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CFH and the NPfIT: primary care update

1 September 2009

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National Clinical Lead for GPs
NHS Connecting for Health

Peter was appointed in January 2008 as one of two new GP National Clinical Leads (NCLs) at NHS Connecting for Health. Peter practises at the Stewart Medical Centre, Buxton, Derbyshire

Harold Wilson, the former Labour prime minister, is quoted as saying “a week is a long time in politics”. Perhaps this saying holds equally true in the present economic climate for the National Programme for IT (NPfIT), and NHS Connecting for Health (NHS CFH), the delivery agency.

New announcements, targets and changes in personnel do little to enhance confidence in the delivery of tools to support and promote clinical care, but the chief information officer for health has reiterated that there is no change in focus for NPfIT.

As clinicians strive to deliver the aspirations of better, safer care, we all remain aware that this will not become a reality without the supporting infrastructure, records systems and communication opportunities enabled by effective IT policy.

General practice and primary care have been, and remain, at the international forefront of effective IT use to manage, record, audit and improve healthcare. But is such a position sustainable without continued support, innovation, investment and a more widespread adoption of effective IT systems across the whole NHS? Probably not, but there can be no “going back” on the better use of technology to communicate and share appropriate information for patient care.

For the NPfIT, there are currently clear national clinical and political priorities identified for the coming year:

  • Roll-out of the Summary Care Record (SCR) service on a national basis.
  • Successful implementation of the Electronic Prescription Service release 2.
  • Accelerated deployment of effective and comprehensive IT systems into secondary care settings.

All three of these priorities have clear impact and relevance for GP and primary care IT strategy and development.

Summary Care Record
After a number of years of hard work, consultation, negotiation and learning lessons, the SCR is entering a phase of rapid expansion and deployment. The early adopter sites are starting to explore the options and benefit for creating enhanced SCRs. It is likely that such extended use will be uneven across England, as different areas concentrate on local priorities. These may include palliative care, chronic disease management, hospital admission avoidance and alternative care pathways, ie, out-of-hours (OOH).

Lessons learned from the early adopter sites confirm the need to have an SCR uploaded for a significant proportion of the population in order to make access from different care settings worthwhile. The technical “ease” of access to an SCR and reliability from alternative care settings is important for clinicians, and significantly increases the frequency of use and the contribution to the care process.

In order to implement lessons learned, the plans for the coming year will include:

  • Accelerated roll-out to wider areas.
  • Extending SCR upload functionality to other GP IT systems.
  • Develop “integrated” SCR access through OOH and secondary care systems.
  • Publicise “best practice” with regard to extended SCR creation and use.

Electronic Prescription Service (EPS)
The awaited progress of the EPS programme to release 2 will provide benefits to general practice that have not been noted by the technical innovations in EPS release 1. The first GP system (TPP SystmOne) is currently in the testing phase for the second release, and other major GP systems suppliers are due to follow suit.

As any failure of EPS systems to work reliably could produce a significant risk to clinical safety, there is extensive end-to-end testing to complete before approval is given for the service to go live. There is also likely to be a steady roll-out as early adopter practices need to be linked to pharmacies with compliant software systems.

Secondary care systems
The successful deployment of “enterprise” systems in secondary care is currently the major priority for NHS CFH. The north, midlands and east (NME) programme area is implementing the Lorenzo Regional Care product; and in London and the south the Cerner Millennium product is targeted for a new site implementation.

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It is likely that the deployment of such systems will be a major challenge for the NHS, local organisations and staff. The immediate priority will be to support the clinical and business processes of secondary care, but ultimately there will be significant benefit for GP and community care. The universal smooth electronic exchange of information between care settings is a key step to improving the safety and efficiency of care for patients.

As it will take new systems in secondary care a number of years to reach maturity and widespread deployment, a variety of “interim” solutions will remain to provide communication links with general practice. NHS CFH will continue to support the best use of such systems to provide communication and safe patient care.

Choose and Book
If measured by the number of referrals made, the Choose and Book functionality is an undoubted success. However, variations in uptake and usability from area to area need addressing. The recent release of a further upgrade is another step to improving functionality for clinical users, with the move towards searching for appropriate services using clinical coding rather than
inconsistent keywords.

NHS CFH is determined to maintain and further improve usability and performance to meet the needs of clinical and administrative users.

Shared electronic record systems
The keenly awaited release of a report by the Royal College of GPs on on Shared Record Professional Guidance in August 2009 will provide professional principles endorsed by all the major GP and community stakeholder groups. This may well prove a key document, providing research and professional opinion to guide the development and refinement of governance principles for use in the GP and community environment.

NHS CFH and strategic health authority chief information officers are committed to support these principles and incorporate them into requirements for GP/community systems.

General Practice Systems of Choice
The national agreement to fund a choice of practice systems has allowed GPs to continue to use preferred software from providers who follow an agreed strategic development path. During the coming year there is likely to be stakeholder consultation to review the strategy for ongoing contractual arrangements.

Alignment of communication between the systems, value for money, fitness for purpose, strategic fit and development priorities, are all likely to attract attention and comment. The GP Systems of Choice (GPSoC) roadmap is constantly under revision (see Resource).

The NHS has witnessed continued pressure and change over the last 61 years consisting of social, political, economic and technological developments. The 21st century has seen an obvious rise in the expectation of effective, safe and accessible care for an increasingly “consumerist” patient group.

Significant increases in financial investment have often shown disappointingly slow response and change in productivity and outcomes, resulting in us increasingly turning to technology and computerisation to help modernise and reform the NHS.

Primary and community care will continue to provide the bulk of patient contacts with the health service, yet remain challenged for resources by the new and relatively expensive services in specialist centres. In order to manage, prioritise and compare health services effectively, the GP and community IT systems will need to maintain and develop quality, reliability and usability.

NHS CFH is committed to supporting these objectives, and to enable secure, direct access to the information held within the patient’s health record. Thankfully, with the range of current GP system providers, this is a realistic and achievable objective. And the individual system suppliers continue to develop functionality to enhance clinical care, business efficiency and the patient experience, within an increasingly co-operative framework.

So perhaps the GP sector should be reassured that IT systems delivering significant contributions to healthcare will not be “swept aside” – rather, they will increasingly be encouraged into the NPfIT, conforming to common communication standards, and become integral to developing strategy.

NHS CFH must remain aware of the local innovative projects that offer local solutions, which are cost-effective and drive up care quality. Such developments have the potential to become next year’s strategic direction!


GP Systems of Choice Roadmap