I am effectively a poacher turned gamekeeper. I have a background of complaining about the National Programme – and yet I am now one of its GP national clinical leads. This makes me particularly well placed to listen to GPs’ experience and to make sure that it feeds into delivering the most clinical benefit for patient care.
GP user groups are leading the way in terms of what is possible for information systems in practice. I am an additional advocate on behalf of my profession, representing its choices and suggestions at a senior level within NHS Connecting for Health, to deliver the patient benefits GPs really want to see.
GP Systems of Choice
GP Systems of Choice (GPSoC) allows surgeries to have a choice of systems to deliver maximum clinical benefit and avoid unnecessary system changes. This has led to a secure future for systems that have met national priorities, while at the same time meeting local needs and giving improved value for money for taxpayers.
Difficulties remain, of course; but many of these arise from historic experiences and, in some parts of the country, from a rather short-sighted strategy of enforcing “top-down” change without clinical justification.
Worldwide experience shows that the engagement, trust and “ownership” of clinical system implementation by users are key to success and to the early delivery of benefits. GPSoC reflects this need by allowing GPs to stick with their existing system, as long as it develops to meet the needs of the NHS.
Choose and Book
Choose and Book was the earliest exposure that many GPs had to the National Programme. Many felt the advantages were, at best, limited – even for patients. It required a significant time investment from clinicians and GP administrative teams; although when it works well, patients seem to like it.
Nowadays there is a slow but steady shift in opinion. There is much wider, if sometimes reluctant, acceptance of the system. Around 91% of GP practices currently use Choose and Book every month and more than 8 million referrals have been made via the system.
Some GP practices continue to have problems with local technical issues, but more of my colleagues feel their problems are being taken seriously, and acted upon. Hospitals are required to make sufficient slots available, as well as describing their services in ways that make them easily searchable in order to secure “business.”
Difficult issues of consent
At roadshows across the country, doctors and other NHS staff have articulated their worries about the governance of shared records, security and consent. I am involved in discussions about the Summary Care Record (SCR), which enables NHS professionals, such as those operating in emergency or out of hours care, to access basic information about patient medication, allergies and – eventually – significant medical history.
I welcome the recent University College of London evaluation report, which has given us all some very important points to consider. Some clinicians and patients have been very vocal on the subject, but for me the crucial issue is that the solution needs to be jointly owned and understood by clinicians and patients, and to work for both groups.
NHS CfH is commissioning independent work to update guidance on medical record sharing and governance to progress this issue.
An additional future challenge is the changeover to the SNOMED clinical terms. There are always valid concerns about the risks surrounding data migration, and NHS CfH is working to assess these risks and support the development of new ways to enable efficient coding using SNOMED in the clinical consultation.
With common coding, the exchange of information will be easier and safer across care settings, and along with GP2GP transfer, it will reduce the administrative burden on practices.
Don’t grumble, criticise (constructively)
Recently GPs in the East Midlands told me that they needed practical resources to help them maximise the benefits of current and new systems, as well as an overview of how different programmes work together.
All practices are at different stages of development and, in the areas where there are problems, my priority is to establish a system to engage with practices in a consistent, effective way that supports the change management process.
We have to be upfront with GPs about the risks and benefits involved in these ambitious changes, and to remain open and honest about lessons learned from pilots and early adopters. All practices should be actively encouraged to use telephone helplines and support desks in order to report any errors, deficiencies and faults.
The culture of grumbling and “working-around” system deficiencies – but not filing reports – needs to be replaced by the “open” attitude of constructive criticism. As in clinical practice, it is usually the system at fault rather than the individual!
Looking to the future
What do we expect the surgery of the future to look like? There will be an increasingly wide diversity of professionals working there, including nurse practitioners and healthcare assistants, who will often take on many of the tasks previously done by GPs.
The front desk and waiting room will be quieter, as patients will not have to make multiple visits. An increasing number of patients will communicate with their doctors via electronic channels, receive text messages for their appointments and regularly monitoring their health at home.
Patients will have access to care plans and self-help resources and be able to compare their care with NICE guidance. In the consulting room, biometric measurements will be inserted directly onto the patient’s record while the patient and doctor agree management plan changes, supported by “online” guidance and material.
In my experience, GPs want and need to be kept informed about changes at the right time for their surgery, as well as knowing how to escalate issues when difficulties arise. As a professional group we have high expectations for systems that focus firmly on clinical care, but which also support surgery and wider NHS business processes.
Only by listening to GPs, using their feedback and experience, and ensuring that they are properly supported, can we ensure that better, safer patient care facilitated by IT becomes a reality for all.