Missing IT Funds Threaten GP Contract

One of the BMA’s leaders on IT issues has warned that the new GP contract is at risk unless the Department of Health honours its pledge to provide funding to reimburse practice IT maintenance and upgrade costs as specified under the terms of the new General Medical Services (GMS) contract.

Improved primary care IT systems are vital to the success of the GMS contract, but additional investment committed by the government for primary care IT as part of the contract this year has not yet been allocated to primary care organisations (PCOs). The money is currently being held by the National Programme for IT (NPfIT), with the suggestion that some may be held back to fund national projects.

Dr Paul Cundy, joint chair of the GP IT committee, which represents the Royal College of General Practitioners (RCGP) the BMA’s General Practitioner Committee (GPC) and practice systems user groups, told E-Health Insider: “The whole GMS contract is based on IT, and the failure to allocate promised funds has been a major source of delay.”

Dr Cundy added: “The feeling is that we have a negotiated contract that is pretty clear cut and if the IT funding is not met it could be a breach of contract.” The Wimbledon GP further warned that unless the issue was resolved soon “there will be lots of practices doing their own thing on IT.”

He said that he knew of practices that had taken out loans of up to £15,000 to upgrade their systems on the basis that they were told they would get reimbursed.

One PCO IT manager who contacted E-Health Insider said that having already told their practices what their IT allocations would be this year now faced the prospect of having to go back and tell them they would only get half the amount promised.

Under the terms of the new GMS contract, agreed between the GPC and the government this summer, PCOs will take over responsibility for, and ownership of, practice IT systems. PCO ownership of practice systems is seen as vital to implement the new ‘Quality Framework’ at the heart of the GMS contract.

The contract specifies that as part of this take-over of practice-level IT PCOs will pay 100% reimbursement to practices for IT maintenance and minor upgrades backdated to April 2003. In the GMS contract the government pledged to invest an extra £17m in primary care IT in 2003-2004 specifically for maintenance and upgrades

Although GPs voted to accept the new GMS contract back in June, the extra money for IT has yet to materialise. On 1 May health minister John Hutton wrote to the BMA’s Dr John Chisholm, chair of the GPC, stating: "I am aware that the PCOs are waiting for definitive guidance on this (funding) and I will ensure that this guidance is provided as soon as practicable." The guidance is still awaited.

One possible explanation for the delay is provided by the PCO IT manager, who told E-Health Insider: “We have just been told ‘unofficially’ that the GMS allocation for IT to give GPs 100% funding of their IT needs will now be halved, and the other half used by the DoH for its central projects such as e-booking.”

The suggestion that funds may have been held back for national projects was flatly denied by Dr Laurence Buckman, negotiator for the GPC on the GMS contract. He told E-Health Insider: “GPs were promised, and will get, 100% funding for their equipment and updgrades.”

He heatedly added that the ‘rumours’ money would be diverted “…are put around by PCTs who know nothing.” Dr Buckman did concede that continued delays in allocations was, “a very sore point for the NHS Confederation and DoH as well.”

Dr Cundy added that the new GMS IT funds appeared to be held by Richard Granger, NHS IT Director General, and the NPfIT. “We were negotiating about IT for England with the Department of Health, but they gave the money to Richard Granger… So there is now a fight between Richard Granger, who holds the purse strings, and everyone else who negotiated the contract.”

Questioned about the suggestion that the NPfIT was holding back GMS funds to possibly support national projects, Dr Cundy warned: “If it’s not 100% [reimbursement] as far as I’m concerned you can tear the rest of the contract up.” He added that one unfortunate side effect had been to lose the momentum that had built up behind primary care IT. “It’s been a major source of delay.”

Dr Buckman concluded that he did not know when the money promised would start to flow, just that it will. “Presently the money is all in the national programme. The trouble is getting the money from the national programme to PCTs in England.”