GP Contract Services: Data Caveats

For all GP Contract Services that involve automated data collections, the data for each GP practice will only include patients who are registered at that practice at the time that the data are collected.

If a patient received the care outlined in a GP Contract Service at one GP practice but then subsequently moved to another GP practice before the end of the reporting period (and consequently before the time that the data are collected) then the patient would be included in the data for the second GP practice.

Patients may be included in more than one management information count within the core contract components, ESs and vaccination and immunisation programmes that involve automated data collections. Many of these GP Contract Services involve payment counts and management information counts.

Payment counts are often viewed as success counts, whereby patients are included in these counts if they have received the care that is outlined in the GP Contract Service (e.g. if a patient has received the required vaccination). In contrast, management information counts are often viewed as exception counts and are used to help demonstrate why patients have not received the care that is outlined in the GP Contract Service.

There are a number of management information counts that are commonly used across GP Contract Services; these include counts of patients who:

• Were contraindicated to the care outlined in the GP Contract Service.
• Declined the care outlined in the GP Contract Service.
• Did not consent to the care outlined in the GP Contract Service.
• Received the care outlined in the GP Contract Service by another healthcare provider.
• Did not attend their appointment for the care outlined in the GP Contract Service.
• Had no recorded reason for not receiving the care outlined in the GP Contract Service.

For all GP Contract Services, success trumps exceptions. This means that patients who are included in payment counts (i.e. patients who have received the care outlined in the GP Contract Service) are not included in the corresponding management information counts that cover the reasons why the patients have not received the specified care. For example, a patient was recorded as receiving the required vaccination for a GP Contract Service but was also recorded as declining this vaccination. This patient would only be included in the payment count for this service; they would not be included in the declined management information count as once a patient has been included in a success count they are not included in an exception count.

If a patient did not receive the care outlined in a GP Contract Service but had multiple reasons for not receiving this care then they could be included in each of the appropriate management information counts. For example, a patient was not recorded as receiving the required vaccination for a GP Contract Service but was recorded as being contraindicated to this vaccination, declining this vaccination and not consenting to this vaccination. Unlike in the success trumps exception example, this patient could, in some circumstances, be included in all three of the associated management information counts regardless of the order in which the data were recorded. Once a patient is included in one exception management information count they still have the opportunity to be included in other exception management information counts.

There may be instances of where the Business Rules for a given GP Contract Service do not exactly mirror the guidance for that given service. This is often due to the high level of complexity of certain services, which is sometimes difficult to specify in the form of Business Rules.

NHS England and NHS Employers are sometimes forced to make pragmatic decisions when specifying the counts/indicators that make up the GP Contract Services. In all instances, however, Business Rules support the spirit of these counts/indicators and also ensure fair and consistent payment and management information reporting for GP practices.

Learn more about the business rules for the GP Contract Services.

Some GP Contract Services include management information counts that focus specifically on activity that has taken place outside of GP practices; this may involve patients receiving the specified care/medication by another healthcare provider. Not all GP Contract Services include these other healthcare provider counts and, for such services, the relevant activity may still have taken place outside of GP practices. This may result in lower than expected figures as the appropriate care/medication may not have been recorded in the patient record, or it may have been recorded but not collected by GPES. This is due to the Business Rules only specifying the necessary data that are due to be collected.

For automated data collections via GPES, there is a delay between the end of a given reporting period and the date that the data were collected; the length of this delay varied across the different GP Contract Services. During this delay, patients may have moved between different GP practices or GP practices may have merged or even closed. Such instances may have had a profound effect on GP practice patient list sizes.

Some GP Contract Services 2018-19 may have involved duplicate submissions of data. This is where data for the same reporting period of a given GP Contract Service were manually entered into the CQRS and also automatically collected via GPES. If a GP practice manually enters data into the CQRS for the same reporting period as an automated data collection via GPES, and the manually entered data are not financially approved, then the automated data collection overrides the manually entered data.

A number of the vaccination and immunisation programmes that form part of the GP Contract Services are also published as part of the NHS Immunisation Statistics for England. See the Childhood Vaccination Coverage Statistics publication for the full details of this data collection.

Please note that, from April 2026, the definition of moderate and severe frailty used for the indicators CCDCMI31 to CCDCMI39 has changed.

The Canadian Study of Health and Aging Clinical Frailty Scale (CFS) score component has been removed. As a result, patients are now identified as having moderate or severe frailty based solely on a recorded frailty diagnosis.

This change was introduced because it wasn’t clear from the previous definition whether the indicators should include all patients with moderate or severe frailty or only those diagnosed during the reporting year.

The revised definition is based on the following considerations:

• The presence of a frailty score does not necessarily indicate that a patient has been formally diagnosed with frailty, as frailty scores are intended to support, rather than replace, clinical judgement.
• The Canadian Study of Health and Aging Clinical Frailty Scale is not the only frailty assessment tool used by clinicians.
• Following an initial frailty diagnosis, a patient's frailty severity is likely to be reassessed periodically, resulting in additional frailty scores being recorded. However, a new diagnosis code is typically recorded only when the patient's frailty severity changes, for example from mild to moderate or from moderate to severe.
• Although there is no frailty resolve code, once a patient has been diagnosed with frailty its progression tends to move from less severe to more severe.

For indicators CCDCMI31 to CCDCMI37, including only patients diagnosed during the reporting year, together with patients identified through a CFS score, could result in the inclusion of patients who had been diagnosed in previous years but subsequently reassessed using the CFS.

It was therefore agreed that these indicators should include only patients diagnosed during the reporting year. Consequently, the CFS score component has been removed from the indicator definition.

As a result of this change, the indicator descriptions have been updated. Please refer to the Data Dictionary for the revised indicator descriptions.

Counts CCDCMI38 and CCDCMI39 have also had the CFS removed however these counts include all patients diagnosed with moderate/severe frailty from 1 April 2017

Please note that the descriptions in the Core contract business rules specification currently reflect the original wording for the indicators and therefore may not match the descriptions used within this publication which have been amended to be more informative.

The Human papillomavirus (HPV) vaccination programme automated GPES extract started in September 2023, therefore there will be no data prior to this month. 

The Indicators no longer in QOF ceased to be reported on in March 2024, therefore there will be no data after this month.