The Exeter system is a database of all patients registered with an NHS GP in England and Wales (see Figure 1, below). It is used by all health authorities in the two countries and is one of the largest population databases in operation in the UK.
The core tasks that it performs (see Figure 2, below) include:
- Patient registration
- Prescription certification
- Breast screening call/recall
- Cervical screening call/recall
- NHS organ donor register
- GMS quarterly payments.
|Figure 1: Home page of the NHSIA Exeter system website 1|
Figure 2: Extract from the NHSIA Exeter system website showing products and services 2
The Exeter system manages more than 60 million patient records, which include the name, address, date of birth and registered GP for each patient. It is linked electronically to the National Health Service Central Register in Southport.
The database is used to calculate capitation payments to GPs and to manage the national breast and cervical screening call/recall programmes.
It holds details of when and with which GP a patient registers, and thereby controls the production of the patientÍs medical card (FP4).
It also maintains a list of patients who have been deducted from GPsÍ lists and will facilitate the bulk transfer of records from one GP to another, e.g. when a GP retires.
Attempts are being made to ensure that all temporary residents are registered on GP clinical systems and that claims for this service are made electronically. The Exeter system enables this payment and also allows these patients to be cross-checked against a main register.
The registration system allows demographic analysis of patient data and permits specific planning issues to be addressed: for example, a primary care organisation could map graphically the population it serves.
The system enables the production of prescription exemption certificates for maternity and chronic sickness.
Breast cancer is the most common cancer in women, affecting between 1 in 12 and 1 in 14 women. In the UK there are approximately 24000 new cases of breast cancer and 13000 recorded deaths from the disease each year.
The national breast screening programme started in 1987. Its main aim is the early detection of breast cancer and by 1997 it had detected more than 40000 new cases of breast cancer.3
The Exeter system provides the call/ recall service. It identifies women deemed to be at highest risk of breast cancer, i.e. between the ages of 50 and 65 years, and invites them in for screening every 3 years.
GPs are involved by reviewing the call list and identifying any patients who are unsuitable, e.g. those who have been deducted or are undergoing treatment. No clinical data are held on the patient. The call / recall information is transferred electronically to the new health authority in the event of a woman moving from one GP or health authority to another.
Complex statistics can be generated from these data by looking at various parameters, such as percentage uptake of screening, total population screened, and workload implications for the future.
Cervical screening is aimed at preventing cervical cancer. The workload implications of cervical screening for the health service are enormous. Published data from the National Audit Office show that, in 1996/7, 3.5 million women in the UK were offered cervical screening using computer-based call/recall systems.4
The Exeter system invites women for screening on a 3 - or 5-yearly cycle depending on local preferences.
A list is sent to the GP for review before the production of pre-defined letters of invitation. Unlike the results of breast screening, cervical smear results are recorded; these then automatically generate an appropriate recall or remove the patient from recall if she is over 65 years of age.
GMS quarterly payments
The current system of payment to GPs and practices via GMS is both complex and poorly understood by many, especially newly formed primary care organisations. Under the proposed new GP contract, details of which will be announced this month, a practice-based contract will replace GMS, effectively replacing the Red Book.
The GMS quarterly payments system maintains administrative information on practices and individual GPs, registrars, assistants and retainees, including a list of patients registered with each GP.
The Exeter system stores the banking details of each practice and is able to calculate the superannuation payments made on behalf of GPs and their staff. Capitation, fees, allowances and benefit payments can be calculated through a series of regular adjustments. Payments have traditionally been made quarterly, but with the introduction of electronic links for items of service, payments have largely moved to monthly.
Payments for services such as cervical cytology, vaccination and immunisation, contraceptive services, child health surveillance, dispensing and items of service are all calculated using the Exeter system. When local schemes for additional services have been agreed, payment to the practice has to be made via the Exeter system.
NHS organ donor register
When patients register with a practice, they complete a GMS1 form and, as part of this, state whether they wish to be placed on the UK organ donor register. This information is recorded on the Exeter system and transmitted electronically to the UK Transplant Support Services Authority.
The Exeter system contains an enormous amount of information that has a legitimate use across a range of organisations and practitioners in the health service.
ïOpen ExeterÍ5 gives health authorities the power to grant access to this information to authorised organisations, e.g. primary and secondary care trusts, GP practices, laboratories and pharmacists, with ultimate control resting with the health authority. It can provide very useful information for these organisations. However, potential misuse of this information does need to be closely monitored.
The Exeter computer system provides a comprehensive and powerful database of all patients registered with an NHS GP in the UK. However, it remains to be determined how it will integrate with electronic health records and electronic patient records. The system is of great importance not only to GPsÍ clinical work but also in ensuring GPsÍ income.
- NHSBSP. Breast Screening Review, 1997.
- Dr Nigel Watson is vice-chairman of the IM&T subcommittee of the BMA's GPC and a GP in Hampshire