Systems choice was a ‘geographical absurdity’

Professor Mike Pringle, one of the clinical leads for the national programme for IT, has described the previous arrangements on GP choice of system as a "geographical absurdity" that had become a barrier to success.

Professor Pringle said that last month’s decision to allow GPs to choose from a wider range of accredited systems was a "very significant" change. He explained that the question of systems choice had become a barrier to the success of the national programme.

Following the announcement last month that GPs are to be provided with a wider choice of systems, E-Health Insider Primary Care spoke to Prof Pringle and Dr Gillian Braunold, the joint GP clinical leads for the National Programme for IT. Both were closely involved behind the scenes in the negotiations that led to the change of policy.

Until last month, a practice with a system that was not being offered by their local service provider, or one of the over 50% of practices using EMIS, was effectively outside the programme. It either had to switch systems or wait for the new primary care systems as part of the ‘integrated solutions’ being developed by iSOFT in the North and IDX in the South.

"There was a geographical absurdity about system availability," said Professor Pringle. "We had a significant number of GPs who found the national programme was not working in their interests."

"This [the wider range of systems] stops some of the behaviour that we have seen going on in the country in which people have had to move off systems they want to stick with," said Dr Braunold. "People will be reassured that their primary care system provider will not disappear."

She added that the shift in policy on GP systems was "about reassuring people and providing them with a map on how systems will develop". If you are using one of these systems now you now know it will be part of the national programme."

Under the new arrangements, if a system provider is signed with one of the four LSPs covering the five regions of England, it will be available to any practice in the country. If a system is not in contract with the LSP that the practice or PCT is within, they will be able to take it from one offering the system.

Dr Braunold suggested that because this created a scenario in which LSPs could lose revenue from practices taking systems from elsewhere, it would be in LSPs’ interests to sign additional contracts with practice system providers to prevent revenues leaking away.

Rather than standardised systems, the preferred route now appears to be enforcing new interoperability standards. The big proviso is that to be national programme compliant and funded, systems must be offered from central data centres.

Prof Pringle stressed that enforcing new interoperability standards would mean "there will be no difference from the world of having a fully integrated solution."

He said that these new interoperability standards will be set by the programme and suppliers, and focus around: interoperability with the Spine and Care Records Service, ability to support GP-to-GP record transfers; support electronic transfer of prescriptions and Choose and Book.

He added: "The key is that if you wish to stay with a system supplier that will be available to you, and funded, as long as it meets three criteria: it must be contract with the national programme; it must meet standards of interoperability; and it must meet a business case test."

As of last month, and EMIS signing a contract with CSC, the LSP for the North West and West Midlands, four practice systems so far meet the above criteria: In Practice Systems, iSOFT, The Phoenix Partnership and EMIS. "Others may become so," said Prof Pringle.

"The programme is not saying it will fund any systems. There must be both a demand for it and a clear business case that ensures value for money will be achieved."

Asked whether the LSPs and their core solution providers – IDX and iSOFT – would still be developing entirely new primary care systems Prof Pringle said it would be up to them but they’d have to develop systems that were significantly better than those already available. A national programme spokesperson told EHI PC: "It’s still in their contracts."

Prof Pringle said that the new pluralistic approach would only apply to primary care and not to the hospital sector as well. "This is a unique solution to the unique situation in primary care."