NPfIT mandates LSP PACS solutions

The reclassification of PACS as a core service means that trusts are now mandated to use the LSP-provided PACS solutions under the contracts let by the NPfIT.  This appears to shut down the option for any English NHS trust to sign PACS contracts outside their LSP, even where they believe they can secure a better deal.  

Confirming that PACS was now a core mandatory service a spokesperson for the NPfIT told EHI: “The direction notice issued by [NHS chief executive] Sir Nigel Crisp on 11 September 2003 requires trusts to use the contracts let by the National Programme for IT in the NHS for core services and not enter into expensive new procurements."

Andrew Haw, IT Director at University Hospital Birmingham NHS Trust told EHI that the announcement PACS was now a core service helped clarify matters.  “It certainly clarifies the integration issues.  As long as you could buy PACS and Radiology Information Systems separately that introduced additional complexity."

The NPfIT spokesperson also confirmed that ‘core services’ equals exclusivity. “The National Programme contracts include an exclusivity clause for core services that were described in the output based specification (OBS) published in early 2003." However, the core services described in the OBS and for which contracts were let to LSPs were all meant to be fully funded centrally.

Significantly, despite the reclassification no extra central funding for the capital costs of the LSP’s PACS offerings will be provided to trusts beyond the £60m already committed for this financial year.  A spokesperson for the NPfIT told E-Health Insider: “Funding for PACS remains as originally discussed and agreed." 

An anonymous trust IT director told E-Health Insider that with the difference in funding arrangements there now seemed to be two categories of core services. “If P1R1 etc is hard core then PACS now seems to be soft core".

Commenting on the level of central funding he expected to receive to support his trust’s PACS implementation he said: “It’s not clear what degree of contribution will be coming from the centre, we’re assuming it will be between 1% and 99%."  He added that he didn’t expect any funding announcement until the national programme had collated all trust PACS business cases.

The national programme is emphatic that the contracts negotiated with LSPs for supply of PACS represent exceptional value for money, but this view is not universally shared by all trusts or clinicians. 

Another possible reason for the reclassification on PACS may be related to the fact that several trusts have been developing detailed business cases and looking to move forward PACS procurements outside NPfIT, and in some cases predating the programme.  One trust IT director has told EHI that he is certain his trust can secure a better deal on PACS than that negotiated by the NPfIT. 

E-Health Insider has learned, that many trusts have yet to see fully detailed prices for their LSP’s PACS solutions, making it extremely difficult for them to build a credible local business case for PACS. Essential when implementation is dependent on the trust committing significant local investment to meet revenue costs such as long-term storage.  

NPfIT contracts though are not designed to permit opt-outs.  The national programme spokesperson confirmed to EHI that LSPs will be paid a fixed price for PACS implementation across each cluster, even if some trusts do not implement the solution. “In the case of PACS, where the aim is to roll out to 100% of acute trusts within three years, the prices assume that the solutions will be taken by all local health communities."

Under this type of deal any trust following its own path could result in other local health communities facing an increased price for their PACS system.

Further steps to ensure that trusts take all NPfIT services and systems also appear to be imminent.  An NPfIT spokesperson told EHI: “It is likely that the deployment of the national programme technologies will, in future, be incorporated into the performance objectives of all NHS organisations."

PACS is due to be rolled out across the NHS in England by 2007 with the first wave of implementations now due in early 2005.