.

Leicester Diabetes Centre: D-MED study

Familial Hypercholesterolaemia (FH) is a genetic, inherited condition, which can cause extremely high cholesterol levels. Without treatment, it can lead to heart disease at a very young age; people with undetected FH are four times more likely to have a heart attack or stroke than the general population. FH is identified via a cholesterol test to identify patients most at risk, followed by a genetic test to confirm FH. Once confirmed, the risk of heart disease can be dramatically reduced through the commencement of medication to lower cholesterol levels. 

FH in the UK population is believed to be approximately 1 in 250, meaning more than 260,000 people in the UK may have FH. Less than 10% of these people have been diagnosed contributing to avoidable heart attacks and premature death. The NHS Long Term Plan outlines a commitment to improve this to at least 25% through better access to the NHS genomics programme. However, with limited access to genetic testing and unprecedented demand in primary care, it is essential to prioritise those most at risk.  

The FAMCAT2 Algorithm has been developed by University of Nottingham academics (PRISM) and has high predictive accuracy to identify FH. The algorithm generates a FAMCAT2 probability score for all patients aged 16 years and over with a cholesterol result. Once a score has been established, patients can be ranked in order of their probability of having FH, helping health care systems to prioritise referrals for testing in accordance with capacity at regional genomic testing hubs.   

In one scientific paper, it was found that FAMCAT2 required only 23 genetic tests to find one patient with FH, whereas the Simon-Broome methodology needed 102 tests. [ref: Cost-Effectiveness of Screening Algorithms for Familial Hypercholesterolaemia in Primary Care by Matthew Jones, Ralph K. Akyea,Katherine Payne et al  https://www.mdpi.com/2075-4426/12/3/330]    

PRIMIS is delighted to be leading on the implementation of the FAMCAT2 algorithm across the UK. 

Access to the FAMCAT2 Algorithm  

The FAMCAT2 Algorithm can be accessed one of three ways:

FAMCAT2 Tool

FAMCAT2 API

FAMCAT2 Algorithm 

 Advantages of using the FAMCAT2:

• It is evidence based. There have been publications in peer-reviewed journals spanning each iteration of the FAMCAT research.

• It is accurate. Based on a retrospective cohort study of over 1 million patients, FAMCAT2 more accurately predicted FH than other case finding methods. 

• It is cost effective. Research findings conclude that while other methodologies to FH identification have utility, they require more resources to detect fewer or the same number of cases of FH. 

• It helps prioritise workload and align to the capacity in regional genomic testing hubs. 

• Early identification and effective treatment of people with FH can help to ensure normal life expectancy.  

Guides and documents

Explore FAMCAT2 papers and documentation on our publications page:

Publications

PRIMIS has had the privilege of working on the FLU-CAT study for the last three years. The study is being carried out in partnership with Professor Calum Semple, Professor in Outbreak Medicine at the University of Liverpool, and has been funded under an NIHR Pandemic themed research call.  

During the Covid-19 pandemic, PRIMIS was asked to work alongside the GP system suppliers to design and implement a data entry template to support primary care decision making. Consequently, the tools have been utilised hundreds of thousands of times across the UK, supporting health care professionals to make difficult decisions about who should be admitted to hospital and who can safely be allowed to stay at home.

The aim of the FLU-CAT study is the real time refinement and validation of criteria and tools used in primary care to aid hospital referral decisions for patients of all ages in the event of surge during a pandemic. Please visit the FLU-CATs webpage for more information:

FLU-CATs

Given the Covid-19 pandemic, it was agreed that the tooling developed by PRIMIS for the FLU-CAT study was made available to all GP practices via their GP system suppliers. 

This project is now complete.

The aim of the GP-PROMPT Study was to prevent cardiovascular and renal complications in patients with type 2 diabetes and microalbuminuria.  At the time there was no routine way for GPs and practice nurses to review all the risk factors that they need to consider during consultations with this patient cohort.  

The effects of using an electronic "prompt" with a treatment algorithm to support a treat-to-target approach had not been tested in primary care prior to this study.  The objective was to test a system alert/ template that brought together all relevant factors and alerted the healthcare professional when a patient had a high risk of heart and kidney disease.   

The alert encouraged the healthcare professional to treat blood pressure, HbA1c and total cholesterol to target.   

PRIMIS experts developed the software and facilitated the reporting of outcomes data to the research team.

External links

Leicester Diabetes Centre - research projects

This project is now complete.

A project to identify and optimise care for patients with mild or moderate chronic obstructive pulmonary disease (COPD) across Healthier South Wirral Primary Care Network (HSW PCN) has been enabled through the use of PRIMIS’ GRASP-COPD. This joint working initiative between Healthier South Wirral PCN, Boehringer Ingelheim and PRIMIS took place between June 2021 and December 2022.  

Aims 

The project aimed to improve patient outcomes and reduce unscheduled COPD-related healthcare resource use through achievement of the following:  

1. Accurate identification of patients within the mild and moderate COPD cohort, based upon patients’ latest spirometry results 
2. Identification of patients with
   1. multiple respiratory diagnoses including those who may have been incorrectly diagnosed i.e., asthma and COPD 
   2. potential undiagnosed COPD (no recorded respiratory disease of any type but multiple SABA inhaler issues) 
   3. uncontrolled COPD
3. Optimisation of respiratory treatments in line with local and national guidelines and environmental targets for the above populations 
4. Empowerment of diagnosed COPD patients in HSW PCN to better self-manage their disease with appropriate and accessible support from local primary care services  
5. Empowerment of the patient, HCP and care provider communities to better identify and manage COPD patients through a full, comprehensive COPD education programme 

Tool

After consultation with clinical staff within the PCN, PRIMIS created a bespoke version of the GRASP-COPD tool to incorporate specifics required for the project such as FeNO testing, multiple SABA inhaler issues and design of a tailored summary data view for each practice. This bespoke version of GRASP-COPD was installed at each of the six participating practices within the PCN and lists of patients requiring targeted review by the clinical staff were generated. 

As part of the project, the clinical pathway for mild to moderate COPD patients was reviewed and improved and its implementation was supported by a comprehensive education programme for clinical staff involved in chronic disease management of COPD patients.  

Outcomes

Aggregate baseline data was collected from all six participating GP practices in June 2021. The same data items were extracted over a year later (December 2022) from a sample of practices in order to assess the impact of the programme.  

• COPD prevalence fell by 0.27% making it more comparable with the national QOF average of 1.9%. This may be due, in part, to the project aim of targeting patients with dual/multiple respiratory diagnoses and ensuring accurate recording 

• Decrease in the number of COPD patients reported as never having had spirometry (down from 15.4% to 12.3%) 

• Increase of 11% in the number of COPD patients with a recorded spirometry result within diagnostic range (FEV1/FVC ratio <70%) 

• 8% decrease in the percentage of COPD patients whose last smoking status denotes a smoker 

• increase in the percentage of patients (diagnosed and undiagnosed) having had a FeNO test 

• increase in the number of undiagnosed patients having a lung function test (to confirm or reject potential diagnosis) 

PRIMIS was delighted to be a supporting partner of this valuable joint working initiative to improve the health and care of patients with COPD within South Wirral.  

GRASP-DM is a free to use quality improvement tool to help GP practices optimise the management and care of patients with diabetes and reduce their risk of developing associated complications.

GRASP-DM:

• provides at-a-glance visibility on how well diabetes is being managed in the GP practice
• enables GP practices to make decisions and act, deciding on the element of care or individual patients for prioritisation
• enables data to be viewed at patient, GP practice and locality levels
• saves time and resources (no reliance on personnel with IT skills to design and produce the equivalent insight)
• provides the ability for GP practices to share data and reports with colleagues within the locality

The tool is fully aligned with NICE Guideline NG28 on Type 2 Diabetes in Adults: Management (August 2022 update) and uses NICE’s visual summary on factors to consider when choosing, reviewing and changing medicines, including identifying individual patients who might benefit from a structured medication review. PRIMIS has a long and successful history of collaborating with pharmaceutical companies to provide quality improvement services to primary care, often at national scale.

We have collaborated with Boehringer Ingelheim Ltd on the distribution of the GRASP-DM for over 10 years, enabling over 3,500 GP practices to identify opportunities to improve the management and care of patients with diabetes.

GRASP-DM requires use of the CHART software tool (MS Excel workbook) to process the output of GP system searches. The CHART tool and system searches can be downloaded from the GRASP-DM online resource area.

[Updated January 2024]

If you wish to access the GRASP-DM online resource area, please complete the following online form:

GRASP access request form

The maintenance and distribution of GRASP-DM is funded by Boehringer Ingelheim Ltd. Boehringer Ingelheim has undertaken a medico legal review, but PRIMIS has retained editorial control and intellectual property rights for the tools.

PRIMIS does not share data with the pharmaceutical industry. With prior agreement and only when specified within a joint working agreement, there may be pre-determined circumstances where aggregated, summative data may be submitted to a pharmaceutical company. The purpose is to assess the success of the joint working project. Please note that this would never involve the reporting of patient or practice level data and would always be supported by a Data Sharing Agreement with the Data Controller (individual GP practice).

GRASP-DM is funded by Boehringer Ingelheim Ltd. Boehringer Ingelheim has undertaken a medico legal review, but PRIMIS has retained editorial control and intellectual property rights for the tools.

GRASP-HF is designed to assist GP practices to identify patients with heart failure. Over one million people in the UK have heart failure, with 200,000 new diagnoses every year. Estimates suggest there are a further 385,000 people with heart failure who are currently undetected, undiagnosed and, consequently, missing out on life-preserving treatments. These numbers are on the rise due to several factors including the anticipated exponential growth in (our ageing) population.

Using simple GP system searches alone, the tool helps with case finding activity, identifying patients with heart failure who have a missing diagnosis code. The output has been carefully designed so that patients are prioritised in accordance with their likelihood of having heart failure.

GRASP-HF can also assist in ensuring that those with confirmed heart failure are additionally coded according to accepted classification. Knowing these classifications are important precursors to defining the appropriate evidence-based treatment.

[Updated January 2024]

Use the form below to request access to the GRASP-HF searches for EMIS Web and TPP SystmOne.

GRASP access request form

PRIMIS has a long history in designing and making available quality improvement tools, such as the GRASP-HF tool.  We are delighted to be part of the British Society for Heart Failure (BSH) Strategic Partnership for the 25in25 Initiative, along with the NHS Benchmarking Network and Strategic Intelligence Alliance in Healthcare. The aim is to achieve the BSH led ambition to reduce deaths due to heart failure by 25% in the next 25 years.

"We have run the searches - 446 in group 1, 3 in group 2 and 11 in group 3. We certainly find it helpful and we are looking at how to create alerts in the system so that we can address this retrospectively as well as having a proactive system to flag them up as we go along."

Dr Krishna Kasaraneni, Sheffield

The effects of osteoporosis and resulting fragility fractures can have a profound impact on patients and their quality of life. Fragility fractures can cause substantial pain and severe disability.

Optimising medication is critical to preventing fragility fractures. Treatment is exceptionally effective at improving bone density – when taken correctly it can reduce the risk of fracture by more than 50%. However, evidence shows that medication adherence can be poor with around half of all patients discontinuing their medication within the first year.

Patients with osteoporosis are usually monitored by their GP within primary care, and as such providing an easy and effective way to regularly monitor the adherence to treatment is crucial to improving patient outcomes and preventing fragility fractures.

Working collaboratively with the University of Oxford and HIN Oxford and Thames Valley (formerly Oxford AHSN) on their Bone Health programme of work, PRIMIS has developed GRASP-Osteoporosis Rx, a reporting tool for GP practices that identifies patients who might benefit from a medication review of their anti-osteoporosis medication. Clinical expertise in osteoporosis and anti-osteoporosis medication provided by Professor Kassim Javaid (University of Oxford) combined with the health informatics expertise of PRIMIS has enabled GP practices in the Oxford area to detect patients that are not currently adherent to their anti-osteoporosis medication. PRIMIS training in quality improvement techniques, similar to those used for the PINCER prescribing safety intervention, supported a proactive approach to change management for the treatment of patients with osteoporosis.

The Bone Health programme of work has resulted in:

• increases in anti-osteoporosis medication prescribing and adherence, which has the potential to reduce the number of fractures.
• reduced variability of anti-osteoporosis medication prescribing between GP practices.
• better coding of fractures (QOF fracture coding increased by 20.8%).

PRIMIS has been able to contribute to cutting edge research being led by the NIHR Manchester Biomedical Research Centre and University of Manchester aimed at increasing adult hearing aid use. 

The clusters randomised controlled trial ‘Follow-up and structured monitoring for adults offered an NHS hearing aid for the first time (FAMOUS): has been a major collaboration between the University of Manchester, University of Nottingham and University College London Hospital. The key aim of the research is to understand and resolve the thousands of instances of low-use of hearing aids in adults with hearing loss. 

PRIMIS was able to provide tooling that identified candidates from participating practice populations and then measured numbers of patients referred to/seen by audiology, the number of hearing aids fitted and the number of first time fittings within the last year in order to facilitate the research project. 

External links

Read more

PRIMIS is delighted to support the Leicester Diabetes Centre on the MED-HELP study. The objective of the study is to explore whether healthcare training and patient reminder text messages can significantly reduce low-density lipoprotein-cholesterol (LDL-C) levels in patients with or at risk of CVD who are displaying signs of statin non-adherence. 

PRIMIS has developed complex tooling to identify eligible patients, monitor when text messages have been sent and report on medication adherence. The PRIMIS statin adherence tool calculates the number of days covered from the date of the first issue to the date that the tool is run. Dose instructions can be updated within the tool and adherence recalculated, as required. 

To minimise the impact on participating GP practices and to ensure that data is flowing through to the research team at agreed milestones, the PRIMIS remote dial in service is being utilised for this study. 

It is hoped that this research will potentially improve statin adherence and optimise statin prescription habits in participating practices. This will result in a reduction in cholesterol in at-risk patients, and as such reduce the risk for future cardiovascular events. 

Please email us if you would like further information.

Further reading

NIHR Complex intervention comprising text messaging and healthcare professional training

There are approximately 5,000 adults living with diagnosed motor neurone disease (MND) in the UK at any one time. It is estimated that an average practice can expect to have just one new diagnosis every 18 months. The path to diagnosis is long for patients, ranging between 9 to 27 months from reporting their first symptom to obtaining a diagnosis.

The MND Association and the Royal College of General Practitioners (RCGP) collaborated to produce a “Red Flag” tool for MND. This tool was designed to prompt GPs to look for additional symptoms and improve timely referrals to neurology, therefore speeding up the time to accurate diagnosis.

A study revealed that, given the rarity of MND, awareness of the Red Flag tool was not high and that the integration of the tool into existing systems was felt to be crucial.

Working with the MND Association, the University of Oxford and the University of Sheffield, PRIMIS has been commissioned to develop a GP clinical system computerised model of the Red Flag tool. This MND Alert triggers in a GP consultation when a pattern of Red Flag symptoms or signs are present in the patient record.

Following on from this, PRIMIS is delighted to be collaborating with the University of Sheffield, Primary Care Sheffield (PCS) and the MND Association in a study to further validate the computability of the Red Flag tool and the performance of the MND Alert.

This study is funded by LifeArc’s primer fund which aims develop to solutions to accelerate MND diagnosis and will be involve GP practices in South Yorkshire ICB.

PRMIS work on the project is due to conclude in May 2025.

[Updated April 2024]

Further reading

MND Association

Mei XW, Burchardt J, Ranger TA, et al Identifying key signs of motor neurone disease in primary care: a nested case–control study using the QResearch database BMJ Open 2022;12:e058383. doi: 10.1136/bmjopen-2021-058383

Baxter, S., McDermott, C.J. Decision-making and referral processes for patients with motor neurone disease: a qualitative study of GP experiences and evaluation of a new decision-support tool BMC Health Serv Res 17, 339 (2017). https://doi.org/10.1186/s12913-017-2286-0

PRIMIS is delighted to collaborate with researchers from the University of Nottingham to build the MODUS risk calculator within live GP clinical information systems. The calculator is designed to identify patients at higher risk of immune suppressing drug toxicity. We believe the work will result in a digital solution that can easily be reproduced across GP practices with the potential to reduce the number of blood tests being routinely performed in primary care.

The project is led by Prof. Abhishek (Consultant Rheumatologist, Nottingham University Hospital Trust) and the academic team that developed and validated the risk calculator in CPRD (Clinical Practice Research Datalink). The risk-stratified approach developed by the researchers was found to be acceptable by patients and health care professionals and value for money for the NHS.

Using our extensive experience in translating risk calculators into real world NHS IT systems and supporting the scale and spread of innovation in primary care, PRIMIS is working alongside the academic team to reproduce the risk calculator within live GP clinical information systems.

The work is funded by the University of Nottingham’s MRC Impact Acceleration Account (MRC IAA) Award. The MRC IAA is key part of the MRC’s translational research strategy that provides funding to research organisations to support impact activities and accelerate the transition from research to everyday clinical practice.

PRIMIS’ work on the project commenced in January 2024 and is due to conclude in December 2024.

Please email us if you would like further information.

Further reading

Nakafero G, Grainge M J, Williams H C, Card T, Taal M W, Aithal G P et al. Risk stratified monitoring for methotrexate toxicity in immune mediated inflammatory diseases: prognostic model development and validation using primary care data from the UK BMJ 2023; 381 :e074678 doi:10.1136/bmj-2022-074678

University of Nottingham press releases: New study reveals way to predict side-effect risk from common immune suppressant medication

National Vaccine Uptake Monitoring

PRIMIS is proud to have worked closely with colleagues at the UKHSA since 2015 to support their vaccine uptake monitoring for a variety of immunisation programmes including:

• seasonal influenza  (see below for details)
• childhood immunisations (MMR, DTaP and Hexavalent, Hepatitis B, Meningitis ACWY)
• shingles
• rotavirus
• human papillomavirus (HPV)
• pertussis for pregnant women
• pneumococcal (PPV and PCV)
• COVID-19 (see below for details)

The PRIMIS team also works closely with the GP system suppliers on their implementation of the data specifications and undertake a number of data validation projects with a sample of practices in order to provide a report on the validity of the related ImmForm uptake data collections by GP system suppliers. 

In addition, PRIMIS frequently provides ongoing advice to UKHSA to provide important contextual information about primary care, clinical coding and data recording that may impact their work including the SNOMED Bridging Studies project (see below for more information).  

Influenza Vaccination Monitoring Specification 2021/22

PRIMIS has been commissioned by Public Health England (PHE) to develop and maintain the national data specification that will assist in the identification of priority patients for the seasonal influenza vaccination programme and will additionally allow all GP clinical system suppliers to provide regular activity reports regarding vaccine uptake to PHE.

This data specification comprises all the relevant SNOMED clinical terms (over 17,000 codes) and the inherent logical business rules that help to identify eligible patients and assign them to the relevant recall groups. If you would like to request a copy of the PRIMIS seasonal influenza specification, please click the following link (below) and complete the request form. We aim to process your request within a maximum of 3 working days. It should be noted that the registration process enables us to alert you to any updates to the specification.

Seasonal influenza SNOMED specification request form

Please note that the specification is a technical document and its interpretation requires a high degree of knowledge and experience of SNOMED clinical terms, logical business rules and electronic health records in general practice. It has been designed for use by NHS colleagues involved in the management of data/data flows for the seasonal influenza vaccination programme. We reserve the right to approve access to the specification on this basis only. 

Additional note: use of the Specification shall be limited to research purposes where prior approval has been confirmed by PRIMIS via email. If you are a Researcher or represent a research organisation requiring access to the Specification please email PRIMIS.

Patients seeking advice on eligibility for the seasonal influenza vaccination

Influenza Specification Versions

National Covid-19 Vaccination Uptake Reporting Specification

PRIMIS has been commissioned by UKHSA to develop and maintain the national data specification that will assist in the identification of priority patients for the Covid-19 vaccination programme and will additionally allow all GP clinical system suppliers to provide regular activity reports regarding vaccine uptake to UKHSA and Government.  

This data specification comprises all the relevant SNOMED clinical terms (over 17,000 codes) and the inherent logical business rules that help to identify eligible patients and assign them to the relevant recall groups. An equivalent specification has also been produced in legacy terminology (Read Version 2) for the devolved nations within the UK.

Please note that the specification is a technical document and its interpretation requires a high degree of knowledge and experience of SNOMED clinical terms, logical business rules and electronic health records in general practice. It has been designed for use by NHS colleagues involved in the management of data/data flows for the Covid-19 vaccination programme and we reserve the right to approve access to the specification on this basis only. 

If you would like to request a copy of the PRIMIS Covid-19 specification, please click the following link and complete the request form. We aim to process your request within a maximum of 3 working days. It should be noted that the registration process enables us to alert you to any updates to the specification in what is an evolving situation.

Request form

Each GP clinical system supplier in England has developed system searches for their respective practices based upon the PRIMIS specification for patient recall purposes and to generate regular vaccine uptake data submissions for ImmForm.

If you are a patient seeking advice on your eligibility for the Covid-19 vaccination, please visit https://www.nhs.uk/conditions/coronavirus-covid-19/coronavirus-vaccination/coronavirus-vaccine/ Patients who are eligible for vaccination should wait to be contacted by NHS services regarding booking. The NHS will let you know when it is your turn to have the vaccine. It's important not to contact the NHS for a vaccination before then.

It should be noted that PRIMIS has not been involved in the development of the Clinically Extremely Vulnerable (CEV) or Shielded Patient List (SPL) coding lists. NHS Digital has overseen the design and development of these. Please refer to the bottom of this page for further information and related resources from NHS Digital.

If you have any enquiries regarding PRIMIS’ work on any national immunisation programme, please email us.

PHE SNOMED CT Bridging Studies

The aim of the SNOMED CT Bridging Study is to monitor and evaluate the implementation of SNOMED CT on PHE’s national immunisation programme. Over a four-year period, data is being collected from a group of approximately 40 practices on a quarterly basis.

The study will enable PRIMIS to inform PHE, the GP system suppliers and participating practices of any coding anomalies and inconsistencies as SNOMED CT is implemented, as well as correct, where possible, coding problems that threaten the integrity of the data and thereby the reporting requirements of the national immunisation programme.

The benefits case is:

1. to identify and report (in real time) any coding anomalies and inconsistencies that may impact on the reporting requirements of PHE’s national immunisation programme
2. to identify and report (in real time) any coding anomalies and inconsistencies that may impact on the integrity of general practice clinical records as a consequence of the transition to SNOMED CT, and, where feasible, identify and suggest remedies to the participating practices, GP system suppliers and NHS Digital
3. the provision of an assurance mechanism for practices and the communities that they function within that the conversion to SNOMED CT has not interfered with the integrity of their patient records (within the scope of the national immunisation programme)

PRIMIS completed and published the outcome of the SNOMED CT Bridging Studies project in 2021.

A reference set (refset) is a data structure defined within SNOMED CT to represent a group of SNOMED CT terms that share specified characteristics. They are basically subsets of the full SNOMED CT dataset.

Refsets require ongoing maintenance. Future releases of refsets are subject to iterative refinement both as a result of end-user feedback and careful consideration of each SNOMED CT release in relation to the original specification. Refsets may need to change in both size and range if underpinning policy is revised or underlying SNOMED CT content changes.

Unusually for PRIMIS, we are not involved in the management or maintenance of the Primary Care Domain refsets, rather we are involved in datasets more likely to be used outside of primary care, such as those used in secondary care or community care settings (eg. Summary Care Record (SCR) or Emergency Care Data Set (ECDS) via close collaboration with respective refset owners).

Please contact enquiries@primis.nottingham.ac.uk if you would like further information.

PRIMIS is supporting researchers at the University of Oxford to undertake a large randomised controlled trial in primary care to establish whether deprescribing common drugs that lower blood pressure is safe or effective in older people in the longer term (a year or more). This is a follow-on study to the original OPTIMISE trial and is looking to enrol a much larger study cohort and follow participants for longer.

As a first step PRIMIS has developed an analytical tool to process raw data from both EMIS Web and TPP SystmOne GP IT systems to identify patients potentially eligible for recruitment to the trial. The analytical tool, which is being deployed to study GP practices, applies a set of algorithms developed by the research team to easily and accurately identify patients fulfilling the trial inclusion criteria. 

In addition to supporting recruitment to the trial PRIMIS is also providing searches for the collection of outcomes data for the duration of the trial.

External links

OPTIMISE2 on the University of Oxford website (includes links to papers)

Background

PINCER is a pharmacist-led IT based intervention to reduce medication errors in primary care. The intervention involves searching GP clinical systems using computerised prescribing safety indicators to identify patients at risk from their prescriptions, and then acting to correct the problems with pharmacist support. PINCER was developed and tested by researchers at the Universities of Nottingham, Manchester and Edinburgh. 

Findings from the PINCER Trial were published in the Lancet (see publications link below), and demonstrated that PINCER is an effective method for reducing medication error in primary care. 

What happened next?

In 2017, PRIMIS was funded by the Health Foundation to work with Spring Impact to design a replication model for the national scale and spread of PINCER using a social franchising approach. As a result of this work, in 2018 PINCER was selected by the AHSN Network for national adoption, rolling out PINCER to GP practices across the 15 AHSNs in England.

As part of the national rollout, PRIMIS (supported by the AHSN Network):

• created the PINCER specification, business rules and clinical system searches for 13 evidence-based prescribing safety indicators
• developed a national comparative analysis service (CHART Online) which gave an accurate picture of the scale of medication error in primary care and provided the opportunity to measure impact
• developed and delivered a comprehensive training programme enabling pharmacists and pharmacy technicians to deliver the intervention 
• worked with IT system providers to embed the national PINCER indicators in their software 
• provided a technical helpdesk to support pharmacists and practices 

Key impacts

• PINCER rolled out to over 2,800 (41%) GP practices in England.
• Over 2,350 health care professionals (including 1,785 primary care pharmacists) were trained • over 27 million patient records searched.
• 220,981 patients identified as being at risk in at least one indicator at baseline (equivalent to a rate of 8.2 per 1,000 patients).
• Analysis of data from 1,677 practices showed reductions in numbers of patients at risk of medication error for a range of indicators, particularly for indicators associated with gastrointestinal bleeding, a common cause of medication-related hospital admissions (18,935 fewer patients at risk: 32.7% reduction).
• Findings from the national rollout showed comparable reductions in medication errors to the original research study, demonstrating the successful replication of the intervention at scale. 
• PINCER’s ability to reduce medication-related hospital admissions and patient harm is currently being evaluated as part of a large NIHR Programme Grant for Applied Research (PRoTeCT), led by the Universities of Nottingham and Manchester.

The current status of PINCER

Following the successful conclusion of the national roll out, localities that have opted to continue with the implementation of PINCER have been directed to a new online PINCER Resource Area, which includes the new updated SNOMED CT PINCER searches.

Primary care organisations (for example a PCN or an ICS) wishing to implement PINCER within their locality can register their interest by completing the online 'Register your interest' form below.

The PINCER indicators continue to have impact via their inclusion in clinical decision support tools and national policy drivers. If you are interested in licensing the National PINCER Data Specification please contact PRIMIS. 

Links

Register your interest in PINCER 

PINCER publications and documentation

The PRIMIS SPACE tool was delivered in conjunction with Trudell Medical UK Ltd. and was a targeted initiative designed to improve the management of respiratory conditions in primary care, particularly for patients using inhalers who might benefit from a spacer device. The programme focused on optimising inhaler prescribing, usage and patient outcomes through high quality data management and clinical support tools.

The PRIMIS SPACE tool enabled GP practices to:

• improve data quality: ensuring accurate and comprehensive recording of inhaler prescriptions and usage
• enhance clinical outcomes: suppoprting healthcare providers in delivering evidence-based care for patients with respiratory conditions
• promote rational prescribing: encouraging appropriate inhaler prescribing practices to maximise therapeutic benefits and minimise waste
• support patient adherence: helping patients to use their inhalers correctly and consistently to improve condition management
• facilitate continuous improvement: providing tools for ongoing evaluation and improvement of inhaler management techniques

The PRIMIS SPACE programme was welcomed by PCN pharmacists and practice nurses. The programme came to a close in May 2024.

Please email PRIMIS for further information.

SPACE Quick Guide