EMIS users urged to protest about systems choice

The letter from Dr Manpreet Pujara, chair of EMIS NUG, stresses that the latest official guidance to existing suppliers makes clear that practices using EMIS will not be eligible for central funding “whereas central funding for some others will continue".  It warns of the potential risks – such as data loss and reduced data quality – of having to replace existing systems before a better replacement is available.     

The proposed strategy will, he claims,  “greatly reduce the choice of systems available to GPs and to replace current systems over the next two to four years".

Dr Pujara’s letter urges GPs affected – including all EMIS practices – to take action. He writes: “Those of us who find this situation unsatisfactory must act now.  There will not be another opportunity in two years’ time."

EMIS systems are used by over half of general practices in England but the company has not signed contracts with local service providers (LSPs).

The chair of the EMIS NUG reiterates that the GP contract includes a clear commitment to providing a choice of practice systems.  “GPs feel betrayed that the government has reneged on its commitment to offer GPs a choice of clinical systems as agreed in the new contract."

“The LSPs don’t appear to be paying the slightest bit of attention to the GP contract commitment to choice [paragraph 4.34]," Dr Mary Hawking, EMIS NUG committee member told E-Health Insider.

In August NPfIT set out its policy for existing suppliers, which makes clear that those not within an LSP portfolio will not be eligible for central funding under NPfIT.  In addition, legacy suppliers will not be allowed to connect to the NHS Care Records Service spine unless they are an integrated part of an LSP solution.

The effect, says the letter, will be force the 56% of practices in England currently using EMIS systems to move to another, unproven, clinical system they have not chosen.

“The guidance seems to be about wiping out existing suppliers and replacing them with an unknown single system, when you ask to see a demo they can’t even produce an outline one," Dr Hawking said.

Offering the advice of the NUG the letter says: “The NUG agrees with the aim of NPfIT in principle BUT strongly disagrees with the emphasis placed on single systems."

It goes on to state that GP computing in the UK has become a world leader due to the iterative way in which it has developed over the past 15-20 years, and that sweeping this away for an as yet unseen and unproven system is a high risk strategy.  “It is not possible to write a new functionally rich system from the ground up in a few years."

The letter notes that while from “a financial viewpoint the new [centrally funded] NPfIT systems and offerings may seem to be very palatable" actually changing over systems should not be undertaken lightly. 

“Changing your practice’s clinical system is no mean feat as most of you will know and there are major implications for the practice and staff as poorly managed upgrades and data conversions result in disaster."

Dr Pujara says that he would be more than happy to change his clinical system “if the alternative system offers better functionality and usability than my current system", but argues this is not what NPfIT and its contractors are offering.

“We are being told that we will be migrated to a system that hasn’t even been Alpha-tested and about which nobody is prepared to say what is in it or what functions it will have," Dr Hawking told EHI.

Commenting on the development of new LSP systems Dr Pujara says: “As end users of the new system we will not have any input into the development process as the LSP will only respond to the cluster board where there may be little GP involvement."  

The current strategy set out by NPfIT contains significant risks for GPs, their patients and the hard-won achievements of primary care computing, warns Dr Pujara.  “Do we really want a new clinical system developed in record breaking time with little clinical involvement and no proven track record?"  The alternative he suggests is to make existing systems NPfIT compliant at a fraction of the cost of replacing them.

Dr Pujara says NPfIT appeared to give place a low priority on primary care, which it described as a ‘department’ of the single systems to be delivered by LSPs. Dr Hawking commented, “It’s incredibly acute-centric view of the world, which pays no attention to the systems that GPs already use."

Dr Pujara concludes by urging EMIS users to make their collective voice heard, by contacting their MP, their Local Medical Committee or Primary Care Trust.  He notes that when a significant number of EMIS users faxed and emailed their MPs earlier in the year it resulted in Parliamentary Questions and “some activity the NPfIT team to try and resolve the issue".

Dr Paul Cundy, chair of the joint BMA/Royal College of GPs IT Committee, however, advises EMIS users against lobbying their MP.   Citing the announcement of the National Audit Office investigation into NPfIT, he said “Whilst I respect your right as EMIS users to do as you see fit I do not, in the circumstances, think it will be of any benefit to launch a second MP lobbying campaign."