Primary care trusts (PCTs) in some areas of northern England have set out plans to move all GP practices onto a single system, TPP’s SystmOne, as contracts for the GP Systems of Choice (GPSoC) initiative are about to be signed.
More than a dozen PCTs in the North-east have published IM&T plans which outline the desire to move all practices onto SystmOne by 2011 and East Midlands Strategic Health Authority has told its nine PCTs not to offer free choice through GPSoC ‘by default.’
The SHA has also instructed its PCTs to consider retaining ‘ownership’ of whichever primary care systems are adopted to control what providers do with the systems and to enable access to patient information.
In a paper seen by EHI Primary Care, Dave Marsden, East Midlands director of strategic IM&T, says there are a number of key strategic issues that PCT boards should consider before proceeding beyond the initial sign-up of existing GP systems under GPSoC.
The paper states: “Whilst there is a clear provision under nGMS contract for GPs to have a choice of system it would seem reasonable for the PCT as the commissioner of GP services to have a view about which of the 8/9 systems they might prefer GPs to use.”
Marsden cites the clauses in the nGMS contract which state that each practice will have guaranteed choice from a number of systems but that such choices will be consistent with local delivery plans and in line with local business cases and service level agreements.
He adds: “In the light of this it could be argued that a PCT has the option to ‘encourage’ its GPs to move to a shared primary and community care system such as TPP’s SystmOne which is already deployed in seven out of nine of our PCTs and will be deployed for all community services by March 2008.”
The paper adds: “Clearly this is a sensitive area and we understand that there are multiple pressures on PCTs. The SHA view is that PCTs should discuss this and form a view rather than adopting free choice by default and that that view should be revisited on at least an annual basis.”
Dr Paul Cundy, co-chairman of the Joint IT Committee of the British Medical Association and the Royal College of General Practitioners, said he had seen the letter from NHS East Midlands.
He told EHI Primary Care: “We have shared it with Gillian Braunold [Connecting for Health’s joint primary care lead] and she has confirmed our view that the letter is unacceptable. It should be withdrawn or ignored…It is completely at odds with our contract with government and agreement with CfH.”
On ownership of systems, the paper from Marsden says PCTs have a key decision to make.
It adds: “PCTs have a choice between allowing providers to own the system and to independently configure it for themselves in their best interests or to own it as a commissioner system that is configured to ensure that providers (only) do what providers are required to do.
“Further if commissioners retain ownership of the system and require (all of) their providers to use it they will have real time access to information on (all of) their patients.”
Marden made plain in a statement to EHIPC, however, that the SHA was fully committed to the implementation of GPSoC which the authority saw as a major step forward for GP computing.
He said : "My briefing note to PCTs was intended to remind them of their responsibility to take a strategic view of GP IT which will be used to inform their discussions with practices about their future choice of system. This was the intention of the statement: ‘that PCTs should discuss this (GPSoC) and form a view rather than adopting free choice by default’.
"I appreciate that this has been interpreted otherwise and hope that this clarification will allay GPs’ concerns."
Dr Gillian Braunold said:" I am pleased that Dave Marsden has been given the opportunity to clarify his position. His choice of words regarding choice was unfortunate but the paper as a whole is supportive of GPSoC and emphasises the need for PCTs to invest in the training and implementation activity that they will need to undertake in support of GPSoC.
"Under GPSoC practices will be able to confirm their choice of system and will be able to retain their existing system or migrate to an alternative once they have agreed a business case for migration with their PCT."
NHS North East IM&T plans written in May show that at least 14 PCTs wish to move all practices onto SystmOne.
The plan for County Durham and Darlington PCTs states that, as of March 2007, there were 20 practices using SystmOne, 50 practices using EMIS, 10 practices using INPS Vision and six practices using iSOFT Synergy. The trusts’ migration plan is to move to a position in 2009 where there are 60 SystmOne practices and 25 remaining EMIS practices and 2011 where the entire community is covered by SystmOne for general practice as well as community, child health and prison systems.
The plan states: “The overall plan for clinical systems aims to standardise on TPP SystmOne, deploy TPP SystmOne to all community staff (including community hospitals), all general practices, all prisons, all unscheduled care services, all child health teams, Ensure TPP SystmOne is integrated to other NHS systems and to social care systems.”
The identified benefits include reduction in maintenance and server replacement costs, availability of a single patient record with integration across primary care, enabling appropriate information sharing and more effective data collection.
It acknowledges that a key risk to the plan is that “GPs are not willing to change to the strategic solution”. The plan identifies financial savings for the PCTs in excess of £600,000 by 2010/11 if the switch is made.
The IM&T plan for Tees local health communities states that a migration path towards a single strategic solution is planned by 2011 with TPP remaining the strategic solution for PCTs, a strategy which it says be reviewed when Lorenzo 3.5 becomes available in 2009.
The current plan for migration includes moving all practices in Middlesbrough to TPP by 2009 and all practices in Hartlepool and North Tees by 2010,
Similar strategies are outlining by other PCTs in the region including Newcastle and North Tyneside PCTs. The plan for the North of Tyneside local health community states that all three North of Tyneside primary care organisations have board level agreement on the LSP Phoenix system (SystmOne) being the strategic GP system of choice.
The IM&T plan states: “The Phoenix system is therefore being rolled out to practices on an ongoing basis, as and when practices make a choice to migrate to this system. Practices are being encouraged to consider implementation of Phoenix, but the actual pace of implementation is being dictated by choices made by individual practices within the framework of GPSoC.
"The first seven practice implementations of Phoenix have taken place in 06-07. At the time of writing, a further seven implementations are being planned following written letters of intent being received. It is expected that this number will increase very significantly throughout 07-08 and beyond.”
Last week CSC, local service provider for the North, Midlands and East, announced that it had reached 600 installations of SystmOne in the region.
Leigh Donoghue, CSC’s director of primary care, told EHI Primary Care that in Yorkshire and the Humber 30% of practices now use TPP and 20% in the East Midlands.
He added: “The momentum for deploying these systems, which first began when Accenture was the local service provider to the North-east and Eastern cluster, has continued to thrive in CSC’S NME [North, Midlands and East] Programme for IT patch and across the region, take-up of the TPP system is building.”