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What is the National

Programme for IT?

A multi-billion-pound programme to modernise IT in the NHS, to make care more efficient and co-ordinated.

What does it involve?

A central database will be created of electronic patient records. This will facilitate electronically booked referrals to secondary care and electronic transfer of prescriptions.

Anything else?

The programme is also overseeing the creation of a high-speed data network so that diagnosis can be done remotely, for example by video. It will also be used to transfer images such as X-rays by computer, and will let patients access their records quickly.

That's good news, isn't it?

Yes, but GPs are concerned about the amount of information that will be kept on the centrally held patient records, known as the 'spine'. They fear patient confidentiality could be breached. Others simply think the money would be better spent elsewhere in the NHS.

Have GPs been able to voice these fears?

Most GPs, including the GPC's IT sub-committee, feel they have not been adequately consulted over the plans and it's not yet known whether there will be any GP members of a new development board.

How is the NPfIT being implemented?

England has been divided into five areas, or 'clusters'. For each of these the NPfIT has commissioned local service providers (LSPs) to operate and manage the new IT systems, ensuring they adhere to national standards and can share information with the rest of the country.

What's the fuss about GPs' choice of IT system?

In order to be involved with NPfIT in the future, software suppliers must sign contracts with LSPs. That enables central funding to become available to PCTs to pay for those systems.

Sounds simple so far

Yes, but many GPs believe their choice of IT system is under threat. NPfIT guidance states that the 'majority of existing systems will have been replaced or integrated within either an LSP solution or management responsibility, at some point during the next two to five years'.

LSP 'solutions' refers to the Lorenzo system (a new clinical IT package being designed by iSOFT) for three clusters and Carecast (by IDX) in the other two.

Doesn't new GMS guarantee GPs choice over IT?

Paragraph 4.34 of the new contract states: 'Each practice will have guaranteed choice from a number of accredited systems that deliver the required functionality.' NPfIT says GPs will have the choice of 'at least two' systems.

So what's the problem?

Many GPs fear choice will be restricted and that they will only be able to continue with their existing system, even if it is signed up as an LSP contractor, for a finite period. They accuse the NPfIT of being vague on what choices will be available and for how long.

What does EMIS want?

Its user group is calling on its users ­ and other systems' user groups ­ to lobby MPs to ensure choice of IT systems becomes unrestricted. It wants to maintain an open market ­ if a system is compliant with the National Programme, EMIS believes it should be available as a choice.

What does the NPfIT itself have to say about all of this?

It has sought to calm GPs' fears by releasing revised guidance that specifically assures GPs they will receive a choice of system; that they can continue to use compliant system; that GPs should not be pressured to change; and says it is 'on the cusp' of instigating a 'proper, formal' channel for discussing problems with GPs.

What does EMIS say to that?

It says the new guidance and assurances change little for its users.

As long as it still feels unable to sign an LSP contract, there will be no central funding for EMIS systems so the 56 per cent of practices that use EMIS will end up changing systems regardless.

Wouldn't all this blow

over if EMIS signs LSP contracts?

EMIS says that's unlikely and that even if it does, revised NPfIT guidance still says the spine will support direct connection of existing GP clinical systems to deliver Choose

and Book, electronic transfer of prescriptions and GMS-

required functionality only as 'an interim measure'.

Why is changing system so problematic for GP practices?

For a start GPs have no idea whether Lorenzo or Carecast will really be better than their current system, nor are they clear what the 'alternative' systems will be.

Any change of system inevitably leads to some loss of functionality and corruption of data.

This could in turn compromise patient care. It could also potentially undermine a

practice's ability to earn quality points under the new


Does everyone agree choice is the real issue?

Not exactly. The GPC says EMIS may be procrastinating over signing contracts as it postures for commercial advantage.

Other software providers have accused the company of scaremongering.

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