The consultation - well worth reading & considering the implications for general practice and your local health communities
closes 23rd August: you have time to comment
Remember Connecting for Health & NLOP (No Longer Our Problem: I can never remember the official meaning)?
When things were not going according to plan, CfH passed responsibility for enforcement to SHAs - while not allowing any deviation from central diktats.
Is history repeating itself?
NLOP was hardly a success...
In 2013, basically, NHS England & government confiscated all the properties in which the local health economy - PCTs & predecessors - had invested & gifted them to a new, wholly owned company, with no accountability to anyone as far as I can see.
Was this planned or a legislative/administrative blunder?
As with Capita, something seems to have gone wrong somewhere (unless it was all part of a cunning plan) - or maybe a total success in helping to destabilise/abolish general practice.
Too many "unintended consequences" might suggest that the original plans (if any) were not properly thought through.
How will Digital First affect all of this?
This consultation on Digital First practices *is* important.. not that disagreeing (if possible) is likely to make any difference.
I'm so glad to have retired!
Wouldn't work in rural or remote areas where internet access is either totally lacking or very poor, and GPs deal with minor injuries & cottage hospital services.
How do "Digital First" services amanage in areas where the nearest A&E is over an hour away?
"Digital First" could only cover patients who could afford digital access - which rules out many in deprived areas & most in remote areas.
GPatHand patients are mostly young, mobile & healthy - but consume more health services than those registered with regular practices.
Does NHS England ever think things through?
When I was in practice, after the nGMS contract, it took awhile to work out what the partners' incomes were for the preceding tax year.
Now that you have the additional complication of Capita incompetence, and a significantly higher employers contribution being calculated back by HMRC, will it be possible for GPs & their accountants to work out pension contributions before the deadline for filing?
Is this a call for NPfIT v2?
The Tech Manifesto appears to consist of an Infograph - and a Press Release (& yes, I have tried the RCGP website).
One of the things missing from the 'Manifesto@ is the need for GP systems to support the business of general practice - but as the assumption seems to be that independent general practice won't exist for much longer, perhaps that isn't surprising!
Wouldn't this require repeal of the Rehabilitation of Offenders Act?
I remember the problems of continuity of care - or just care - on admission to and discharge from custody being discussed frequently when I was in practice, and the same problems came up: the GP record is a cradle to grave record (& under the new GP contract the aim is to digitise everything - & upload all or part to LHCR, one of the aims being "research"..) which means that incorporating the prison medical record into the GP record would mean a *permanent & indelible* entry of any detention - including time on remand.
Which is why it has not been done before.
I would have thought that a service targeting the young & mobile would have considered the likely demand for travel clinic services.
It looks as though GPatHand patients may be 'forced' to re-register with their previous practices - or change their holiday plans/preparations!
PS the practice profile most closely resembles that of University practices: how do they manage?
"Smaller state" (USA model?) simply involves transferring functions best managed on a pooled risk basis (such as healthcare - where the normal developed economies model is universal compulsory insurance or tax funded) to an individual funded model with high transaction costs - and premiums related to claims.
Socialism is *much* better - & who in their right mind now has any trust in the Conservative understanding or management of Business or the Economy?
Single systems have their own problems
I had had the impression that changes in the pension system - & LTA - was a contributory factor to taking the pension early - which no longer requires retirement from work - or even change in role.
How do taking the NHS pension am
and leaving the workforce (including locum or non-GP work) correlate?
DOI - retired - late - 31.3.13 - so escaped the effects of HSCA 2012
Every practice does things differently: my advice would be to ask you trainer - and suggest the practice should have a "Coding/EPR handbook for Trainees" - to be updated when SNOMED is fully operational!
re David O'Hagan comment.
If PCSE are "only data processors" they ought to be acting under instructions from the "Data Controller" - and are only allowed to process the data in accordance with the instructions they have received.
Was that in the contract signed by NHS England?
And who is the Data Controller in this case?
If the problems started with a change in the Business Rules (Change? In September?That's *half way through the year*!!), why does it only apply to EMIS practices & not S1 practices? (What about Vision?)
Has anyone checked whether this is a mapping problem? In the 4 to 5 byte conversion in 1994, my favourite mis-map was "Whole blood transfusion" converted to "lateral rhinostomy"..
In the "Tired all the time" patients being listed as "depression", is this a Business Rule/extraction problem (easily correctable) or a Code Conversion problem (TATT actually mapped to "Depression")? If the later, this - in addition to corrupting the EPR - could have serious, long-term repercussions for the patients including job applications and insurance.
I really hope the problem lies with the authors of the Business Rules!
A 2 partner practice with 20,000 patients?
Could Pulse find out how 2 GPs - and corresponding staff and premises - manage to provide adequate services to this number of patients?
And how - & by whom - is the underlying technology funded/supplied?
The IGA - Information Governance Alliance - is issuing guidance for Health and Social Care.
Unfortunately the General Practice/Primary Care Suite is now scheduled for March to May (previously March to April) - so it might appear to be a bit late to allow implementation by 25th May.
Please note that Bedfordshire is 100% TPP SystmOne - which might have some influence on the suggestion that GPs shouldn't be the Data Controllers any longer.
Connecting for Health decided that in a single shared record, GPs - and all other users - were Data Controllers in Common - with everything that that implied under DPA and will imply under GDPR.
It would be useful to know which system enables the entry of data without an associated date or time, the nature of this data (sounds serious if it includes Codes and immunisations) and whether it only arose after TPP changed its EDSM systems - as the article states. (if so, why are EMIS - X -EMIS transfers (presumably GP2GP) affected?
I agree with the previous commentators: are the practices having to troll through computer printouts from system X practices to locate the missing data? And how will they be able to date it?
Who has been using the Template, and in which organisations?
If this is a TPP template, then only the organisation making the entry will be able to correct the error - so correction may be a major problem.
Does the coding of the mothers as having died trigger any other actions e.g. removal from the practice list, any call/recall registers - or be reported to DWP or HMRC?
With integrated records and massive data sharing, this Coding incompetence could have major repercussions!
I thought the Luton & Dunstable scheme cited by Jeremy Hunt was commissioned - and funded - by Luton CCG (& previously PCT) to reduce emergency admissions (& costs)?
JH's schemes sound different.
Will GPs be directly employed?(hosp covers liability, sick-pay, maternity & holidays - *&* employer's pension contributions, redundancy), or will service be contracted out to commercial (or non-commercial) organisations - who may find it difficult to recruit sufficient GPs?
*If* pay is limited to £80/hr, what additional benefits will there be to bring it to close to market forces?
Especially if contracts mean that the GPs involved cannot claim to be self-employed for HMRC purposes?