London Primary Care Procedure Requests (PCPR)

Primary Care Procedure Requests records investigations, tests, and procedures ordered in primary care. Primary Care Procedure Requests provide a crucial view of how investigations and diagnostics are initiated and this is essential for improving early detection, monitoring, safety, and equity in primary care. The data set includes: 1. Requested procedure or investigation, for example: - Blood tests (e.g., HbA1c, lipids, renal function) - Imaging (X ray, ultrasound, CT, MRI) - Diagnostic procedures (ECG, spirometry, ambulatory BP) - Screening tests (e.g., cervical cytology) - Referrals for community diagnostic services Recorded using SNOMED/dm+d codes. 2. Clinical details linked to the request - Reason for request (if coded) - Linked diagnosis or problem - Relevant observations (e.g., symptoms, vital signs) - Priority/urgency (routine, urgent, 2WW where applicable) 3. Metadata including Request date/time, Ordering clinician, Practice and organisation identifiers, Status (requested, completed, cancelled), Whether the request was generated via a template or protocol. 4. Workflow and follow up indicators such as Expected review date, Flags for monitoring (e.g., repeat blood tests for chronic disease), Links to results when returned. What Procedure Requests excludes: - They do not confirm that the test/procedure was completed (results are separate). - They do not include hospital initiated tests unless entered manually. - They do not include medication orders or prescriptions. - They do not include administrative tasks unless coded as a request. Researchers would find the below most important or relevant when using Primary Care Procedure Requests: 1. Diagnostic pathways and early detection Procedure requests reveal: - How quickly tests are ordered after symptoms appear - Delays in diagnostic pathways - Variation in investigation patterns between clinicians or practices This is crucial for cancer, cardiovascular, and metabolic disease research. 2. Monitoring of long term conditions Requests show: - Frequency of monitoring (e.g., HbA1c for diabetes, U&E for ACE inhibitors) - Missed or delayed monitoring - Variation in adherence to clinical guidelines 3. Safety and quality of care Researchers can identify: - High risk patients missing essential tests - Incomplete follow up after abnormal results - Over or under use of investigations 4. Inequalities in access to diagnostics Linked demographics allow analysis of: - Variation in test ordering by ethnicity, age, deprivation - Differences in access to imaging or specialist diagnostics - Disparities in chronic disease monitoring 5. Workforce and workflow optimisation Procedure requests help researchers understand: - Which clinicians order which tests - How multidisciplinary teams influence diagnostic activity - Bottlenecks in test ordering and follow up 6. Linking across datasets Procedure requests can be linked to Observations (results), Appointments (encounter context), Medication Orders (treatment decisions), Hospital datasets (SUS). This enables full pathway research from symptom → request → result → treatment → outcome. Using Primary Care Procedure Requests, researchers can: - Improve early diagnosis by analysing delays and variation in test ordering - Strengthen chronic disease management through monitoring patterns - Reduce inequalities by identifying gaps in access to diagnostics - Enhance patient safety by detecting missed follow ups - Support personalised care with detailed diagnostic histories