Clinical commissioning groups have one big priority and one big problem when it comes to IT and information.
The priority is to enable better information sharing across the health economy. The problem is that they do not know where the funding will come from to enable them to do that. Or who is going to be responsible for the infrastructure, services and systems that will be needed to do it.
Joined up
Last month, EHI Primary Care conducted an exclusive survey of GPs, CCG chairs, board members, IM&T leads, and others involved in commissioning. It found that 82% hope that IT will help them to provide better clinical information to GPs over the next three to five years.
Areas for investment include clinical dashboards, on which 65% of respondents are expecting to spend money on in the next three years, plus tools to share information with secondary care (58%) and tools to share information with community services (49%).
Dr Saj Azfar, Rochdale GP and clinical IM&T lead for Heywood, Middleton and Rochdale CCG, says his CCG is working with neighbouring Bury on its IT plans.
The two areas hope to invest in the Medical Interoperability Gateway jointly developed by GP system suppliers INPS and EMIS, as between them they have a mixture of INPS Vision and EMIS systems.
Dr Azfar adds: “We want to become more interoperable with other systems and are trying to model ourselves on Cumbria [the area where the MIG was first launched].”
He says that the local community and mental health provider, Pennine Care NHS Foundation Trust, which last year pulled out of plans to implement the Lorenzo electronic patient record through the National Programme for IT in the NHS, has also shown interest in the MIG and is keen to work on information sharing with its CCGs.
Calling on telehealth
Getting the IT infrastructure up to scratch is another priority in Rochdale, and one that 60% of the 90 plus respondents to the survey want to invest in by 2015.
Despite recent question marks over its take-up and effectiveness, 48% of respondents also predicted they would be investing in telehealth and telemedicine products.
David Cripps, a board member of West Suffolk CCG, said that he would like to see investment in telehealth, with the local hospital possibly acting as the provider.
He adds: “We are not going to be able to keep pace with the number of consultations unless we have an awful lot more GPs – and they aren’t available and they are also expensive.
“There is a community of silver surfers out there who are IT savvy and telehealth is going to be very useful for these people.”
But wondering about the money
Despite having plenty of ambition, however, respondents were less universally confident about whether the funds would be available to complete their priority IT projects. Just under one in ten (9%) were confident or very confident about having the money they needed, 43% said they were ‘fairly confident’; but 42% were not confident.
Cripps argues that while there are opportunities to make changes that will benefit patients and potentially save money, it will be far from easy.
He adds: “We have got to be allowed some space to get things wrong, which is always going to be hard in such a tight financial environment.”
Uncertainty about funding for NHS IT as a whole and funding of GP IT were two major concerns highlighted by the survey.
Roz Foad, chair of the British Computer Society’s Primary Healthcare Specialist Group, said her personal view is that uncertainty over what will happen when the current GP Systems of Choice arrangements end next March remains the biggest concern.
She adds: “It is widely acknowledged that there has to be replacement, but we still have no real indication whether this will be at a national or local level, and what the funding arrangements will look like.
“Will CCGs be allowed to mandate all their practice members to use one system? I want to know if the individual GP practice will retain the right to choose their system; but until we get more guidance, it is a worrying time for all.”
NHS information strategy prolongs the wait
Dr David Wrigley, a member of the BMA GP committee’s IT sub-committee and a board member of his local CCG in Carnforth, Lancashire, argues that GPs’ interests would better be served if CCGs held the purse strings rather than a more remote, national body.
The difficulty for CCGs at present, he says, is that no-one knows how IT will be managed and resourced in future and argues that the need for more clarity is now pressing.
Elizabeth Wade, head of commissioning policy and membership at the NHS Confederation, agrees that there are on-going concerns about how primary care trust functions such as estates and IT will transition to the new model.
She adds: “It’s not necessarily obvious which bit of the system they will transition to and if, for example, on IT infrastructure it’s CCGs. Is that going to be affordable, and to what extent will it be covered by CCG management costs?”
As the publication last week of the government’s NHS information strategy has not shed light on such questions, it would seem CCGs may have to wait and see on these questions for a little while longer at least.