Dr Peter Short and Dr Manpreet Pujara
Dr Peter Short and Dr Manpreet Pujara

Dr Peter Short, one of two new GP clinical leads just appointed by Connecting for Health, is clear about how he will measure his success in the job.

“When I go back to full-time clinical practice in two years time I hope my colleagues will say to me that it is working a lot better than when I started two years ago.”

For Dr Short and Dr Manpreet Pujara, the other newly-appointed clinical lead, the attraction of the job is the chance they believe it offers to deliver improvements to the lives of patients and clinicians through the use of IT.

Dr Pujara: GP clinical lead ‘a new challenge’

Dr Pujara is a GP in Rochester, Kent, and comes to the role having spent the last few years as chairman of the EMIS National User Group (NUG), leading criticism of the National Programme for IT (NPfIT) strategy on GP system choice. Charges of being poacher turned gamekeeper may not be entirely appropriate however since, perhaps with a lower profile, he has also been working on the inside of the programme for several years as a member of CfH groups on programme such as GP2GP, the Electronic Prescription Service and Choose and Book.

He says: “I resigned from being NUG chair mainly because GPSoC was signed up and I thought it was the ideal time for me to move on and look for a new challenge. I proactively went for this job and I will measure success not just in terms of usage but in terms of how comfortable I feel with where we get to.”

Dr Short: Getting GP lead job ‘bit of a surprise’

In contrast Dr Short says he spotted the advert in the BMJ and it came as “a little bit of a surprise to me and my partners” when he got the job. Dr Short brings with him some medico-political credentials as former deputy chairman of Derbyshire Local Medical Committee (LMC) but has also some previous experience of working with CfH, as one of 12 GPs sent to Chennai in India by CfH in 2005 to work on the development of iSoft’s Lorenzo system.

That experience taught him that clinical input was essential to the development of systems and that clinical engagement in all forms must be an ongoing priority for CfH.

He says: “What’s worrying are these surveys that suggest there is less feeling of involvement from GPs. I’d like to see a ramping up of engagement and see how we can get GPs more involved and how we can convert that into benefit for the programme.”

NLOP can help clinical engagement

Dr Short hopes that the introduction of the NPfIT local ownership programme (NLOP) will encourage PCT and strategic health authority chief executives to put a priority on clinical engagement.

For their own part the two GPs are taking part in a programme of primary care updates being conducted by SHAs and plan to keep in close contact with GPs both via the GP IT systems national user groups and through the BMA’s General Practitioner Committee and LMCs

Dr Short says regional GP leads for CfH will also feedback information to the centre and that their will be more formal arrangements for a two way transfer of information from PCTs.

Engagement currently ‘very variable’

The doctors believe engagement with the national IT programme is very variable among GPs and accept that some GPs are disillusioned.

Asked how they would seek to turn around the views of those GPs Dr Pujara says: “I would say to them what are the alternatives? In the two presentations I have given so far I have felt very comfortable talking about my own experiences, how we use technology and where things work and don’t work.

Think about things like Choose and Book, 18 week waits and free choice? If you want to give patients’ choice and you want to be informed yourself about what’s out there you can’t do that in a non-IT world.”

GPSoC shows CfH listening

Dr Pujara says the agreement on GP Systems of Choice, which guarantees IT system choice for practices, is an indication that CfH is listening to what GPs need. He and Dr Short hope it will enable GPs to make better informed decisions about the merits of their existing system against what local service providers have to offer both now and in the future. In the future Dr Short predicts that decisions about choice of IT system will move away from single practices as groups of practices take a more corporate approach about the systems they need to provide not only clinical support but also deliver high quality information in their role as commissioners.

Integrated systems across primary and secondary care, still the aim of CfH and high on the agenda of many PCTs, will have to prove their worth to practices.

“Single systems have to bring benefits for both patients and clinicians,” Dr Pujara says.

In some parts of England practices are already beginning to share information across primary and community care. Dr Short describes such developments as exciting but also warns that the profession needs to move incrementally as it gets to grips with the implications of sharing records.

Slow but steady build on SCR

Asked whether they support CfH’s current consent model for the Summary Care Record, both emphasise the importance of moving slowly and winning the support of colleagues.

Dr Pujara adds: “The important thing is the informed patient. If PCTs have gone through all the steps and talked to patients I am reasonably comfortable with that but we have feedback coming through and we need to keep looking at the consent model.”

Back on more concrete ground the GP clinical leads are keen to promote the potential benefits of both the Electronic Prescription Service and GP2GP.

Dr Pujara has been involved in EPS for several years and suggests that although release 2 has been delayed by a few months, he hopes it will become available for many practices over the next 12 months.

Benefits of EPS now within reach

But he adds: “The benefits also relate to the priority general practices puts on some of the changes that have been made. For example we have had paper-based repeat dispensing for some time but it’s not used as much as it could be. Electronic repeat dispensing is part of release 2 but patients and practices won’t get the benefit of that if we don’t get them to look at this system.”

On Choose and Book the GP leads are happy to play a trouble shooting role and Dr Short is well aware of the impact of other NHS initiatives that have led some hospitals to limit appointment slots in order to meet waiting time targets.

“Choose and Book is taking the flack for implementation issues that are nothing to do with technical and software issues,” he says.

Into the ‘firing line’?

The problems with e-booking are just one example of the difficulties inherent in the role of a GP clinical lead. Last week Prof Mike Pringle, their predecessor as GP clinical lead, described the job as “three years in the firing line” so perhaps there is some comfort in the fact they have only signed up for two rather than three years.

“It’s a huge challenge,” says Dr Pujara. He adds: “There is also an element of how much control we have as policy is not dictated by CfH. But we intend to do our damnedest to provide what clinicians and patients want.”


Fiona Barr