The National Programme for IT’s policy on legacy systems is causing confusion among trusts and suppliers over who should pay the costs of upgrading systems to enable them to communicate with the spine.  

Evidence seen by E-Health Insider indicates that most NHS trusts are unwilling to collaboratively fund suppliers upgrade costs – an approach one supplier has canvassed trusts on based on guidance from NPfIT. 

A letter passed to E-Health Insider, sent to trusts by Protechnic Exeter, states that many NHS trusts are uncertain about the route to make their current systems spine compliant and how this work will be funded.  Without being made spine compliant current systems will not be able to link any of the new national services.

The letter makes clear that a significant number of trusts still wrongly believe that the costs of integration, for existing systems where there is no business case for the supplier to make the investment, will be funded by NPfIT.  Confusion on the issue has been compounded by NPfIT previously issuing guidance stating that it would fund the cost of legacy integration.

“Many trusts said that they had been told that the National programme would be funding compliance so declined to participate," says the letter.

In a recent questionnaire sent to English trusts using its systems, Protechnic Exeter – following what it says is NPfIT advice – asked what level of funding they would be willing to collaboratively provide to fund the costs of making its ePex community and mental health electronic patient record system spine compliant. 

Writing to trust clients on the responses received Richard Hinchcliffe, chief executive of Protechnic Exeter, states that the responses received made clear “…there is a general lack of understanding of what is going on in support of the National Programme".

The letter says that a collaborative approach to funding upgrades is meant to apply where there is no clear business case for suppliers to fund the developments themselves.   “…it is the national programme’s preferred option that the development costs of are shared across the current user base and this point was reiterated several times by Peter Mason [head of legacy issues with NPfIT] in a recent presentation at the ePex user group," states the letter.

Asked whether this was in fact official policy an NPfIT spokesperson told EHI: “The national programme expects legacy suppliers to make their solutions compliant at their own cost; however, NPfIT accepts that here may be exceptional business circumstances within NHS Trusts; these will be assessed by the national programme on their own merits and specific arrangements made."

Trusts, however, appear unwilling to stump up suppliers upgrade costs.  Only half of English trusts completed the Protechnic Exeter questionnaire, and only nine out of 23 said they were willing to fund development of ePex to make it spine compliant. 

Of the nine most said £12,300 was as much as they’d be prepared to contribute.  Protechnic Exeter’s figures suggest it would cost about £250,000 to make its system spine compliant.

The letter notes, “there is no money to connect all other systems (the vast majority) including ePex."  Sources spoken to by E-Health Insider indicate that without additional central investment very few existing systems will ever being made spine compliant. 

The work to connect all systems to the NHS spine is considerable and requires changes to all existing systems plus the development of a suitable message engine.  According to the letter, “…systems will not be able access services at all without adhering to the correct security protocols and providing a legitimate doctor-patient relationship."

The Protechnic Exeter MD says that the company is committed to the goals of the national programme, but faces a dilemma on how to fund making its systems spine compliant.  “Given the NHS has already awarded the contracts for all future systems to four large service providers then we can’t hope to sell new systems to recoup the investment we would have to make to achieve compliance."

Hinchcliffe also notes that the market environment in which the call for trust funding has been required is down to NPfIT. “The NHS has created these circumstances by removing our market at very little notice and mandating that we make costly developments with no funding in order to have the chance to retain any existing customers (but without providing any guarantees."

Asked to clarify the position on making current systems spine compliant the national programme spokesperson said: “Legacy solutions are an integral part of the NHS CRS particularly in the early years of the national programme. The programme is working with legacy suppliers to ensure these solutions, where appropriate, are made NHS CRS compliant."

Hinchcliffe’s letter adds that following the agreement with the BMA that GP systems should not be replaced until there is something better to replace them with, the same principal now appears to being applied to other care areas. 

Citing recent guidance from Peter Mason, Hinchcliffe says: “There is a growing feeling that there is no point moving to an intermediate system if ultimately the solution will be Lorenzo or Carecast [the iSoft and IDX solutions] given the potential data loss over each change of system (For trusts, the upheaval, retraining, potential data loss and impact on staff and patients just isn’t worth it)."     

Protechnic Exeter declined to answer questions at the end of last week but a spokesperson stressed that the company supported the “essence of what the national programme is trying to achieve for the patient".