SPIRE
The SPIRE website contains information for both the general public and healthcare professionals.
What is SPIRE?
SPIRE Reports
SPIRE Variables
Events
Encounters
SPIRE Reporting and Extraction Processes
What is SPIRE?
SPIRE is the Scottish Primary Care Information Resource. It is a service which allows information to be requested from GP practice records and collected centrally to produce statistics for Scotland as a whole. SPIRE also provides a platform for practices to see information about their patients, though report on topics such as practice activity, vaccination uptake and multimorbidity. More information about SPIRE and the current status of its deployment are available on the SPIRE website.
SPIRE uses a different model for data collection than is used for other ISD datasets. There is not a central dataset containing all of the GP practice information for Scotland. Instead, individual requests for small amounts of information relating to specific purposes will be sent to practices. All such information requests need to be approved by the SPIRE Strategy and Oversight Group prior to being sent out to GP practices. The practices can then choose whether or not they want to opt-in to the request. Patients can also ask their GP for their data to be excluded from any patient identifiable extracts. Information is not stored for longer than necessary, and any information is safely destroyed after use.
If you wish to request data through SPIRE please complete the data request form either on the SPIRE website or the offline version 
.
SPIRE Reports
The following is a list of SPIRE reports available to GP Practices. Note, these reports run locally in the practice and no data are extracted. For further information about any of these reports please contact the Primary Care Team at nss.isdgeneralpractice@nhs.net.
Please note: SPIRE reports do not give professional advice; physicians and other healthcare professionals should exercise their own clinical judgement based on the information SPIRE reports provide. SPIRE queries and reports are currently based on Read code identification; where the Read code is absent, patients may not be identified in the SPIRE output.
Influenza Vaccination
Multimorbidity
Disease-modifying anti-rheumatic drugs (DMARDs)
Triple Whammy
Warfarin
Learning Disabilities
Autism
Shingles Vaccination
NSAIDs and antiplatelets
Patient Encounters (Vision only)
eFrailty Index (eFI)
Very Long Acting Reversible Methods of Contraception (VLARC)
Minor Surgery
Smoking prevalence
Hep C and antivirals
Diabetes and HbA1c measurement
Apixaban and FBC
Enhanced Services
In development
Atrial Fibrillation
Chronic pain
Metformin
Respiratory search
In the UK, annual influenza immunisation is conducted to protect members of the population who are at greater risk of ‘influenza-associated morbidity and mortality’. The immunisation programme is provided locally by the Government as a Direct Enhanced Service (DES) and administered by GPs. Payment for the service is based on the number of eligible persons vaccinated by the practice during the specified qualifying period.
The purpose of this report is:
- To identify patients who are eligible for the flu vaccination DES payment
- To facilitate submissions to Practitioner Services Division (PSD) for payment of DES
- To identify patients who have received the vaccination but are ‘not eligible for claim’, so they can be evaluated and submitted for payment if appropriate
- To validate SPIRE output against GP clinical system searches
Patients within a practice who have two or more long term conditions (LTCs) may require a more coordinated approach to address their combination of healthcare needs. A multimorbidity report at practice level will inform the design of future reports at a cluster and/or Health & Social Care Partnership level.
The purpose of this report is to:
- Indicate those patients in a practice with multiple long term conditions (selection of LTCs and their clinical criteria approved by SCIMP)
- Encourage feedback to further develop the report output
Patient Safety reports
Disease-modifying anti-rheumatic drugs (DMARDs)
This report aims to identify patients prescribed Methotrexate and Azathioprine who have not had a Full Blood Count done in the past 16 weeks thus highlighting patients at risk for timely intervention.
This report aims to identify patients aged 65 years and over prescribed an oral non-steroidal anti-inflammatory drug (NSAID) and also prescribed a Diuretic and an Angiotensin Converting Enzyme (ACE) inhibitor or Angiotensin Receptor Blocker (ARB) (the ‘Triple Whammy’) thus highlighting patients with a high risk of adverse drug effects.
This report aims to identify patients prescribed medication which contains Warfarin without a record of INR having been measured in the past 16 weeks thus highlighting patients at risk for timely intervention.
This report aims to explore the potential of SPIRE to understand the co-morbidity profile of patients with learning disabilities. More specifically to
- Show the number of patients who are Read coded with a learning disability
- To provide helpful information about recommended coding
Autism
This report aims to explore the potential of SPIRE to understand the co-morbidity profile of patients with autism. More specifically to
- Show the number of patients who are Read coded with autism
- To provide helpful information about recommended coding
This report will enable monitoring of shingles vaccine uptake by GP practice, NHS board and Scotland.
The purpose of this report is to:
- To monitor the impact of the shingles vaccine on the incidence of shingles and long term neuropathic pain conditions
- To understand vaccine uptake by gender and ethnicity and also the impact of deprivation and rural versus urban setting
- To calculate vaccine effectiveness
- To enable public health interventions to encourage vaccine uptake to help protect the elderly population from shingles and associated long term neuropathic pain conditions.
- To enable GP practices to monitor the uptake of the shingles vaccine amongst their elderly population
This report aims to identify patients aged 65 years and over prescribed a non-steroidal anti-inflammatory drug (NSAID) and prescribed an antiplatelet medication without gastroprotection weeks thus highlighting patients at risk for timely intervention.
This report also provides an opportunity to validate SPIRE output against GP clinical system searches, Scottish Therapeutic Utility (STU) reports and data held within the Prescribing Information System (PIS).
This report aims to identify and stratify patients within a practice by a frailty index score which is calculated through a cumulative deficit approach. The purpose of this is to identify people living in the community who are frail before they have a crisis that requires an acute admission or other serious intervention by:
- Calculating an eFI score and stratify practice patients by this score
- Encouraging GPs and other healthcare professionals to use the eFI score to identify frailty and to target preventative community-based support that enables people to live well in the community and avoid hospital admissions
Patient Encounters (Vision only)
Patient encounters can be used as a proxy for practice workload.
The purpose of the report is to:
- Provide information which can be used to help GP practices to operate more effectively and efficiently, and target areas for improvement.
- Aid the monitoring of particular groups of patients.
It is not clear what the current quality of these data are in practices.
Very Long Acting Reversible Methods of Contraception (VLARC)
This report aims to identify number of females with a contraceptive device in place. More specifically to:
- Provide practices with numbers of female patients who have undergone a procedure for receiving a contraceptive coil, showing results from within the last month and any point before that
- Provide a search for the number who have had contraceptive Implants inserted/reinserted or removed, both at any point in time and within the last month
- Provide registers of female patients who have contraceptive coils or Implants still in place, for which the last entry was for a fitting and no subsequent removal
- Identify female patients whose implants have expired
Accurate registers will ensure that practices may claim correctly for VLARC procedures, and that patients are contacted for removal/change of their contraceptive device at the correct intervals.
This report aims to improve the monitoring and process for remuneration of minor surgery procedures.
The purpose is to:
- Understand the current recording of minor surgery procedures i.e. Read codes, criteria etc.
- Determine the absolute counts of relevant events associated with a minor surgery procedure for a previous full financial year and corroborate with SPIRE output.
- Agree an initial set of read codes, which identify patients receiving Minor Surgery, with practices and GP facilitators within an NHS Board
- Develop a SPIRE Local report that includes minor surgery patient and payment information, which can be exported and submitted to the NHS Board, or Practitioner Services Division (PSD) directly, for remuneration of minor surgery procedures conducted in practices.
A longer term objective is to agree criteria and read codes nationally for this Directed Enhanced Service (DES)
This report aims to identify (at the lowest possible level) what the smoking prevalence is within an NHS Board, particularly in the most deprived areas.
This report is to identify and monitor cases of Hep C. By identifying the cases the individuals can be contacted and offered antivirals to clear their infection. This is part of the HCV elimination strategy (by 2030).
Diabetes and HbA1c measurement
This report is to identify and monitor the number of patients diagnosed with type 1 and type 2 diabetes and to report their HBA1c measurement.
This report identifies patients prescribed the anticoagulant Apixaban and identifies those who have not had a FBC (Full Blood Count), U&E (urea and electrolytes – a measure of renal function) and weight readings taken annually as part of Apixaban monitoring.
The following is a list of reports in development. These reports will run locally and no data will be extracted. For further information about any of these reports please contact the Primary Care Team at nss.isdgeneralpractice@nhs.net.
This report aims to improve the monitoring of antibiotic prescribing in primary care. The purpose of the report is to:
- Give an indication of the volume of antibiotic prescribing in GP practices.
- Help quality improvement.
- Help GPs reduce unnecessary antibiotics use.
This report aims to identify patients with atrial fibrillation and who require anticoagulation.
The purpose of the report is to:
- Provide a simpler version of the GRASP-AF tool used in England (and which is chargeable for Scotland).
- To check that patients with relevant scores are coded with appropriate prescriptions.
This report aims to quantify the burden of chronic pain in primary care, feeding back to GPs, Practices and the NHS to inform provision, quality and safety of chronic pain management services.
The purpose of this report is:
- To provide a reporting tool to GP practices to enable them to identify patients with Chronic Pain without a Read code
- To allow GPs to create a Chronic Pain register - a list of all patients in the practice with Chronic Pain
- To enable GP practices to be better placed to evaluate the services currently provided
There are numerous Enhanced Service Report for a variety of NHS Boards. If you would like further information please contact the Primary Care team at nss.ISDGeneralPractice@nhs.net.
This report will aim to identify patients aged 18 and over prescribed medication which contains Metformin where the most recent eGFR is ≤30ml/min thus highlighting patients at risk for timely intervention.
High risk asthmatics are not always easy to identify basic searches and patients with the greatest need tend to be the ones who do not respond to routine review.
The purpose of this report is to:
Identify patients fully registered of all ages with a coded diagnosis of asthma (and no more recent code of asthma resolved) who:
- Have had one or more hospital admissions or A&E attendances with asthma in the previous year
OR
- Have ordered six or more ‘short acting beta agonist’ inhalers in the previous year OR
- Have ordered 6 or less steroid containing inhalers in the previous year
OR
- Have had two or more asthma exacerbations in the previous year (prescription for oral steroids)
AND
- Have not had an asthma review within the previous year
SPIRE Variables
With agreement the following dataset variables are available in SPIRE.
| Name | Definition or Description |
| PatientID | Primary Key and acts as a unique identifier for the patient in this database |
| ClinicalSystemID | Identity value of the patient within the EMIS PCS or Vision V3 database. |
| DateOfBirth* | Patient's Date of Birth |
| Gender | Is a letter representing the Gender (e.g. M or F) exactly as recorded in Emis or Vision |
| Surname* | Gives the name of the patient |
| Forenames* | Gives the name of the patient |
| Title | Gives the name of the patient |
| NHSNumber* | Holds the NHS Number of the patient |
| CHINumber* | Holds the CHI Number which acts as a unique identifier for the patient for all NSS projects |
| Address1* | Gives patient contact details |
| Address2* | Gives patient contact details |
| Address3* | Gives patient contact details |
| Address4* | Gives patient contact details |
| Address5* | Gives patient contact details |
| Postcode* | Postcode is useful for demographic analysis |
| HomeTelephone* | Gives patient contact details |
| WorkTelephone* | Gives patient contact details |
| MobileTelephone* | Gives patient contact details |
| RegistrationDate | Contains the date the patient registered at this practice |
| PatientTypeMSDiId | Contains a value from an enumeration describing the type of patient extracted from the Clinical System: Regular, Private, Temporary, Other Non-GMS. These are 1, 2, 4, 8 respectively. |
| PatientType | Contains the original value for the type of patient exactly as recorded in Emis or Vision |
| RegistrationStatusMSDiId | Contains a value from an enumeration describing the registration status of the patient: Registered, Died, Left, Other Deregistered are respectively by 1, 2, 4, 8 respectively. |
| RegistrationStatus | The original value for the registration status of a patient exactly as recorded in Emis or Vision. |
| DeregistrationDate | The date the patient deregistered from this practice |
| DeregistrationReason | Describes the reason for the deregistration |
| DateOfDeath | Contains the date the patient’s death was recorded. Note this is usually different to the Deregistration Date as the deregistration paperwork can take several weeks. |
| MaritalStatusId | Contains an ID for the Marital Status of the patient |
| RegisteredGP | Contain the GMP code(s) of the doctor(s) with which the patient is registered and usually sees, respectively. |
| UsualGP | Contain the GMP code(s) of the doctor(s) with which the patient is registered and usually sees, respectively. |
| PreviousSurname | Previous surname for the patient if there is one |
| CSUpdatedDate | Is the date the patient details were added/updated in Emis or Vision |
| SpireUpdatedDate | The date the event was extracted from the Clinical System into SPIRE Local (This is important for checking updated patient details) |
Events
The Clinical Event table contains details of each clinical event extracted from the Clinical System. A Clinical Event is any form of diagnosis, reading, measurement, prescription, medication or other clinical finding recorded in the patient’s medical history. Note that prescriptions are included alongside diagnoses in the same database table - this is not always the design of other patient database products.
EpisodeTypeMSDi is a shorthand representation of the episode type (F for First, N for New etc) whereas EpisodeType is the original EpisodeType as recorded in the Clinical System before interpretation.
| Name | Definition or Description |
| EventID | The Primary Key and acts as a unique identifier for the event in this database |
| PatientID | The Foreign Key referencing to the unique identifier of the patient that each event is recorded against. |
| EventDate | Is the date the event is recorded for. Note that this may be different to the date the event was recorded especially if filling in a patient’s history such as the dates they experienced a symptom. |
| ReadCode | Contains the V2 Read code of the clinical event. Note that both Vision and EMIS use V2 Read codes. If in future other Clinical Systems are introduced in Scotland, such as SystmOne which uses CTV3 codes, or others which may use SNOMED codes, a mapping will be provided. |
| ReadTermId | Contains the full V2 Read Code along with the TermID if a TermID has been used to give further detail. Read Code 13F8. is for “Hospital Patient”, the full ReadTermID 13F8.11 is for “Hospital Inpatient” |
| Value1 | Contains either the numeric value of a Reading event, or the quantity of drugs prescribed in a Prescription event |
| Value2 | Is used only for the Diastolic blood pressure where both Systolic and Diastolic blood pressures are recorded at the same time |
| EpisodeTypeMSDi | Contains one of the following values depending on the type of event: for prescriptions, A (acute), R (repeat) or I (issue of a repeat prescription); for non-prescriptions, F (first), N (new) or O (other). |
| EpisodeType | Contains the original Episode Type from the Clinical System before MSDi interpret it. The EpisodeTypeMSDi of 'N' for ‘New’ is rendered as 'EPI002' in Vision and '2' in Emis - the original value is provided for clarity. |
| HcpId | The coded identity of the health care professional who entered the event: either the GMP code if they have one, or the initials if not. |
| HcpType | The type of health care professional: GP, practice nurse, etc |
| DrugName | Only populated for Prescription events and provide additional information around the prescription |
| DrugDosage | Only populated for Prescription events and provide additional information around the prescription |
| DrugForm | Only populated for Prescription events and provide additional information around the prescription |
| Source | Only populated for Prescription events and provide additional information around the prescription |
| PrintDateTime | Only populated for Prescription events and provide additional information around the prescription |
| IssueMethod | Only populated for Prescription events and provide additional information around the prescription (EMIS only) |
| Strength | Only populated for Prescription events and provide additional information around the prescription |
| Bnf | Only populated for Prescription events and provide additional information around the prescription |
| Dmd | Only populated for Prescription events and provide additional information around the prescription |
| EncounterID | The unique identifier for the encounter associated with this event (And potentially other events) |
| ClinicalSystemID | The unique identifier for the event as used within Emis or Vision (This is important for checking updated/deleted events) |
| CSUpdatedDate | Date the event was added/updated in Emis or Vision |
| SpireUpdatedDate | Date the event was extracted from the Clinical System into SPIRE Local (This is important for checking updated events) |
Encounters
The Encounter table contains details of each interaction (such as appointments) between the patient and a health care professional.
All Patient Encounter data items stored in the Encounter Table of the SPIRE Local database are available for extract.
| Name | Definition or Description |
| EncounterID | Primary Key and acts as a unique identifier for the encounter in this database |
| PatientID | Foreign Key referencing to the unique identifier of the patient that each Encounter is recorded against |
| EncounterDate | Date of the encounter |
| HcpId | Coded identity of the health care professional recorded against the encounter: either the GMP code if they have one, or the initials if not |
| HcpType | Contains the type of health care professional: GP, practice nurse, etc |
| Session | Type of encounter, this description has several synonyms in Vision and Emis including ‘Encounter Type’ |
| Location | Description of the location of the encounter (EMIS only) |
| Duration | Duration of the Encounter |
| ClinicalSystemID | Unique identifier for the encounter as used within Emis or Vision (This is important for checking updated/deleted encounters) |
| CSUpdatedDate | The date the Encounter was added/updated in Emis or Vision |
| SpireUpdatedDate | Date the Encounter was extracted from the Clinical System into SPIRE Local (This is important for checking updated Encounters) |
SPIRE Reporting and Extraction Processes
Local reports and queries are sent to the practice via eLinks and are run within the GP practice only, no data are extracted, all information stays in the practice.
All requests for data extraction are scrutinised, agreed and prioritised by the SPIRE Strategy & Oversight Group. Four main questions will be considered for all requests for SPIRE data with regards to privacy risk assessment. They are:
1. Who is asking for request? E.g. NHS colleague, an academic or other?
2. Why are they asking? E.g. is it in public or primary care interest?
3. What are they asking for? E.g. are the data very sensitive, about vulnerable populations or potentially disclosive?
4. How are they intending to access, process and release data? E.g via a safe haven, academics undertaking analysis and/or a peer reviewed publication.
Further approvals are also required for research and/or linkage to other datasets.
Once agreed Extract requests are sent via eLinks for the practice to view. No data are extracted until the practice opts in. If the practice opts in data are securely transferred to a secure storage area in National Services Scotland for analysis and release subject to ISD’s disclosure and confidentiality protocols.
