EMIS the largest supplier of GP systems in the UK has announced that it will not sign contracts in their current form with any of Local Service Providers (LSPs) appointed to deliver the National Programme for IT (NPfIT).

Dr David Stables, medical director of EMIS, told E-Health Insider that EMIS remained “basically very supportive of the National Programme" but would not sign the sub-contractor contracts. "EMIS will not sign the current standard NPfIT sub-contractor contracts with LSPs. The contract terms were untenable."

Explaining why the company had decided not to sign Dr Stables said: "The proposed LSP contracts would result in a single, uniform system with insufficient focus on primary care." 

He added that signing the contracts would have "Fundamentally altered the relationship between EMIS and our customers so they could no longer get the same quality of service. Primary care and EMIS would have been subsumed."

The announcement is the first significant rebellion by a major existing supplier of NHS IT systems against the new regime.  With EMIS systems in use in 58% of GP practices, many of them fiercely loyal, and with GPs bridling at the idea of having new systems imposed upon them, the news represents a serious headache for the national programme.

Initial indications suggest that many EMIS users intend to back the firm, not only because they are familiar with the existing systems but because of the clause in the new GP General Medical Services (nGMS) contract that promises to provide practices with a choice of systems and pay for them.   

Dr Manpreet Pujara, a full-time GP who chairs the EMIS National User Group, told EHI: "My big concern is that nGMS clearly says GPs will have a choice.  To me that means more than an ‘either/or’ choice.  If my system does everything necessary I don’t see why it should not be funded."

In the new world of NHS IT envisaged by the NPfIT EMIS was meant to accept becoming a sub-contractor to the LSPs awarded exclusive contracts to run the IT in five NHS ‘clusters’ in England.

Under the strategic outsourcing arrangements of the NPfIT it is meant to be up to LSPs to decide which specialist clinical software to offer NHS customers.  EMIS, however, believes that the nGMS contract unequivocally guarantees that general practices will be able to choose which systems they want, irrespective of whether they are within a particular LSPs portfolio of products.

The key question would appear to be whether the National Programme will agree to fund primary care systems chosen by practices, from suppliers not signed-up with Local Service Providers.  The alternative scenario would be that practices can choose whatever system they want but would have to pay for any system not provided through an LSP.

In a statement provided to EHI the national programme said: "The National Programme has agreed contracts with prime contractors, and is confident they will deliver the services we have contracted from them. The issue of sub-contracting is one for the contracted LSPs to address."

According to Dr Paul Cundy, head of the BMA’s General Practitioner Committee’s IT group, the collision over funding practice systems has emerged because the nGMS contract and NPfIT were developed separately. "The Downing Street inspired NPfIT seems to have little grounding in business processes and is more about procurement than implementation."    

Dr Cundy added that the nGMS contract was absolutely clear that practices should have a choice of two and ideally three accredited systems, and that it was not the for NPfIT alone to determine what these systems were. He also noted that he saw the decision by EMIS not to sign LSP contracts as "partly a commercial approach". 

“The nGMS contract states categorically that GPs will be provided with the systems of their choice", stressed Dr Stables.  "And it would be a breach of contract if they were denied that choice."

He confirmed to EHI that EMIS has taken legal guidance on this key part of the nGMS contract, and that the firm "Had no indication that the National Programme takes a different view."

For Dr Grant Kelly, a member of the GPC. said the challenge thrown down by EMIS is a potential watershed for the national programme.  "It’s not so much a threat but a test, if they fail it becomes a threat.  If EMIS wins all suppliers know they can pull the national programme any way they wish. It’s the dividing line between the old and the new." 

Though NHS IT director general has successfully taken up cudgels against the IT industry to get them to fall into line on pricing and sign up to huge penalties if they fail to deliver, GPs may prove more intransigent. 

However, Mr Granger has provided strong indications that he is willing to go head-to-head with GPs who don’t fall into line.  In an interview in today’s (22 Jan, 2004) Guardian he said: "There are GPs in the IT community and GPs who want to be in the IT community who are passing comment. I would ask them to question their record in creating the present inefficiencies, because they were there when it happened."

Granger went on to pledge that whatever the outcome of negotiations with EMIS all LSPs will offer a choice of "more than one GP solution".  EHI understands that each of the four LSPs appointed so far will offer at least two GP systems, either ones currently available such as InPractice Systems, Torex, or new systems under development by firms such as iSOFT. 

Responding to Mr Granger’s comments Dr Stables said: "I want to counter Richard Granger’s comment that suppliers are blocking interoperability.  The National Programme blocked the GP-to-GP record transfer project, so that is pretty rich."

He continued: "We’ve been pushing for interoperability for four years, and have been frustrated in our attempts to set up large-scale trials by the NHS."

Dr Stables went on to counter what he regarded as unfounded recent criticism about EMIS’s products.  "We have successfully passed three separate proof of solution (POS) tests in the sand-pit, using generic software that we can apply to all our systems.  There is no question that we can make our systems interoperable with the spine." 

Despite Mr Granger’s apparent willingness to play hardball with GPs, one seasoned observer of the primary care IT market questioned whether this would prove viable.  He told EHI that with a General Election looming, he believed the last thing Granger’s political masters will want is an obscure fight with doctors, and Granger may come under political pressure to compromise with GPs. 

Dr Kelly concluded: "I think this is where Granger needs to tread very carefully, if No 10. begins to get cold feet his support could dissolve very quickly. It’s just a very high risk strategy all round and EMIS have just upped the stakes."