A work in progress

Whatever way you look at it, the end of 2007 sees primary care IT with a long list of projects still to be completed, but much progress underway, EHI Primary Care editor Fiona Barr reports.

In 2004 the Department of Health in England set out its wish list for the National Programme for IT in its NHS Improvement Plan.

That included delivering access to detailed care records and allowing electronic referrals, requests and orders by June 2005, e-booking of all hospital appointments by the end of 2005 and full implementation of electronic transfer of prescriptions by 2007.

Summary Care Record trials begin

The last 12 months has seen few mentions of detailed care records while the NHS strives to get the Summary Care Record off the ground. This year five PCTs have become early adopters of the SCR and Connecting for Health acknowledges on its own website www.nhscarerecords.nhs.uk that it will be several years before it is rolled out across England.

Those in the early adopter areas have the task of testing out both the practicalities of working with summary records as well as the job of assessing the current hybrid consent model, a proposal that remains unacceptable to the British Medical Association.

So far, several hundred patients have registered for HealthSpace, the DH’s online portal that will allow to patients to view their own SCR over the internet while one GP supplier, EMIS, has promised to rollout internet access to patient records to all its GP practices.

Choose and Book use grows

Choose and Book figures for the week ending December 14 show the system is being used for more than 45% of first outpatient appointments, a far cry from the DH’s target of 90%. GPs have continued to complain of technical problems using Choose and Book during the year while the national Choose and Book team tries to tempt refusenik practices into the fold with claims that the system is now much better than in its early days.

Next year will see the end of the GP incentive scheme for Choose and Book, which could reduce practice enthusiasm further. On the other hand, attempts by some hospitals to block paper referrals and the introduction of free choice at referral might lead to a gradual increase in take-up.

Electronic Prescription Service

Almost 55 million prescription messages have now been transmitted electronically via the Electronic Prescription Service and more than 17% of prescription messages are being sent via the service although substantially less are being dispensed via the EPS.

The challenge for the EPS in 2008 will be to see the successful deployment of release 2 which contains most of the benefits such as digital signatures on prescriptions, repeat dispensing and electronic reimbursement for pharmacists. Again, the original target of full implementation by the end of 2007 proved far too ambitious.

GPSoC reaches fruition

In 2007 the GP Systems of Choice initiative came to fruitition with eight suppliers selected to supply systems to practices. GPSoC is designed to provide GPs with the freedom to choose their own system guaranteed in the nGMS contract in 2004.

However, conflict still remains with local service providers and PCTs arguing the case for single solutions in the face of strong opposition from practices.

At the same time CSC, which was accepted as a supplier of TPP’s SystmOne under GPSoC, has yet to sign its GPSoC contract. Practices and PCTs have also yet to migrate to GPSoC contracts in large numbers although Connecting for Health argues that the majority will sign by the end of March as not to do so would mean the financial burden of paying for systems will otherwise remain with PCTs.

GP2GP shows power of collaboration

On a very positive note GP2GP transfer of records has been seen as a success of the programme with more than 2,000 practices using EMIS LV 5.2 and INPS Vision 3 now able to send and receive records electronically. CfH says the success of the scheme has been down to a “massive collaborative effort” between itself, PCTs, strategic health authorities, the GP professional bodies and clinical system suppliers.

2008 year of telecare and telehealth

Next year the DH will also focus its attention on the use of telecare and telehealth services with the launch of its national demonstrator project in Kent, Newham and Cornwall. Although CfH will not be delivering on its target of ensuring that telehealth devices are installed in every home that needs one by 2010, the potential to develop a national business case for use of assistive technologies looks promising.

Meanwhile both Scotland and Wales are pressing ahead with their own primary care IT projects. The Emergency Care Summary in Scotland contains the details of 5.1million patients and is accessed by out-of-hours centres around 25,000 times a week while Wales has just announced it is to extend its own version from Gwent to Gwynedd, Anglesey, Pembrokeshire and Ceredigion.

In Scotland ETP and repeat dispensing is due for completion by February 2009 and Northern Ireland also has plans for bar-coded prescriptions. Scotland plans to launch a new e-health strategy in spring next year, with a continued emphasis on telehealth and moves to paperless ways of working.

Wales also developed its own framework of GP suppliers in 2007 and is developing its Clinical Portal as well as launching small scale pilots of patient access to records.

In all four countries, 2008’s primary care IT diary already has plenty of entries.