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The new contract made a provision for the transfer of the responsibility for IT from practices to PCOs. How this applies in reality is not as simple as you may think.
Official nGMS guidance stated that PCOs will be responsible for funding the purchase, maintenance, future upgrades and running costs of integrated IT systems and other NHS infrastructure and services. The ultimate aim is the move to a fully integrated IT system across the whole NHS.
Although many practices have suffered disputes and delays in the provision of adequate and effective hardware, other aspects of IT, such as software, have often been omitted or ignored in discussions.
Software in practices is not just the main clinical IT system. Practices often use a
selection of additional software to deliver services.
As practices develop more services and as new technological developments emerge, practices often need additional clinical software, for example to manage patients in an anticoagulation clinic, to interpret 24-hour ambulatory BP readings or to assist in audit.
Practices are implementing new ways of working and are opting to take advantage of software that assists various processes. This could be a patient self-check-in touch screen, higher functionality appointment software like FrontDesk or a PC-based panic button like Little Green Button. The rate that new software for practice comes on to the market is increasing all the time think of things such as text messaging software and software for non-clinical electronic filing systems.
Practices are businesses and as such require business software for accounting, payroll, call-logging software etc.
Occasionally PCOs may fund some of this software, but this is unusual and practices are often faced with funding things themselves. So practices should try to come up with imaginative ways to fund each piece of software. And they should be alert to all the financial nuances.
PCOs often fund software for some practices but not all, for example when an additional module is part of the core clinical system. It is important to ask your colleagues in other practices what software the PCO funds for them where this does happen it can support your funding request.
Most PCOs have an incentive scheme for prescribing and this can be utilised to purchase software where this will improve patient care. Should practice-based-commissioning take off, savings here can be used to fund additional software for the practice. A word of caution though consider annual maintenance costs!
As the practice develops more in-house services there is a need for specialist software. When developing your costings for these services ensure you build in all purchase and maintenance costs and that these costs are met in full in the payment you receive for the new service.
Much of the new software available to practices is attractive because it enables the practice to run more efficiently. For software in this category, the cost of the software is often recouped quite quickly by savings in staff time the self-check-in system for example. Alternatively some software replaces a more costly alternative system (eg, the Little Green Button PC-based panic button software).
Following the implementation of the QOF, useful tools have come on the market to assist the audit process and identify patients who fall outside targets. The automation of all of this audit and recall work really can save time but the main benefit is the increased performance towards the QOF and the income this creates for the practice. Practices can often justify the cost of this software because of the increased income and decreased workload.
New software is encouraging innovative management schemes. For example, practice initiating new ways of managing their appointments often need a more responsive and functional appointment system like Front desk.
Software to bring the efficiencies to non-clinical filing systems the practice has enjoyed for clinical correspondence also improves communication and information retrieval for all management, administrative and other non-clinical correspondence. Although efficiency savings often emerge, practices may actually be happy in this situation to fund the software in this category themselves.
As well as failing to address software costs, the nGMS also failed to address the question of data loss. If hardware is stolen or irreparably damaged the NHS will itself fund the cost of replacement. But practices should satisfy themselves that if all their hardware was wiped out the PCO would respond promptly so the practice is not left to function with little or no hardware.
And replacing IT is not the only issue. If hardware failed completely and data was lost, the practice faces not only the dire consequences of losing patient records and business and accounting data but also the lost income generated from this data. For instance, a new and aggressive virus might wipe your clinical server causing you to lose all patient information.
Practices wishing to insure against data loss to protect their income might find this impossible without also insuring the hardware and will need to decide whether to insure the hardware too, or risk not having insurance against data loss.
IT in the practice goes beyond the provision made in nGMS but practices should explore ways to fund new software, either through funding from the PCO or by using incentive scheme savings or in the practice through efficiency savings.
But practices should explore each potential source of funding and make a conscious decision as to which applies when purchasing a new piece of software. As independent business practices should consider software purchase as a business decision.