Why GPs face Hobson’s choice

The question of what constitutes a choice is now central to the future of general practice computing, a field in which the UK has been a world-leader over the past two decades.  Will the future of GP IT be a world of entrenched monopolies or a market that provides meaningful choices to GPs and which can continue to deliver innovation and active clinician commitment?

In an exclusive interview with E-Health Insider, Sean Riddell (right), deputy managing director of EMIS, the current market leader in the GP systems market, says that GPs are being denied the choice of systems promised to them in the new GP contract and reaffirmed in an April statement by the BMA and NPfIT.

He said that the August NPfIT policy document ‘Initial Guidance to Existing Suppliers’ provides the clearest statement yet that the NHS in England is fast heading for an oligopoly based on two regional monopolies.

Commenting on the guidance Riddell said: “This will create a situation in which ultimately there are just two GP systems in England and people will be coerced into using them."

Single systems

He noted that while the NPfIT document appeared to just offer an interim ‘either/or choice’ on GP systems, its clear underlying aim was to move over two to five years to single LSP systems in which primary care “is just another department" of the unified system offered by each LSP.

“In the North you can either have iSOFT’s Lorenzo, once it’s written, or Torex’s Synergy Enterprise.  In the South you can have the IDX Solution’s product, once it’s written, or In Practice Systems – which again is a choice of one."

Riddell said that the new guidance to suppliers was clearly against the letter of the GP contract which pledged a choice of systems, a commitment reiterated in the joint BMA/NPfIT April statement which reaffirmed the principle of GP choice.

“GP choice was clearly stated in the GP contract and in the April agreement, which made clear that this meant clinician choice – and not NHS IT managers or PCT executives," said Riddell. 

“For GPs, the guidance comes down to the Ford choice: you can have any colour you like as long as it’s black."  Anyone choosing anything other than the black Model-T will have to pay for it themselves and may find their alternative barred from being allowed to connect to the spine.

GP contract

Asked why he believed NPfIT seemed to have rowed back on the GP contract commitment to offer GPs a meaningful choice of systems, Riddell said: “With this clear direction of travel to single systems, and politicians being told that the programme will happen, why offer choice?"

He added: “The LSP and NHS cluster has to want you to be offered a choice, and they only want to offer the minimum choice."

Asked why EMIS had not signed contracts with any of the LSPs, Riddell replied. “There has been an assumption that the ball is in our court, but this is a two-way street. In the South it’s the NHS cluster that does not wish to be more inclusive in their offering."

Even if clusters do offer a wider choice of GP systems, the latest NPfIT guidance makes clear that even compliant alternatives are not intended to be anything other than a short-term option. “You have this area of existing systems that, if made compliant, can interact with the spine for the next two to five years," said Riddell.

The NPfIT guidance states, however, that within two to five years only LSP systems will be allowed to connect to the spine, effectively switching off the access route for other application suppliers. 

“After that the only way they can operate is by being integrated into an LSP’s core system. Given the nature of the contracts the question is why should an LSP want to become more inclusive or to offer choice?" 

Standardisation

Commenting on the policy of LSP-only connection to the spine, he said: “It does seem to go against the commitments made in the GP contract and in the joint BMA/NPfIT statement in April.  In effect it says you will be compelled to take the LSP route."

The EMIS deputy MD said that in his view the objectives of a national programme could be more effectively served by standardisation of data rather than systems.  “You should have ruthless standardisation at a data level, but it does not have to be at the application level."

Riddell pledged that EMIS would remain fully committed to the whole of the UK market and will continue to invest in developing its systems. “We will interoperate with other systems and push for choice in the healthcare market. Without choice where will innovation come from?"