It is quite difficult to reliably identify:
- NHS GP surgeries
- Accident & Emergency Departments
- Minor Injury Units
in UK OpenStreetMap data.
It would be useful to be able to identify these things for a) more clearly exposing the purpose of a site for general mapping or search purposes and b) producing travel time/accessibility analyses.
The UK has four seperate publicly-funded national health services, one for each of the four constituent countries (sometimes "nations" or "home countries") of the UK:
- NHS Wales
- NHS Scotland
- the NHS in England
- Health and Social Care Northern Ireland.
These are sometimes collectively referred to as "the NHS", although the NHS in England alone is also referred to as "the NHS" by itself and by others in England. (More confusingly still, the NHS in England use domains and social media account names that imply an all-UK status, such as NHS.UK and @NHSuk.)
All four systems deliver healthcare that is generally free-at-the-point of use for almost all residents of the UK, with the situation being more complicated for prescriptions in England and some other "primary" healthcare, such as dentistry.
The four systems are structured and operated in different ways, although the structures of Wales, Scotland and Northern Ireland are relatively similar in that they all have public organisations that are both responsible for the healthcare of the population of a region and deliver most secondary care healthcare services in that region (Welsh Health Boards, Scottish Health Boards, and Northern Irelands Health and Social Care trusts).
All four systems also maintain their own sets of reference data, although there is and has been some collation of data by the English NHS Digital's Organisation Data Service (ODS).
One of the major points-of-contact across the UK for people seeking healthcare are GPs ("general practitioners") working in "GP surgeries". It is through these that people often first obtain general non-emergency primary care, and it is through these they obtain referral to specialist and secondary care.
The English NHS Digital service manual content guide recommends the use of "GP surgery" and seems to emphasise its use specifically to refer to a single physical location, as opposed to "GP practice" which might be used of the legal entity that operates multiple surgeries.
However, different systems and organisations continue to use 'practice' and 'surgery' interchangeably.
GP surgeries providing NHS-funded care, across the four systems, are overwhelmingly operated by a mix of small and large private contractors, often a partnership owned by the GPs themselves. (This King's Fund article describes the situation in England in more detail.) There are relatively a small number of surgeries that are directly managed and operated by public NHS organisations.
The upshot of this is that operator:public isn't really true (and operator:government definitely isn't) for most surgeries.
However, despite the operator situation described above, it's still important to data users to be able to distinguish between GP surgeries that are being run as part of the NHS and those that are run for 'private patients' (i.e. patients' whose care is funded directly by self-pay or by private insurance).
There has been a proposal for insurance:health but a) isn't ideal and b) wasn't adopted.
I suggest using brand:NHS Wales and brand:wikidata=Q6954180 for NHS Wales-associated GP surgeries (and similar tags for surgeries elsewhere in the UK).
In Wales and England, GP surgeries will often (but not always) show their GP practice code. For Wales and England, this will be a six-character long alphanumeric looking something like W12345 or E98765. This number is also sometimes used in URLs and email addresses. These can be looked up using the ODS, for example W97060. There has been some attempt to promote ref:GB:nhs_ods in OSM in the last couple of years, although use is very low.
I note that the ODS has a role of 'GP PRACTICE' defined.
GP practice codes do not seem to be so prominently used in Scotland in the same way, but ISD Scotland do provide a reference list with a five-digit PracticeCode.
Very few GP surgeries in the UK are now run by single practitioners, wokring by themselves. As touched on above, surgeries will usually have several GP partners and many may also employ "salaried" GPs on top of this.
Furthermore GP surgeries often employ other healthcare professionals, not just GPs. Perhaps most obviously general practice nurses but also many others.
The above might have implications for use of the amenity=clinic vs. amenity=doctors tags.
I note this US and Germany-centric discussion from 2020 and this Norway-centric discussion from 2018.
Personally, in the UK, I think it makes sense to generally tag GP surgeries as amenity=doctors and amenity=clinic for much larger centres, generally operated by NHS organisations, incorporating multiple distinct services - but I think it's fine to leave existing amenity=clinic on surgeries where others have already tagged this. (There's some discussion of surgeries embedded in larger centres below.)
amenity=doctors (Although tolerate 'clinic')
healthcare=doctor (Although tolerate 'clinic')
healthcare:speciality=general
ref:GB:nhs_ods=?????? (For sites in Wales or England. Maybe nhs_isd for sites in Scotland)
For sites in Wales:
brand=NHS Wales
brand:cy=GIG Cymru
brand:wikidata=Q6954180
operator:type=government
operator:type=public
Some GP practices may be co-located with other services in "medical centres" or "health resource centres". For example King's Surgery is located in the Port Talbot Resource Centre (or 7A3P6).
I propose that in these situations, the centre way/area be tagged as amenity:clinic and a node or area be added with GP surgery-specific tagging as above. I reckon this is a good example of where multiple elements may be needed but I might be wrong!
The meaning of emergency=yes (when used of a hospital) is very vague at the moment - it's clearly true of hospitals that are described as "A&Es" to the public or that have fully fledged Emergency Departments (EDs), but it's not clear if it's true of Minor Injury Units (MIUs) or hospitals that host GP Out-of-Hours services even if these are delivery urgent and unscheduled care.
To some extent it's ambigious - whether or not a site can deal with your health emergency obviously depends on the emergency, and data users often won't understand the nature of their health emergency even if we could imagine a tagging system that could engage with this.
I propose to tag all and only A&Es with emergency=yes (bearing in mind the actual use of entities might be more complicated than this), tag anywhere without an A&E or an MIU (or similar, but differently termed, urgent ambulatory care services) as emergency=no. Hospitals with MIUs, or similar, will have neither yes or no.
It might be worth considering tagging MIUs as no:emergency=yes, but I don't think is ideal. It would be useful to identify them more meaningfully. Perhaps simply healthcare:minor_injury_unit=yes? In which case, I might as well also tag healthcare:accident_and_emergency=yes.
I note that some of the NHSs do use "Emergency Department" very broadly in certain circumstances - see England's Emergnecy Care Department Type date item for example.
amenity=hospital
healthcare=hospital
ref:GB:nhs_ods=?????? (For sites in Wales or England. Maybe nhs_isd for sites in Scotland)
For sites in Wales:
brand=NHS Wales
brand:cy=GIG Cymru
brand:wikidata=Q6954180
emergency:yes
healthcare:speciality=emergency
healthcare:accident_and_emergency=yes
healthcare:minor_injury_unit=yes
healthcare:accident_and_emergency=no
healthcare:speciality=emergency
emergency:yes
emergency:no
emergency:no
From a British perspective, I think that healthcare:speciality seems very odd. It has been defined against a list of professional groups, rather than the sort of problems or care that you might be able to obtain at a site.
I think that the healthcare proposal was heavily driven by mappers from Germany, and to an extent a focus on the qualification of individual practitioners makes a bit more sense in the context of the German system where you're more likely to self-refer to a individual specialist.
While 'speciality' might be more common in general British English usage, 'specialty' is both the correct term in British English for a specific of medical qualification or division of the delivery of healthcare (as can be seen in various dataset definitions for the NHSs) and is far more common in American English usage.
This is not worth starting a fight over, however.