Kathie Applebee
BA(Hons) MSc DMS
Psychologist and Management Consultant
Strategic Management Partner (part-time) at the Callington & Gunnislake Group Practice, Cornwall
Kathie juggles her own primary care consultancy with a part-time partnership in a large, rural practice. After 27 years spent working nationwide with practices and PCTs, she can testify to the fact that each year in general practice is busier than the last. When not working, Kathie rides her horse on Bodmin Moor and tries to forget about work
Practices will soon need to be able to demonstrate high-quality data and robust information governance processes before being able to become part of the wider NHS shared records’ service.
Personal Spine Information Services (PSIS) includes the central database, which is due to contain clinical records for each English NHS patient. Each person’s “spine” record will provide an up-to-date summary of their healthcare – drug allergies, operations, conditions, medication history – and details of their contacts with various care providers.
The direct enhanced service (DES) is designed to help practices review their data collection methods and quality, and establish whether their information governance systems are sufficiently robust to meet NHS standards. It also encourages practices to move towards use of the electronic prescription service (EPS) and to consider hosted systems instead of practice-based computer servers.
The funding of the DES (see Box 1) is designed to provide protected time for team members needing training, support for new practice computer users, and any required adjustments to the practice’s skill mix.
[[MiP06_box1_27]]
The DES is divided into four components: the practice plan, the data quality accreditation process, the EPS (and the associated checking of patients’ addresses) and migration to a hosted system. Each component is payable only on satisfactory completion (there should be no aspiration payments), and all payments are due to be made by 31 March 2008. This means your practice will miss out if you don’t meet the various requirements and submission dates on time (see Box 2).
[[MiP06_box2_27]]
Component 1: the plan
Component 1, the plan, is a prerequisite for the other three components: payments of these later components depend on the plan being submitted on time and being approved. It must include proposals for the practice working towards achieving Component 2 (data quality), Component 3 (EPS and address checks) and migration to the N3 network.
There is no need to include an element for working towards Component 4, moving to a hosted system, but Component 4 itself will not be paid unless the practice actually does move to an approved hosted system, either before or after submitting a satisfactory and timely plan.
The plan needs to contain the following elements:
- The name of the practice lead for liaison with CfH (Connecting for Health).
- The name of the practice’s Caldicott (information) guardian.
- An agreement that these roles will be maintained by the practice and the primary care trust (PCT) advised of any changes to named individuals.
- A training needs’ assessment and associated training plan for each NHS computer user in the practice, and a commitment to implementing these training plans.
- Written records of inhouse training events, signed by those attending.
- Evidence of practice compliance with information governance requirements.
- Practice proposals for reaching any outstanding data-accreditation standards.
- Systems for maintaining accurate patient addresses.
- Plans for participation in the EPS, if not already activated.
- A stated willingness to migrate to the N3 network (the high-speed NHS connection), including any hardware upgrades necessary for this move.
- A declaration that all existing users are authenticated and are registered as Smart Card users, and that all new users will be.
- Agreement to the exchange of any relevant information between the practice and the PCT relating to the DES, and the practice’s acceptance of monitoring by the PCT.
Component 2: data accreditation
Before applying for data accreditation, the practice must be “paper light” – that is, using computers rather than paper for recording contemporaneous patient data. PCTs will need to verify that the practice meets the paper-light standards of the Good Practice Guidelines (chapter 8 and appendices 4 and 5) – see Box 3, opposite.
[[MiP06_box3_27]]
The first stage in the accreditation process requires practices to submit a request that states they are ready to be assessed. If the practice has not yet been approved as paper light, appendix 5 of the Good Practice Guidelines contains a model application letter for this, which should be included.
The practice will also have to submit evidence of the various required protocols (see below) and have submitted the MIQUEST query audits, which are available from PRIMIS+.
These audits are automatic searches, which run on all the major GP computer systems. They collect relevant patient data (for example, they look for patients on insulin who don’t have Read codes for diabetes) and then remove patients’ details so that anonymised results can be sent to PRIMIS+. The data analysis staff at PRIMIS+ will then make these e-audits available to the PCTs, who will in turn appoint assessors to visit your practice and review any areas above or below expected levels of data entry (see Box 4).
[[MiP06_box4_27]]
The evidence required in addition to the e-audits includes:
- Evidence of adherence to the Good Practice Guidelines for paper-light consulting (as agreed with the PCT).
- Protocols for:
– Updating patients’ addresses opportunistically.
– Locum use when entering patient data.
– Summarising records promptly from patient-related correspondence and messages.
– Disaster-recovery procedures. - A log of inhouse training events (which should include the induction of new staff, locums and relief staff, and a signing-off process for each person).
- A training log for each member of the team, linked to their individual training needs’ assessments.
- Evidence of the information governance self-assessment tool having been completed on behalf of the practice (the PRIMIS+ website has further information – see Resources).
When the PCT assessor visits the practice, he or she will need to do qualitative checks of a cross-section of records from each clinician who consults on a regular basis (not just the GP principals). They may also wish to review the areas associated with the other evidence submitted.
Once achieved, accreditation lasts for three years. A shorter period may be used in certain circumstances if the assessor feels that this period is too long. Any practices that fail can either appeal against their failure or reapply for accreditation.
Components 3 and 4: EPS and addresses, and hosted servers
Practices not already approved for EPS will need to:
- Access essential training.
- Identify any resulting changes in working practices and implement these.
- Amend any associated standard operating procedures (SOPs).
- Provide patients with information on any changes to their prescription-collection arrangements.
All practices requiring payment for Component 3 will need to be using the current version of the EPS software (EPS Release 1) and commit to using EPS Release 2 if this is still outstanding at the time of their claim.
The addresses’ requirement includes protocols and processes for validating patients’ addresses and other demographic details at the point of referral, and/or when a practice receives information about a patient that contains a different address from that which is already held.
For Component 4, practices will need to demonstrate they have N3 connections and are using approved remotely hosted servers instead of practice-based ones.
Resources
PRIMIS+ IM&T DES portal
www.primis.nhs.uk/data-accreditation
Information governance toolkit
www.igt.connectingforhealth.nhs.uk
Good Practice Guidelines for General Practice Electronic Patient Records v3.1
(Department of Health; July 2005)
www.dh.gov.uk/assetRoot/04/11/67/07/04116707.pdf
Your GP system supplier may provide assistance in the form of training needs’ analyses and training plans. Your PCT should be providing PRIMIS+ or other facilitators to help with data standards, and will provide assessors for Component 2 of the DES.
