On the road

  • 24 October 2006

Mike PringleFiona Barr

The National Programme for IT is at a “tipping point” and will soon be delivering the success stories it initially promised, NHS Connecting for Health’s GP clinical lead Professor Mike Pringle has told EHI Primary Care.

In an interview to mark the beginning of a set of 22 engagement forums in 11 cities throughout England, Prof Pringle says that the workshops are an opportunity for those in primary care to hear about what CfH is doing.

He adds: “At this stage I believe we are close to the tipping point in terms of products and successes which will persuade people that CfH is going to be successful, it is going to deliver and it is going to be well worthwhile.”

So far there has been one set of workshops, in Newcastle, and the next will take place in Leeds this Thursday 25 October, with 100 people booked into the afternoon session and 25 for the evening forum. The sessions are designed to cover progress so far on NPfIT and what those working in primary care can expect next from CfH.

“We want to hear about how people are responding to what they are getting from CfH and what they want from what’s coming through in the next 12 months or so.”

Challenging questions

Professor Pringle acknowledges that the hour-long question and answer sessions in Newcastle generated some “challenging" questions about NPfIT, with audience concern focusing on Choose and Book and GP Systems of Choice (GPSoC).

The promise of system choice for GP practices, included in the 2003 nGMS contract, has been a long time coming and the prospect of another delay has loomed lately with the announcement that GPSoC, intended to be ready for April 2007, must now go out to tender for suppliers to take part in the project.

However, he is confident that the April 2007 deadline will be met: “We have to get Treasury approval but we don’t think that in itself will be a problem and we then have to get for OJEU [Official Journal of the European Union] procurement but I don’t see any reason why that shouldn’t be in place by April next year.”

The delays in delivering a model for system choice have left GP practices in some parts of the country under pressure to move either to their local service provider’s preferred GP solution or to its ‘alternative’ provider.

For GPs in the North East and Eastern Clusters, under the control of Accenture who are now about to leave the programme, this has meant more than 200 practices have switched to TPP’s SystmOne product, Accenture’s ‘alternative provider’. The new LSP for the northern clusters, CSC, which already runs the North West and West Midlands cluster, has suggested that it will continue with TPP in the North east and Eastern areas but no announcement has yet been made on its own cluster.

Professor Pringle raised the prospect in his talk to Newcastle that TPP could become the alternative provider but told EHI Primary Care that he did not know what would happen.

However, he added: “GPSoC will be in by April and then the alternative GP solution will be much less significant as it will be a much more open market place.”

With system choice as a possible good example, Prof Pringle argues that the experience of CfH for those working in primary care has been very different in different parts of the country.

“Some people have had a lot of problems with, let’s say, Choose and Book and other people have not had a problem at all.”

On Choose and Book Professor Pringle says he has no information about whether the Department of Health will meet its target for 90% of bookings to be through the system by March next year, although he believes that, in time, resistance from within the profession will be overcome.

However he also highlights areas where primary care trust referral management centres are handling all bookings via Choose and Book, in contradiction to what he describes as the philosophy of Choose and Book which is that choice discussions should take place in the GP surgery.

He adds: “One of the other things that came out very strongly in Newcastle was that the Directory of Services is crucial. Some of them are very useful and some of them are less useful.”

Contents of CRS and opt-out

The other key area which the meetings are designed to cover is the NHS Care Records Service, the focal point of what CfH must deliver and one that has been a subject of some contention, with concern concentrated on the security and confidentiality aspects of the records system.

Current plans are for the Summary Care Record to be set up using an implicit consent model, with a GP summary automatically uploaded to the spine following a public information campaign inviting patients to opt-out. Patients would then have a further chance to opt-out and check their summaries as they present opportunistically in the surgery.

At the Newcastle workshop Professor Pringle set out the advantages of such a model – one that is similar to working systems already running in Hampshire, the Wirral and Scotland.

However the model continues to be opposed by the British Medical Association, the General Practitioner Committee and the Royal College of General Practitioners who want all patients to be given the chance to opt-in to the SCR. The GP clinical lead told Newcastle participants that the opt-in model would create a significant workload for GP practices, would create a lag before summaries were available and had been used and abandoned in the province of Alberta in Canada.

Professor Pringle says the consent model is currently under review as part of Harry Cayton’s ministerial review of the NCRS, due to report at the end of November.

He adds: “We had a vote in the afternoon meeting about which model the audience would prefer and it was 100% in favour of opt-out. Of course that’s just a straw in the wind and these meetings are not going to be making policy but the meeting was an opportunity to explain to GPs what the debate was about because many of them are a bit bewildered about it.”

Sealed envelopes

The engagement forums are also being used to outline the latest thinking on sealed envelopes, the device that will be used for Detailed Care Records to hide information on records that patients do not feel happy to share.

The new policy is to have a two tier system of information deemed “sensitive” or “extra sensitive”. If a patient says part of their information, or their whole record, is sensitive it will be hidden but another doctor in the practice or outside the practice will be able to see that there is a sensitive item and can ask for consent to view it.

If a patient says part of their information, or their whole record, is ‘extra sensitive’ the information will not be shared and while another doctor in the practice will see that there is a non-shared item and can ask for consent to view, anyone from outside the practice will not know it is there.

Prof Pringle says a CfH work stream has been working on the concept of sealed envelopes which are due for delivery in 2008.

“There was a call for a simplification of the proposals which were getting very very complex and unwieldy. This simpler and more practical methodology has been proposed and accepted.

“In Newcastle we asked people if they thought it would work for their practices and they were very positive about it. People were also expressing their long-standing concerns about information sharing and whether it’s a desirable thing to do full stop and from my own point of view I was able to set out what I believe will be the very considerable gains.”

In conclusion Professor Pringle claims he and Dr Braunold, his co-GP clinical lead, are very much looking forward to the remaining workshops.

“It’s an opportunity for people to see the big picture. A lot of what CfH is trying to do is what they want and a lot of what they have already got from CfH is what they want.”


The GP engagement forums

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