Dr John Chisolm, chairman of the British Medical Association’s (BMA) General Practitioners Committee (GPC) has pledged to fight to defend practices’ right to choose which practice systems they use.
With just days to go before the closure of the ballot on the new UK-wide GP contract this Friday Dr Chisholm told delegates at the British Computer Society’s Primary Care Special Interest Group (PHCSIG) Summer Conference, that success of the new contract would entirely depend on the use of IT.
In conversation with E-Health Insider Dr Chisolm also said that a no vote this Friday would inevitably make it far harder to implement Integrated Care Records Services (ICRS) within primary care.
Explaining the proposed shift of responsibility for primary care IT from individual practices to primary care trusts (PCTs) in England, Dr Chisolm said: “The intention is to move from running a box of IT to using more integrated IT services.”
In order to deliver the new GP contract “We will need far more integration of systems, more standards and more clinician involvement in setting those standards,” said the GPC chairman.
In particular, he stressed that IT will be essential to implement the proposed new Quality and Outcomes Framework at the heart of the new GP contract, together with monitoring the various clinical and performance targets to which payments will be tied.
The aim, said Chisholm, was to move to IT systems that make information available when and where it was needed, rather than kept locked into individual systems, enabling remote interrogation of patients’ electronic records.
To achieve these goals the proposed new GP contract promises major new investment in IT, but on condition that PCOs take responsibility for IT from practices. Under the new regime PCOs will be responsible for the purchase of systems, upgrades, maintenance, running costs, links and education and training.
Explaining how the transition to PCO ownership of practice systems would work (assuming a yes vote this Friday) Dr Chisolm said the government had committed to making new funding available to enable the transition. The cost of maintaining practice systems up to the point of transfer of ownership will be met in full by PCTs.
However, Dr Chisholm stated that this transfer in ownership and responsibility for systems had not been the GPC’s preferred option. “As the price for that [investment] – and we tried not to agree to it – is the transition to PCO ownership.”
Providing an insight into the negotiations with the NHS Confederation – which has been negotiating with the GPC on the government’s behalf, Dr Chisolm said the question of responsibility for primary care IT, and the shift to PCO ownership had been one of the few non-negotiable areas insisted on. “We had the sense that we were not negotiating with the NHS Confederation, but there was another unstoppable hand involved.”
In turn, however, the GPC had got the promise that practices would retain local choice of which practice systems they use: “Each practice will be guaranteed a choice of systems and not have a system imposed upon them,” said Dr Chisolm.
“We are already getting reports that some PCOs are already trying to impose on practices a choice of one. It’s not on and contrary to the new contract. We will challenge that at the national level.” If initial representations to the government on the issue failed, other mechanisms may be used. “There are other types of challenges we could embark on,” commented Dr Chisholm.
Another huge issue identified was the guardianship and ownership of confidential patient information. Though not irreconcilable with the transfer of systems to PCOs, Dr Chisholm said PCOs “should not assume that the data is theirs”, and called for a debate on data sharing – something made even more urgent by the development of ICRS.
On one of the central tenets of ICRS – roles-based, needs-based access to records – the GPC Chair added there was a strong argument in favour of piloting to ensure that “information does not fall into the wrong hands”.
A final area of concern identified by Dr Chsiholm was to ensure clinicians are fully involved in choosing and specifying systems. “I have a concern that purchasing decisions will not be made by people who have to use the kit themselves.”