A year in review

Primary care editor Fiona Barr looks back at the highs and the lows of 2009.

The worsening economic climate may have become the dominant theme of 2009, but there was also some good news for primary care IT.

Quiet success stories have included  NHS Connecting for Health’s progress on GP2GP record transfer, the defeat of proposals for much wider data sharing across Whitehall, and the delivery of the first large scale medication distribution system via the web.

More negatively, a question mark has hung over the future of the patient portal HealthSpace for much of the year. The government also failed to have the Flu Line ready for when a pandemic was declared. And problems continued to dog Choose and Book and other national projects such as the Summary Care Record and Electronic Prescription Service.

Yet at the coalface, IT suppliers and their NHS customers have been getting on with the job; with contract wins, new product launches and acquisitions all a feature of the last 12 months.

Pandemic flu

The government was initially caught napping by the arrival of a flu pandemic in April, and was forced to admit that its Flu Line was not ready as planned. However, by July, the Department of Health and NHS Direct had swung into action and the world’s first government-run swine flu diagnosis website was launched.

The National Pandemic Flu Service crashed on the first day, but since then has worked fairly smoothly and successfully, taking the pressure off GPs and running the major distribution of a prescription drug via telephone and the web.

Data sharing

In February, the Coroners and Justice Bill suddenly began to arouse attention as it emerged that clause 152 would allow widespread data sharing across Whitehall departments. A host of medical organisations joined with privacy campaigners to protest against the clause – and in March the government bowed to pressure and it was dropped.

Concern about the data sharing enabled by electronic patient record systems continued this year, with GPs being warned by the BMA that they should be ‘constantly alert’ to potential threats to patient confidentiality and privacy. In August, the Royal College of GPs published a report on the implementation of shared electronic patient record systems and called for patients to act as “full partners” in sharing clinical data.

Primary care IT suppliers

GP system supplier EMIS unveiled its next generation system EMIS Web in June and promised NHS Connecting for Health accreditation by November – although the date has since slipped to 2010.

Meanwhile, healthcare IT supplier TPP announced that it had been chosen as a strategic solution in the three northern clusters by local service provider CSC. TPP’s SystmOne was also accepted on to the GPSoC framework in June, while it also announced plans to expand into secondary care and became the national system for prisons in 2009.

Primary care has also seen a flurry of alliances and acquisitions as companies have sought to position themselves for the years ahead. ACS, which bought out-of-hours software supplier Adastra in 2008, announced it had raised a £55m war chest to make other acquisitions in the primary care IT market. Over the year, it bought a hosting company, a staff scheduling software firm and GP and palliative care system suppliers Healthy Software.

Other acquisitions included Scriptswitch, which was bought by United Health, while document management specialists PCTI announced an alliance with GraphNet Health as well as a deal with digital dictation and voice recognition software supplier SRC.

GP2GP and Choose and Book

GP2GP proved to be the project with the kind of clinical engagement that other CfH projects can only dream of. In April, it hit half a million transfers in November it picked up the award for innovation in healthcare interoperability at the E-Health Insider Awards in association with BT, and in December a survey of clinicians and administrative staff found GP practices said GP2GP saved time, aided clinical decision making and improved patient safety. An announcement that the project has delivered a million transfers is expected soon.

The team leading Choose and Book can only look on in envy. A BMA report in January found that some clinicians were very positive about the scheme – but others found it unworkable. In March, usage rose to around 54%, but it has stayed at that level for the rest of the year. Slot availability continues to dog the system and at the end of the year CfH  issued guidance setting out how it should be used and how it should not. Whether the NHS takes heed remains a question for 2010.

Summary Care Record and HealthSpace

Another CfH project which has struggled to gain momentum is the Summary Care Record. In January it was announced that 17 primary care trusts would begin implementing the SCR as part of a fast follower group, yet by the end of the year only 151 practices across England had created SCRs.

On the positive side, the integration of the SCR with out-of-hours software Adastra led to a leap in the number of times clinicians accessed the record out-of-hours  and its use in end-of-life care was also identified as a key selling point.

Right at the end of the year, five strategic health authorities announced they would run area-wide roll-outs of the SCR in 2010, leading to renewed hope that the record will become more widely available.

Access to the SCR for patients through the patient portal HealthSpace was always seen as a key part of the programme and in March it was revealed that CfH aimed for four million HealthSpace users by 2014. However, some in the DH are apparently less keen on the project. In June, expansion appeared to have been shelved.  Its future development remains unclear.

EPS

Go live for Release 2 of the Electronic Prescription Service has been much anticipated and in July the first site finally began work in Leeds, using TPP’s SystmOne and Cegedim Pharmacy Manager software. By the end of the year, the NHS was still waiting for most of the other pharmacy and GP software systems to become compliant.

Informatics planning guidance from the DH  has added more urgency to the roll-out by making it a requirement for all PCTs to complete the first two stages of readiness for EPS R2 next year.

NHS Choices

The Department of Health developed its flagship website during the year to meet its aims of providing more information to empower patient choice. In April, it announced that NHS Choices would publish mortality rates and as it worked towards allowing patients to rate and comment on individual GP practices, the BMA reluctantly agreed to work with it. The GP ratings functionality was launched in October and by the following month 3,060 comments had been submitted on GP practices.

Around the UK

In Wales, the first four GP practices began to send electronic referrals in December and Informing Healthcare said the Welsh Clinical Communication Gateway would be available nationally next month.

Both Wales and Scotland announced plans for palliative care records to be widely available across NHS organisations, and Wales announced an agreement with INPS to deliver an Individual Health Record in the country . It said agreements with other suppliers would follow.

Scotland became the first country in the UK to deliver an electronic prescription service and began its procurement of GP systems. In Northern Ireland, Orion was named as the winner of procurement for a proof of concept project for a province-wide electronic care record.

…And finally

Like many others, EHI Primary Care readers are obviously avid fans of The Apprentice. When Sir Alan Sugar declared “You’re hired” to Yasmina Siadatan and it turned out her first job would be selling digital screens to the NHS it became our best read story of the week.