Hard Times

The last 12 months have been tough for those working in primary care IT – and the coming year holds no guarantees of improvement.

That, at least, is the impression given by EHI Primary Care’s exclusive survey of more than 100 IT staff working in primary care trusts, for health informatics’ services, and for the bodies that will take on commissioning, IT and information support in three months’ time.

One respondent, who has found a job in a commissioning support unit, likened the process of getting it to “mental torture.”

A long road travelled

He might have added that it has been a drawn-out form of torture. Those working in PCTs have known their jobs are under threat since July 2010, when the government unexpectedly announced that their organisations would be scrapped as part of the ‘Liberating the NHS’ reforms.

Over the intervening period, the roles that PCTs carry out have been given to the NHS Commissioning Board and its local area teams; to clinical commissioning groups; and to other bodies, including CSUs.

In the process, the survey found that 20% of respondents have lost their jobs, that morale has reached a new low, and the future is far from assured for those who remain.

Part of that uncertainty must come from the continuing financial squeeze facing the NHS and the nature of CSUs. These bodies were not even mentioned in the white paper, but some 20 are to be set up.

Potentially, they could be important players in the new structure, since CCGs will have to look to them for financial, HR, commissioning, and other support.

Equally, they must sell their services to the GPs running CCGs, who may have bad memories of their old PCT IT department; or simply be gung-ho to bring in the private sector.

One senior industry figure told EHI just before Christmas that he felt CSUs had too many staff and, potentially, not enough to do; especially if CCGs do opt to buy some of their commissioning support needs from elsewhere.

When asked about IT priorities for the coming year, one survey respondent noted that “convincing the CCGs we are worth keeping on” was the number one priority for their organisation.

By April 2016, CSUs must establish themselves as independent bodies through “externalisation”; and if the contracts from CCGs are not forthcoming staff numbers could fall or CSUs disappear altogether.

Losing expertise by the wayside

One of the major concerns about job losses when EHI Primary Care conducted its first opinion poll on the reforms in 2010 was that NHS expertise and organisational memory would be lost in the shake-up.

The latest survey certainly confirms the depth of experience among those working for the NHS in IT, with 27% of respondents having worked for the NHS for more than 20 years and a further 33% for between ten and 20 years.

The survey found that of those who have been made redundant, 44% hope to get another job in the NHS, 14% hope to work for the health IT industry, while a further 14% plan to take the opportunity to retire. But 9% predict a future of unemployment.

As the survey was conducted between 19 November and 20 December, there were clearly still many people waiting to hear about their future.

One respondent noted: “I have literally no idea what will happen to me or the team I work in, so I am looking at all jobs as a fallback” and another said: “Unclear as yet whether our CSU has room for me.”

Other respondents who are clearly closely involved in managing the change within their organisation – 40% of respondents were senior managers or directors – lamented the time left to make changes before 1 April.

One said: “High levels of technical change are needed in order to move to a leaner set up, allowing us to safely reduce the number of staff needed.

“National policy is driving us to make all of the changes by 1 April 2013, which is technically impossible in our patch, so we need to manage the huge changes with fewer staff and less funding. Easy in people’s heads; unfortunately we have to do this in real life.”

More uncertainty ahead

Even those with secure or new posts are mainly pessimistic about the future, with only a third predicting the changes with mean a stronger IT and information service in their local area.

Even fewer predicted that they would mean increased investment in IT and information services.

Again this may be a reflection of the need to wait and see what local CCGs will do, not just for commissioning support, but for GP IT support, for which the NHS Commissioning Board belatedly confirmed that CCGs will also hold the purse strings in December.

It is widely predicted that most CCGs will use CSUs for GP IT support in the first instance.

Dr Chaand Nagpaul, one of the BMA GPC’s negotiators, says time constraints along make it likely that money will be “blocked back” to CSUs, but in the longer term CCGs might again opt to shop around or maybe employ their own staff in-house.

Roz Foad, chair of the British Computer Society’s Primary Healthcare Specialist Group, shares the concerns of some of the respondents on the future of IT and information in local areas.

She adds: “I believe the threat to IT services comes from the uncertainty. No-one is fully clear what will happen after April, what the future of GPSoC will be, the suppliers do not know what will be asked of them.

“There are also 582 iSoft practices having to sort out a new clinical system supplier in the middle of all this upheaval, due to the company cutting off support.”

Among the gloom, however, there are those with a more optimistic outlook. The survey found that 24% believed their NHS organisation was giving “a very high priority” to IT and 29% believed the reforms would improve IT services.

Dr David Jenner, a locality chair with Northern, Eastern and Western Devon CCG and a senior policy adviser to the NHS Alliance, points out that the NHS Commissioning Board’s first set of planning guidance, published in December, has a strong IT component.

It places emphasis on issues such as telehealth and paperless referrals that will involve IT by default.

He adds: “I wouldn’t make a call that any public sector budget line will actually grow in future but the requirement for IT is not going to go away.”

Some hope, perhaps, for those like the respondent who wrote: “Basically I would like to have a job! Anything else is a bonus.”