Only six GP practices are currently connected to the national spine, a month after a rapid roll out was expected to have started.
The small numbers appear to reflect GPs’ continuing scepticism over whether LSP-hosted services provide additional flexibility and functionality or increased reliability.
Accenture has not added another practice to its Spine-connected primary care system, supplied by iSOFT, since the Undercliffe Practice in Batley, West Yorkshire, became the first to be connected to the Spine in February 2005.
Five practices in London are now using Spine-connected practice systems, out of a total of 39 practices in the capital provided with new GP systems, supplied by In Practice Systems. No practices in the other three clusters have yet been provided with Spine-enabled practice systems.
Questions about the reliability of the new spine-connected systems were last week underscored by Dr Paul Glover, partner and IT lead at the Undercliffe practice.
Although the practice had formally signed off on the contract, the system still crashed at least once a week. He said: "If this was something we had bought from PC World we would have taken it back."
He emphasised that Accenture had been very quick to respond to issues, but added: ‘This is one of the joys of being a pilot site. It is definitely not ready to roll out across the patch.’
Problems with the NHS Care Records Service (NHS CRS) – the main reason for being connected to the spine – meant that the practice had yet to test the link, said Dr Glover.
Accenture referred questions about future connections to the spine to NPfIT who in turn provided information only about the current connections.
The lack of progress highlights one of the emerging debates in general practice IT – the question of whether GPs will choose to stay with their existing systems with upgrades of hardware and software to access the national spine or move to LSP-hosted solutions.
While NPfIT remains committed to the idea of single system solutions, in practice GPs are proving resistant and a mixed economy is beginning to emerge.
Access to the Spine does not require a new system but it does require the supplier to make their system spine compliant. Most if not all suppliers of practice software are working towards compliance with Choose and Book, electronic transmission of prescriptions and GP-2-GP record transfers.
The alternative to an incremental upgrade of a practice’s existing hardware and software is to move to an LSP-hosted system. A significant minority of practices already use systems remotely hosted by suppliers ahead of connection to the national spine.
The advantages are potentially better security, reliability and robustness with off-site data storage. The drawback is lack of flexibility and functionality in clinical systems.
For example, a practice-based system might use different software solutions for its appointments and audit needs. LSP-hosted systems often do not allow this.
One source said: "Most LSPs do not offer interoperability for third party applications although it is starting. If you can crack that issue you will go a long way to persuading more GPs to move to LSP hosted solutions."
Under current arrangements, long-term full integration with the national spine will require switching to either Carecast or Lorenzo. But neither of the system providers contracted to NPfIT (IDX in the South of England and iSOFT in the North) has so far developed primary care functionality and do not expect to do so until 2007/08 at the earliest.
Ewan Davis, chairman of the primary healthcare group of the British Computer Society said practices would need to consider a number of factors as they make their choice.
He said: "From the GP perspective it is difficult at the moment to make a case for moving from a practice-based system to an LSP-based service." PCTs may make some small financial savings by moving to data centres.
Another source said: "We are beginning to see a more pragmatic approach. Whether it’s being driven by seeing the light or lack of success is the big question."