Definitive guidance on the issue of choice of practice systems has been issued which makes it plain that practices should not be forced to switch to a new system until "a clearly better alternative" is available together with a proven route to migration. The new guidance has been jointly produced by the joint IT committee of the BMA General Practitioners Committee (GPC) and the Royal College of General Practitioners in conjunction with the National Programme for IT (NPfIT) In addition to practices having a choice of systems the GPC will have a guaranteed role in the assessment of any new alternative systems – making GPs the only professional group in the NHS to have a guaranteed role in the evaluation of new systems. Dr Paul Cundy, chairman of the joint GPC and RCGP IT Committee, told E-Health Insider the joint guidance represented "The first chink of engagement between the GPC and national programme, the agreement NPfIT has made directly with the GPC and BMA." Dr Cundy said of the agreement: "Its significance is that it reassures GPs and suppliers that we have choice in our systems. It is a clear statement from the national programme that all LSPs (Local Service Providers) must support the clinical systems that GPs want." On the key issue of systems choice the guidance notes that in parts of England there have been suggestions that the NPfIT will require the rapid replacement of existing GP systems. It adds that while such an approach may be one of the options considered by LSPs, "it is our firmly held view and that of the National Programme that such replacement should NOT occur unless, and until, a clearly better alternative is available along with a tested and agreed process for safe migration to it." The joint guidance states, “Practices with RFA99+ accredited systems with which they are currently happy should not agree to transfer to an alternative system as long as their current supplier has confirmed their desire to make their system “NPfIT compliant"." E-Health Insider understands that no general practice system is yet "NPfIT compliant", as the details of the requirements and process for achieving such compliance are only starting to become available (the guidance provides a list of systems that are expected to be made NPfIT compliant – see below). In terms of which systems will be made compliant, the guidance note states "The National Programme expects LSPs to take all reasonable steps to support any accredited systems where local demand exists." The guidance stresses that paragraph 4.31 of the new GMS contract 2003 ‘Investing in General Practice’ guarantees a role for the GPC in the assessment of any new alternative systems. “The GPC will be directly involved in the assessment of systems,” said Dr Cundy. "One of the lessons we’ve learned from past projects such as NHSnet is that GPs must be involved in the systems we will have to use." The guidance clearly acknowledges that the NPfIT will result in the replacement of many existing systems: "The National Programme for IT may, in due course, require the upgrade or replacement of existing GP systems with some inevitable disruption to GP practices in order to lay the foundations for much improved patient care across the whole health and social care community." Crucially, however, the guidance advises practices against switching between one current RFA99+ accredited system and another, "we would advise that they are unlikely to achieve benefits that justify the cost and disruption that accompanies even a well planned and executed conversion, particularly as any such move is unlikely to meet the medium or long term requirements of the National Programme…" Those practices without RFA99+ accredited systems should seek the advice of their primary care trust (PCT) who should be able to offer a "limited" choice of RFA99+ accredited systems. The guidance states that practices and their PCTs "should not be financially or otherwise disadvantaged by choosing to remain or by exercising [limited] choice". "NPfIT compliant" systems is taken to mean systems able to communicate with the NHS Care Records Service (also known as the spine) to the degree required to support phase 1 releases of the spine software including compatibility with the eBooking and ETP services. The joint guidance states thats that all significant suppliers of GP systems have indicated their willingness to meet this requirement in relation to their systems "subject to detailed agreement with NPfIT". They are listed as: The joint guidance is available at: http://www.bma.org.uk/ap.nsf/Content/NPfIT0404?OpenDocument&Highlight=2,choice Practices seeking advice or wishing to provide information about local activity at odds with the guidance are asked to contact rmerrett@bma.org.uk.
