GP choice in IT systems debated

Duncan McNeil, director of the Design Authority, made his statement at Healthcare Computing 2004 as the last word in a question and answer session which had drawn anxious enquiries from two audience members of the audience about the choices GPs will be offered over IT systems in the future.

One questioner said that he had been asked when practices in his area using Emis systems would migrate to IDX, the selected clinical system supplier for the Southern cluster. Steve Walker, assistant director of primary care delivery, said that the GP contract stated very clearly that practices would have a choice and LSPs were required to support choice.

“In the shorter term there should be no drive for a practice running an accredited RFA99 system to move to another system,” he said, though he also pointed later out that RFA99 was a relatively aged standard and that the issue would be whether systems were able to run the NHS Care Records Service.

Another questioner, Bedfordshire GP, Mary Hawking, asked for a reassurance that she would be able to choose from RFA99 standard accredited systems, not just a limited choice of systems selected by local service providers (LSPs).

“The PCTs [primary care trusts] are taking the view that, economically, they need to have the funding from the LSPs,” she said.

Walker said that the GP contract didn’t explicitly state there should be unlimited choice. He said there would be choice inside and outside the LSP arrangements and there would be an “economic component” in decisions.

Dr Hawking said: "From a GP point of view that’s profoundly unsatisfactory."  She said she could not make a business case for moving systems without a 100% guarantee of the safety of data transfer and of functionality that would be as good as or better than that currently used by the practice. Patients had not been consulted and she was “considerably concerned”.

Walker said he agreed with much of what Hawking said. “I think practices should only be migrated to systems that have better functionality than the ones they have at the moment,” he said.

However he added: “You can’t get away from the fact that there’s a value for money situation here.”

He pointed out that for the past 10-15 years there had been unlimited GP choice and there were now over 100 suppliers and over 150 systems. “That was a direct consequence of unlimited choice,” he said.

Earlier in the session Walker gave an overview of the profound changes being driven by the new GMS contract which mean that up to 30% of practice income will come from the quality of care delivered. 

This new link meant there was a need for a far more consistent approach to data collection in order that practices get paid in line with their expectations. The changes had prompted a debate about funding for IT systems to support the new contract and £30m worth of capital had been awarded in February to in response to GP practice claims. 

Walker said the main priorities must be to replace pre-RFA legacy systems.  He revealed there were 285 practices in England that were still using systems that were theoretically not Y2K compliant and 104 that had no form of computer system at all.