Table 1 Issue type definitions

Physical (P)

Any discussion of or reference to physical symptom, or where the problem is discussed as a physical symptom, disability, or loss of function. (Recording of physical investigations e.g. weight, BP are recorded under ‘Medicalised health prevention/Maintenance’)

Emotional/ psychological (EP)

When the consultation directly addresses psychological or emotional dimensions or consequences of the problem. It is anticipated this will mostly relate to voicing or exploring worries, but is not confined to this. This box does not apply if emotional dimensions are just inferred - they have to be addressed.

Social (S)

Discussion of the consequences of the problem on the patient’s normal social roles or activities of daily living.

Administrative (A)

Dealing with requests for letters and sick notes; making referrals for further consultations; making repeat appointments. Information being sent outwards from the GP for decision making elsewhere.

Medication related (M)

Activities relating to any existing medication; any prescription or administration of new medication. Include the direct administration of medication. Includes reviews and re-prescriptions of contraceptive pill.

Order/ refer for tests (OT)

Issues that raise or resolve the need for tests or investigations to be done beyond the current consultation.

Discuss test results/ treatment (DT)

Issues that follow up test results, investigations, or treatments (other than medication) that were performed prior to the consultation. Related to information coming inwards from elsewhere, to be acted on by the GP.

Behavioural health prevention/ maintenance (BM)

As above, but information given or sought relating to patient actioned prevention, self-management or risk management issues behaviours. Includes discussions of giving up smoking, losing weight, alcohol consumption improving diet, cardiovascular risk assessment. NB if any of these discussions identify a problem, which then leads to a substantial discussion about how to manage this problem (e.g. heavy drinking, obesity), then start a new Problem rather than including this as an issue type.

Medicalised health prevention/ maintenance ( MM)

Information given or sought relating to GP actioned patient prevention, self-management or risk management issues. Particularly discussions or investigations which are not relating to a current symptomatic health problem, but are intended to prevent problems in future. Includes taking BP, weighing, discussion of vaccinations, cervical smears and flu jabs. NB if any of these discussions identify a problem, which then leads to a substantial discussion about how to manage this problem (e.g. heavy drinking, obesity), then start a new Problem rather than including this as an issue type.

3 ^rd party issues ( 3P)

Discussion of problems relating to someone other than the patient. This does not include accounts of others’ comments or views on any of the patient’s problems that are discussed.