A unique meeting held in London last week saw over 200 leading NHS IT suppliers, and would be suppliers, gather to hear details of how the NHS plans to deliver the new NHS IT strategy. Many left with more questions than when they arrived.
Describing the objective Sir John Pattison, DH Director of research, analysis and information, said the national strategy was just a first step in a longer-term programme. "But in terms if something quite extensible in terms of work practices, what we are talking about is really quite spectacular."
With key details of the programme remain to be worked out Sir John told the audience the spotlight was focused on NHS IT. "The whole world is watching us to see how we do".
He said so far the outline strategy had only cleared the initial Gate Zero review of the Office of Government Commerce (OGC). It is only at Gate Two that the full procurement strategy will be approved. "This is current thinking we haven’t yet answered all the questions yet".
Sir John announced that a new national review procedure has been established for current NHS IT procurements. He stressed the aim was not to hinder local progress: “We do not want sensible current procurements to stop”. Some existing procurements may be upgraded to "exemplars".
Outlining the broad shape of the national programme he told the audience that he was a bit "obsessed" about infrastructure. This will provide the infrastructure to deliver the three core applications of e-booking, electronic records and electronic transfer of prescriptions.
On the national bookings target Sir John pointed out that the 2005 target didn’t actually have the word "electronic" in it.
Sir John believes that some of the "biggest early gains in patient care" will come from hospital based e-prescribing systems. The initial target for e-prescribing focuses on electronic transfer of prescriptions (ETP) by 2005.
But the biggest and most challenging part of the strategy focuses on electronic records, which Sir John described as a "massive application".
Electronic Records, now renamed as the Integrated Care Records Service (ICRS), which according to Sir John "indicates a broad, continuously expanding portfolio of services covering the generation, access and development of records".
He confirmed that the preferred approach for delivery of the national programme is "strategic outsourcing", to consortia of suppliers led by Prime Service Providers (PSPs) who will work with Strategic Health Authorities (StHAs) to implement and integrate systems. There will also be nationally delivered services and extensive use of framework contracts.
“We intend to deliver a limited number of PSPs who will work with a limited number of system and service suppliers under sub-contracts,” said Sir John. "It seems likely to me there will still only be a list of 2-5 PSPs, who will be selected through open competition."
He added that the programme is likely to be delivered by groups of StHAs acting together. "There are unlikely to be 28". London, for instance, looks likely to move forward as a single grouping of 5 StHAs.
The role of the StHA will be to select a PSP, work with them to set local priorities, and then implement and integrate systems. There will be service level contracts for all services delivered across StHAs. PSPs will be expected to negotiate "back-to-back contracts with each sub-contractor".
The Centre will play a vital role in setting standards and accrediting suppliers and managing national procurements, but tangible details of how these key areas will be delivered were scant. A baseline document on standards is promised shortly.
Philip Knight, head of service delivery at the NHSIA made clear work on standards and accreditation through the National Accreditation Procurement Process Service (NAPPS) remained at an early stage. "NAPPS is about saying this product is fit for use in the NHS".
Mr Knight said that NAPPS “will be ready for accreditation after April 2003”. He went on to add and suggested that it would take "10 years to get a fully certified and accredited set of products for the whole of the NHS". Initial standards are likely to be very limited.
He declined to answer audience questions on when standards would be available for security and PKI.
Sir John acknowledged the scale of the task ahead: "It will be challenging to get everything in place by March 2003. This is another reason why we don’t want existing procurements to stop."
The suppliers in the audience had a host of unanswered questions. Many of these focused around how PSPs would be configured and whether a PSP could also be a product suppliers.
Sir John stressed that the initial challenge for all PSPs will be to work with the legacy systems in place in each health community, and confirmed that the expectation is for "suppliers to align with multiple PSPs".
In other words, specialist system suppliers may line up with any of the PSPs working with StHAs. This is likely to be particularly relevant for the two leading primary care system suppliers: Torex and EMIS.
Another supplier asked “where is the evidence this will succeed, pointing out that the StHA is not involved in front-line delivery of care. Sir John explained that the StHA is the part of the new NHS structure "with which we think we can relate".
However he added that without engaging front-line staff "we haven’t got a chance of succeeding".
The immediate priority said Sir John was for the service to get into the habit of hitting targets. "I have said to the Secretary of State that I am obsessed with hitting the targets, as we have to get into the habit of hitting them".