Choice? What choice?

Fiona Barr

Fifteen years ago practices wishing to change computer system had a choice from a staggering 42 different suppliers. Today the reality for many of the 8000 plus practices in England who might wish to install a new NHS-funded system in their businesses is rather different. There is no choice.

In 2004 GPs were promised by Connecting for Health that there would be system choice after it emerged that its exclusive contracts with suppliers were in contradiction to the pledges in nGMS contract on system choice.

Guidance produced by the British Medical Association and Royal College of General Practitioners and backed by the National Programme for IT stated: “The National Programme expects LSPs to take all reasonable steps to support any accredited systems where local demand exists.”

In all five LSPs there was to be at least a ‘strategic’ and an ‘alternative’; solution on offer to practices. However so far the strategic solutions promised by the LSPs have yet to be fit for purpose, if they are to be developed at all, leaving those offered an ‘alternative’ system querying precisely what it is an ‘alternative’ to.

Andy Kinnear, head of the Avon IM&T consortium, says: “In simple terms the situation with GP systems is a joke.”

Southern clusters

In his area, covered by the southern cluster where Fujitsu Alliance is the local service provider, plans for the National Programme for IT have perhaps experienced the biggest upheaval with the ejection last year of IDX as the main system supplier in favour of Cerner.

According to Kinnear, Cerner has no GP integrated system, or at least not one the NHS has bought.

Instead GP supplier In Practice Systems looks likely to be the only system on offer to practices in the southern cluster for the moment.

Max Brighton, managing director of In Practice Systems, says the company has signed a memorandum of understanding with Fujitsu.

In an open letter to InPs users he adds: “It is Fujitsu’s clear intention to host a Vision service in their own data centre."

However Kinnear told EHI Primary Care: “By and large GPs want to stay with the system they have but have it enhanced to allow them to see the care record of their patients in hospital, request tests, see x-rays and so on. In Bristol we have 116 practices and only four use InPS so until they come up with an NPfIT offering for us that includes iSOFT and EMIS then things aren’t going to move round here.”

The story of the missing choice is echoed in all other clusters, albeit for different reasons. In London, In Practice Systems already have a contract with BT as the ‘alternative’ supplier and, according to a BT spokesman, have installed 42 systems so far with plans to deploy another 87 systems by the end of the year.

Again the choice between InPs and the strategic solution, IDX’s Carecast, is currently no choice since the Carecast GP solution has yet to appear.

A spokesman for BT told EHI Primary Care that “we have not yet agreed a date with CfH for its delivery.”

EHI Primary Care understand that Capital Care Alliance is watching and waiting for announcements on extending GP choice, before it decides its next move on Carecast.

The possibility that In Practice Systems could become the ‘strategic’ solution is also confirmed by InPS’s managing director. Brighton writes: “We are also in with CCA to include Vision as the core reference system or the alternate GP solution for London throughout the duration of their 10 year contract.”

In the north

In the Accenture clusters, north east and eastern, the strategic choice is iSOFT’s Lorenzo Primary Care, currently still in development, while the alternative system is TPP. Accenture claim it currently also offers iSOFT’s Synergy Enterprise as an alternative system. However few Enterprise systems appear to have been installed. For example, a CfH deployment forecast for the next three months shows plans for installation of 78 TPP systems in GP practices compared to a single Enterprise installation.

The remaining CfH cluster, North West and West Midlands, is also awaiting the arrival of Lorenzo Primary Care as its strategic solution and appears to have not signed up a permanent alternative choice as yet.

A spokesperson for the CSC Alliance told EHI Primary Care: "Primary Care systems are within the scope of CSC’s contract to deliver systems in the North West and West Midlands. Our strategic solution is iSOFT’s Lorenzo application which will meet the needs of both Primary Care and Secondary Care.

"We are in discussion with a range of suppliers as to the provision of alternative solutions in the North West and West Midlands cluster. CSC has worked with In Practice Systems to deploy a number of GP systems in the Bolton area."

Richard Gunn, chairman of iSoft’s user group, says practices continue to report ‘low grade’ pressure to move systems, particularly as their hardware comes up for renewal and the choice is move to the LSP solution where maintenance is no longer a drain on scarce PCT resources or put up with existing performance from equipment that needs replacing.

He told EHI Primary Care: "Once a practice has moved to an LSP system the PCT loses the maintenance bill which is obviously attractive when many PCTs are struggling financially. The other problem is that there is a general feel that NPfIT [the National Programme for IT] epitomises that it must automatically be a problem if GPs have got lots of systems so we will try and remove that problem by pushing everybody to go to a single system.”

Richard White, administrator for the Vision User Group, says that reports of pressures to move system seem to have eased recently. He believes LSPs seem to be focusing efforts on what might be seen as easier targets to begin with, that is those with unaccredited system or low computerisation levels.

He adds: “The test will come when a highly computer literate practice that is happy with its system faces pressure to move.”

Like many, he harbours hope that the choice will soon mean more than an offering of one system per LSP.

A sign that might happen, or at the very least that Connecting for Health is hedging its bets, can be seen in the new IM&T directed enhanced service for GPs. It specifies GPs can earn a payment for using a ‘Connecting for Health’ approved hosted system. It does not say, however, that the hosted system must be hosted by a local service provider. Hope, perhaps, for the free marketeers.