NHS trusts in London have been told they will get a dramatically scaled back programme of IT modernisation following the new contract signed with BT last week.

The new deal with the local service provider cuts £112m – or about 10% of the value of the original £1.1 billion contract – from the deal signed in 2003.

Yet in return for paying a bit less, the NHS will get far less delivered. Most strikingly, many fewer acute trusts will now get Cerner Millennium, and fewer community trusts will get RiO.

The requirement for BT to deliver new GP systems across the capital has been axed entirely.

The scale of retrenchment is spelled out in a 1 April letter from Ruth Carnall, chief executive of NHS London, in which she states: “Cerner and RiO will now not be available to all organisations.”

One IM&T director of a London trust, which had a Cerner implementation slot, told E-Health Insider it had been excluded with no explanation offered.

Trusts that do get the Millennium electronic patient record system will get it under the ‘New Delivery Model for Cerner’ that was trialled at Kingston and then St George’s “following the challenges faced at Royal Free.”

Carnall’s letter adds: “This means that we have the flexibility to deliver a locally tailored solution that will meet the needs of clinicians on the ground.”

Turning to primary care, the letter says: “The provision of GP solutions has been removed and this will now be supported nationally through GP Systems of Choice.”

BT had been contracted to deliver new GP systems, supplied by INPS, to all 1,500 practices in London. It delivered barely 100.

For RiO, the letter says "we have secured two further software releases plus regular configuration releases" for the 50,000 users of the software in London.

Carnall acknowledges that cost reductions mean that the original objective of a comprehensive, integrated London solution will no longer happen.

Instead, more limited sharing of patient information will now rely on the national Summary Care Record.

A further key element dropped from the new contract is a new ambulance solution for London. And there will be no renewal of the Map of Medicine contract when it expires in 12 months’ time.

The original BT LSP contract covered all acute trusts in London. Of the 32 acute trusts remaining following mergers, approximately half will no longer get Cerner Millennium.

Eight London trusts now run Cerner, of which BT delivered six. It is expected to deliver a maximum of ten more.

About 10 of the remaining trusts had been planning to stick with their existing iSoft, IDX or McKesson systems, but others have been told they will get nothing.

Carnall’s letter states: “I know that for some trusts a solution delivered through the programme was not the preferred route, but for others, it will mean a re-think of their strategy.”

One, small, specialist trust suddenly left out in the cold is the Royal National Orthopaedic Hospital NHS Trust, which had been planning on replacing its iSoft-badged Silverlink PAS with Cerner.

Dr Saroj Patel, the trust’s director of IM&T, told EHI: “The contract expires 2011-12 and we were planning to take Cerner under the LPfIT contract. We have had a nominal slot but were told a few weeks ago that we will not be offered Cerner due to the budget cuts.”

Dr Patel said the decision appeared arbitrary and left the trust without a route to implement an EPR. “There has not been any other explanation or any information on what criteria was used to include trusts in CCN3 and the criteria used to exclude them.”

She added: “We definitely do need to move to implement an EPR. This is in our three year strategy, particularly as there has been ministerial announcement to confirm a rebuild of RNOH at the Stanmore site. We are therefore having to completely rethink our strategy.”