New GP choice proposals outlined

NHS Connecting for Health has outlined new proposals for delivering GP system choice based on a multi-step accreditation process. If adopted, the approach could potentially enable practices to buy systems either directly from suppliers or from their local service providers and still have them funded by the national programme.

The proposals now being consulted on are intended to break the impasse on systems choice that has existed for the past 11 months, ensure ‘equity’ and meet the contractual commitment to GP choice of systems contained in the nGMS GP contract.

EHI Primary Care understands that CfH wants to be able to announce the arrangements in March, before the first anniversary of its pledge to resolve the issue of GP system choice.

Under the new proposals, outlined to suppliers at a meeting last week, CfH would establish a new regime of systems accreditation based on a series of elements. Any system complying with these elements would then be available to practices and eligible to be funded by the NHS National Programme for IT through their PCT.

The initial element is understood to be based on suppliers putting in place the infrastructure to accommodate NPfIT systems, such as N3 connection and smart cards. The next element would be based on making sure systems are Choose and Book compliant; the next to ensure they can support electronic transfers of prescriptions. Further steps would include ensuring their systems can support GP-to-GP record transfers. The higher level elements focus on ensuring systems are hosted and support summary record uploads to the spine.

The proposed arrangements would appear to provide a route to enable GP practices to remain with local systems in the medium term, while still being able to benefit from the new national services to be delivered by CfH such as Choose and Book, Electronic Prescribing and GP-to-GP record transfers.

No details on the pricing of these steps and the associated service levels have yet been agreed, but it appears that CfH wants to agree a catalogue of clearly priced services that can then be chosen from locally.

Ewan Davis, chair of the BCS Primary Health Care Special Interest Group, told EHI Primary Care that although he had not been at the meeting the broad approach provided grounds for optimism. "I’m encouraged by what appears to be the shape of the proposals around GP choice, but as ever the devil is in the detail – particularly around funding."

He added: "It would appear to allow GPs to stay with practice-based systems in the medium-term with appropriate support while still enabling them to participate in the new services being rolled out by CfH such as Choose and Book and Electronic Prescriptions."

According to a number of sources spoken to by EHI Primary Care, systems providers will be able to implement these steps al le carte, complying with as many of the elements as they want. The message from CfH appears to be that all can now play within this new world as long as they can reach a minimum technical bar that will be progressively raised over time.

If implemented in its current form this new deal on GP system choice would create the potential to entirely bypass the four Local Service Providers (LSPs) on practice system, enabling them to choose from any accredited GP system with their PCT then being reimbursed directly by CfH.

This would be a radical change of direction for CfH which for almost a year has attempted to negotiate a route by which the LSPs would offer a wider choice of accredited systems. "They’ve not been able to do it through the LSP route because of the complexity," one source told EHI Primary Care.

Part of the problem is believed to be the fact that the five different cluster contracts awarded to four LSPs had very different requirements on GP systems. While Accenture had specific responsibilities to deliver new GP systems in the North East and Eastern regions, it is understood this was left out of the contract signed with CSC for the North West and West Midlands.

The quandary over GP system choice stems from the fact that the new General Medical Services (nGMS) GP contract gave an explicit commitment to GP choice of system, which was at odds with the contracts CfH awarded to LSPs which were based on single standard integrated solutions.

Nominally LSPs have been offering a choice between their preferred, or ‘core’, primary care solution and an ‘alternative’ system. But in reality one of the core systems, Lorenzo Primary Care, remains under development, while it is no longer clear whether IDX are developing a primary care system. Similarly, Cerner, which replaced IDX as the main software supplier in the South in summer 2005, is not thought to be developing a primary care system

This has resulted in a situation in which The Phoenix Partnership’s SystmOne solution has been the ‘alternative’ solution in the North East and Eastern clusters, and InPractice Systems Vision solution has been the ‘alternative’ for the South and London, with the North West and West Midlands left in limbo.

In many cases practices have been content to take the LSP solution to replace an outmoded existing system. There have also been reports, however, of practices that wish to keep their existing systems but find their local primary care trust refuses to fund practice server or other hardware upgrades unless the practices move to an NPfIT-funded LSP solution, irrespective of the commitment to systems choice provided in the GP contract.