Another view: of IT for GP federations

This month, I promised to discuss the draft IT strategy I’m writing for our local not-for-profit GP provider organisation.

We now have 28 practices in two alliances. Their stated goals are; improve services for patients (including improving access and reducing variability between member practices) and; find new income sources from GP work and deliver productivity gains.

Our practices aren’t particularly interested in mergers at the moment; but are interested in exploring joint working.

However, with a shrinking workforce some form of merger might be on the cards – if not between individual practices, then perhaps all into one, big super-practice – so our strategy needs to cope with these possibilities.

Infrastructure

We made the decision ten years ago to move onto one system (from Emis) and it could be argued that we have not capitalised on that as much as we might have done when it comes to sharing information and best practice.

In my last column, I argued that some of the upcoming enterprise functionality might deliver some of what we need to be able to do in the future, which is to work on the Martini principle (any time, any place, anywhere).

But it isn’t just software that we need to consider. Most of our practices are on a COIN (community of interest) network and enjoy a VoIP (voice over internet protocol) phone system; but not all.

Is it worth bringing the others on board? I’ve seen some cool Cisco video IP phones. But a lot of services are now cloud-based, which means you can get a lot of the same functionality with a cheap webcam and Skype or similar.

Do we really need one big network? It’s something we are discussing with our commissioning support unit and clinical commissioning group.

I’m keen to roll out video conferencing to as many desktops as possible, whatever happens. If we can get video calls and chat to be as common as email, we might break down some of the barriers to using both with patients.

We will also be able to improve communications between users on multiple sites. Getting to know one another might help breakdown the barriers to joint working.

Communications

We are also looking at what cloud and enterprise services we use. Our practices can all use the GP-connect web publishing system from Health2works. This includes some syndication features, so it should be possible for practices to maintain their own pages and consortium or joint pages.

We use Basecamp for project management and we are looking forward to the new NHSmail with anticipation – it could help or hinder us.

We have invested in something we are calling GPask. This was taken from an open source question and answer website similar to Stack Overflow.

Many people in the IT world will be familiar with Stack Overflow, since it’s a question and answer site for programmers.  However, we have adapted it to suit the needs of GPs and primary care and to be appraisal ready.

All GPs, nurses, practice managers, CCG staff and consultants in our local area can join. They can ask questions and the community will answer them.

Sometimes, it’s a consultant who answers; sometimes it’s another GP. You can comment, you can debate, you can upvote certain answers, you can bookmark things for your PDP record and print them out later for upload to your appraisal toolkit.

Locals events are advertised on there, as are local jobs and other news items. It’s a way of building a community across a patch and getting people used to working with one another. If you are interested in having a local implementation, get in touch.

Customer facing services

I’m still keen to explore the role of guest wi-fi across our estate, but haven’t seen a finance model that works yet. Landing pages that gather data in return for limited access would be a ‘must have’ feature if we were to pay.

We see point of care testing as having potentially a large role, particularly when it comes to chronic disease management. If you could get your bloods done there and then, so you only had to do one clinic visit, rather than one for phlebotomy and one for a consultation, there would be a huge saving.

Having expert interpreted ECGs, Spirometry and other diagnostic tests helps reduce variation, and I see no reason why primary care can’t be paid for this work, just as secondary care is paid for it, rather then doing it for free.

The key is quality control, consistency, and added value. We are also keen to investigate software for our community/visiting staff that can record images of rashes/ulcers, provide video links or even monitor patients.

Being able to communicate all of this back to base would reduce the time needed for time-consuming visits back into the office, just to update records or re-enter data.

Informatics

The lack of information we get on our own activity from our GP systems is simply staggering; not least because we know just how much data we put into them.

We don’t know how many patients walk through our door each day. What most are coming with? What do most want? What do most think of the service they get?

We employ teams of doctors, yet have little information on who is doing what. Who is seeing whom or what kind of condition? Even the things CCGs analyse to death – prescribing and referrals – are not actually that easy to determine accurately.

How many times do we get an email telling us how busy A&E is? Why can’t we reply with “yes, so are we – here is the data”?

Well, we are developing a relationship with a company called Edenbridge around a tool  that has just been given a new, official name – Apex. It measures all of this and more and shows it at various levels with a series of built-in dashboards.

At a practice level you get one set of data, at a locality another, at a federation level a third. The system can also report data to a CCG.

It’s not a stick to beat practices with – it’s owned by the practices and they choose what to share. Its primary goals are to help improve access and to demonstrate the work being done in order to find ways to improve productivity and reduce variability.

At a practice level, it shows historic data and trends alongside current data, and uses this to predict demand. It will tell you that you don’t have enough doctors in next Wednesday for the usual numbers of patients seen on a Wednesday.

It will show which doctor sees the same few patients over and over and which patients take up all the time. It should automate all our Prime Ministers’ Challenge Fund reporting for us, as well as some of the other local enhanced services schemes for which it usually takes ages to collate data.

Finally, we hope to get more information out of other data sources. We use PCTI’s Docman for electronic document management and feel we could get more data/productivity out of it.

If there was a nationally agreed, embedded dataset that went with every document transmitted it could revolutionise letters in to a practice.

If the national team won’t go for it, then a Cheshire/Merseyside/Greater Manchester team might; and we are keen to push not just from a productivity point of view but from a patient safety perspective, too.

As you can see there is plenty to do! Next time more on patient facing developments and back office wishes.

Dr Neil Paul

Dr Neil Paul is a full time partner at Sandbach GPs; a large (22,000 patient) practice in semi-rural Cheshire. He is also one of the directors of MandN Heathcare Ltd. Dr Paul has been involved in primary care IT and health service management for more than ten years in various roles, including PEC member and urgent care lead. In his spare time, he writes medical iPhone software and is a keen photographer.