Dr Mary Hawking looks at the myraid of questions over the management of GP IT systems in the new NHS.
I worry about the future of GP IT once the new NHS is established in England from April 2013. Whether or not the Health and Social Care Bill is passed, the changes are being implemented without any of the detail needed for planning.
Fifteen months is a very short time to introduce the changes, especially with so many uncertainties and unknowns about such fundamentals as how GP IT will be procured, financed, supported - and controlled - in the nNHS.
The number of things we just don't know is alarming:
- Procurement, funding and support of GP practice systems and IT
- Licensing and requirements for GP IT systems (currently Connecting for Health manages this)
- Planning future developments to support the GP IT needs of the New NHS
- Interoperability plans and liabilities in the nNHS.
- The Information Strategy
- Implementation of the Information Strategy.
- The implications of the Information Strategy for practices and CCGs - and their IT.
- New IM&T requirements and standards.
I'm only going to talk about the first point as there are too many uncertainties about the rest for rational discussion - but as GP systems are mission critical to GPs, patients - and yes, the NHS - smooth transition is essential.
We do not know where responsibility for GP IT will lie, how it will be funded, where control will lie. Will there be any choice of system for GP practices? Will the CCG - or anyone else - be able to dictate which system a practice must use, or deny funding for non-compliance? Or will anyone else?
Who will hold the contracts - and therefore, from the commercial point of view, be the customer?
The situation is even more complicated than might first appear - so a small historical diversion.
Under the nGMS contract in 2003, practices stopped being liable for 50% of their clinical system and IT costs, and responsibility for holding contracts, supplying GP IT and support passed to PCTs - with recurrent funding to cover this - but GPs were guaranteed choice of accredited systems.
Meanwhile, in a parallel universe, the National Program for IT - apparently unaware of either GP IT or the nGMS contract - had awarded five contracts to supply IT to the NHS in England. The CSC contract for North West and West Midlands did not include a GP system; the Fujitsu contract for the South has been terminated without replacement and the two Accenture contracts for the North East & East Midlands and East of England have been transferred to CSC - so four fifths of England are covered by local service provider (LSP) contracts, not all of which include GP systems.
Many GPs were unhappy with this change to the nGMS contract; GPSoC (GP Systems of Choice) was introduced giving GPs a choice of approved systems. This contract ends on the 31 March 2013.
So in many areas there is a mixture. Some GP systems are supplied under GPSoC from the funding added to the PCT budgets in 2004, while others are provided by the LSP from the funding in the LSP contracts.
In both cases, there is no clarity about what happens to the funding (or procurement) when the arrangements end in 2013 and 2015 respectively.
Assuming that management of GP IT is transferred somewhere before April 2013, how will the funding be assessed? By the actual current spend by the PCTs? This varies between PCTs and in different years; and LSP systems distort the picture.
By the original funding in PCT budgets? This would mean double payments for LSP systems - until the LSP contracts end in 2015.
By the cost (plus cost of IT support) of the systems in place as listed for GPSoC? This would give the same problem as the previous scenario. Identifying and allocating funding will be difficult.
So what about the contracts and IT support? Should the two necessarily go together? The planned structure of the nNHS appears to be the NHS Commissioning Board possibly with regional offices and clinical commissioning groups (CCGs) under them.
Will the CCGs be expected to manage GP IT, and if so, will the funding be ring-fenced? Or will the contracts and IT support be managed by the NHS Commissioning Board - and if so, how responsive would that be to local needs?
Will there be any specialist IT support, in particular, support by GP system suppliers and for additional systems e.g. dictation software, Docman and Frontdesk?
Who will decide and on what criteria? The likely candidates would seem to be the CCGs themselves - which might cause friction within the CCG or the NHS Commissioning Board.
See why I'm concerned?
Of course, the DH might decide that as GP systems are mission critical, GPs ought to pay for them themselves - probably without any additional funding whatsoever!
Dr Mary Hawking is a GP in Dunstable, Bedfordshire