IT departments of NHS organisations are beginning to feel the impact of plans to shake-up the structure of the health service which will see PCTs merge and no longer be service provider organisations.
Some heads of department say lastweek’s announcement of the plans has already cast doubt on some implementation plans while others report fears that information management and technology (IM&T) plans, including implementing National Programme for IT systems, will be put on hold while the review is underway.
The health department has outlined its proposals in its document Commissioning a Patient-led NHS.The plan is to virtually halve the number of PCTs by October 2006, and to change the function of PCTs to focus entirely on the commissioning role. In many cases making merged PCTs cover the same boundaries as local authorities.
Ewan Davis, chairman of the British Computer Society Primary Health Care Special Interest Group, said that changes to PCTs will inevitably result in disruption, delayed decisions and loss of focus. He noted though that within many PCTs the latest changes meant that organisation of IT had come full circle. "Local IT is about three re-organisations behind with many Local Informatics Services and in many cases was already co-terminus with local authority Social Services Departments".
Andy Kinnear, head of Avon IM&T Consortium which supports five PCTs in the Bristol and Bath area, said the reorganisation was frustrating for IM&T departments.
He told EHI Primary Care: "In the short term everything grinds to a halt. Even in this last week we are already getting funding decisions deferred and everything has a caveat that you can now only plan so far. There’s an incredibly frustrating aspect to it."
Kinnear said he feared that as the reorganisation gets underway staff would be deflected from implementation work to focus on getting any new administrative and organisational structures up and running.
He added: “There’s a real air of here we go again. You sit here and think that you are probably looking at 12 months of stagnation in terms of strategic decisions.”
Kinnear said some of the 50 staff who work for him had also already raised concerns about their job security. He added: “I don’t think there is any immediate need to panic although there is a certain nervousness around. From an IM&T point of view all we want to do is get on with things and this sort of thing is stopping us doing that.”
Another head of IM&T at a London PCT said the plans seemed to go in a different direction to the one his trust was currently working on.
He added: “We are looking at integrating services with the hospital and setting up new models of care and this seems more aimed at management convenience and savings.”
He warned that if the plan meant there would be more shared IM&T services across organisations that could create its own problems.
“In simple terms the more stakeholders you have the more people you have to please and you can lose time for implementation. There may be possible economies of scale and benefits to recruitment but on the other hand you can become detached from the real action which is around the patient and the clinician.”
An IM&T Director at a PCT in the North East said that organisational changes were always disruptive. "The latest announcement unsettles the local health community and its investment plans."
He added that an immediate likely problem as PCT mergers began to loom was how their different IT strategies would fit. "The investment plans of PCTs may not be easily compatible." Part of the uncertainty he said was how to take forward investment in IT to support community services when PCTs now face the prospect of ceasing to be service providers.
Dr Stephen Earwicker, PEC Chair Broxtowe and Hucknall PCT, told EHI Primary Care the level of risk created by the changes wouldl depend on how well local health communities already work on IT. "In Nottingham we have, for a long time, worked together to try and maximise the benefits of IT investment locally and I would see this fitting in with the move to larger more strategic PCTs."
He added: "I think what is more interesting is how groupings of GP Practices taking on Practice Based Commissioning [PBC] will want to use IT. They will have specific information needs and also, I suspect, requirements for the standardisation of clinical practice amongst their members. Will this drive them towards single provider solutions across a PBC network?"
One senior industry executive told EHI Primary Care that the changes marked the end of PCTs’ local leadership role on deciding what IT infrastructure and systems were needed to support the delivery of local health care. "In the local healthcare environment they will no longer have this role."
He added that Connecting for Health did not seem able to recognise or adapt to the rapidly evolving requirements of primary and community care. "CfH increasingly reflects a model of healthcare that looked quite dated even in 2000."
CfH needs to recognise the need to be far more flexible, he argued: "What are the system requirements of the new PCTs? At the moment CfH does not seem to address that at all. Other than those PCTs getting new community systems primary care doesn’t seem to be getting much of anything at the moment."