PCTs juggle choice and strategy

EHI Primary Care editor, Fiona Barr

The GP Systems of Choice initiative, which comes to fruition this month, seeks to give back to GPs something doctors’ representatives argue has always been rightfully theirs: a choice of IT system.

It is a victory for those who have championed the cause, including the British Medical Association and Connecting for Health’s GP clinical leads, but celebrations are not universal.

Stephen Critchlow, executive chairman of healthcare IT suppliers Ascribe – which pulled out of the GPSoC initiative – argues that GPSoC will not help CfH in its long term aims.

“I think it will be another problem for them,” Critchlow says, Ascribe wishes to be part of the ubiquitous solution and sees the future in area-wide systems.

Delivering those kinds of area-wide solutions in an environment where each GP practice can potentially select a different GP system is the task local service providers, strategic health authorities and primary care trusts are now faced with.

As EHI Primary Care reported last week many PCTs are planning a switch to a single system by 2011, and hoping they can convince GPs to sign up to that vision.

In the North, East and Midlands, local service provider CSC has TPP as its current primary care solution with Lorenzo Primary Care a possible addition. In London the plan is to offer INPS plus EMIS and, in the South, EHI Primary Care understands that LSP Fujitsu is committed to offering only INPS with no plans for an alternative solution or to develop a primary care version of Cerner Millennium.

That leaves GP practices in each of the three regional programmes for IT with a choice of between one and two systems and a long term scenario where the list of suppliers will be narrowed down from eight on the current GPSoC framework to just four.

However, the arrival of GPSoC has also generated positive response from both PCTs and GPs. Richard Scowen, applications manager for Hounslow PCT, told EHI Primary Care that he welcomed the advent of GPSoC, even though all practices in Hounslow used either INPS or EMIS, potentially both LSP solutions in London.

He added: “I would consider GPSoC as a very positive way forward. It does confirm that principle that practices do have choice and provides PCTs with the opportunity to take GPs through the framework at a pace that they feel comfortable with. It’s not a case of you have to move now and you must move to this solution.”

Scowen argues that even before the nGMS contract, when GPs had free choice through the Red Book, primary care organisations like his own sought to limit choice to a smaller number of providers while still maintaining competition.

He adds: “Strategically as an organisation we always want to be able to go to our GPs and say you do have choice. It’s also important in terms of ongoing development – you don’t get the same degree of innovation without it.”

The supporters of GPSoC hope that it will work in the medium term to guarantee choice and encourage development of systems. For many GPs though, the prospect of a switch to an LSP solution is a long way off.

Dr Nigel Watson, chief executive of Wessex Local Medical Committees and a GP in Hampshire, says the average GP in his area “has no idea” that INPS is the strategic solution and that there could be pressure to move to it in the future.

He says: “There are practices in my area looking to change systems and GPSoC should allow them to do it more easily. The ultimate end game for CfH, in terms of a level six integrated system, is not necessarily what GPs want. GPs are more interested in functionality like GP2GP, electronic transfer of prescriptions and how smoothly Choose and Book works.” 

If practices do want to move systems, the view among GPs, although not necessarily PCTs, is that freedom to choose between systems offered by GPSoC should not be diluted.

Derbyshire LMC deputy chairman Dr Peter Short argues that any choice needs to be informed, believing there could be a clash between the business case in one practice or consortium and that of a PCT.

He adds: “My concern for primary care is that practices may not be in possession of all the information and implications of a switch to an LSP system, and that unfair pressure may be applied by differential support to different systems, even under GPSoC. Examples could include training, user groups and so on.”

For EMIS, the leading primary care system supplier in England with a market share of almost 60%, GPSoC is a victory. Having campaigned for such a system since 2004, EMIS is unlikely to stand by if it feels choice is not being offered to practices.

Sean Riddell, EMIS’s managing director, argues that interoperability between health care systems is the model that is being followed throughout the world and PCTs that are not offering choice are behind the times. He adds: “If we find areas where there is a limitation on GP choice we write to the chief executives of those PCTs.” For its part, CfH argues that GPSoC has been “a significant piece of work” that will meet the needs of practices, suppliers and the NHS.

The NHS IT agency argues that the provision of central funding is key to the scheme’s potential success, moving the debate about a practice’s choice of system away from local funding pressures and on to the merits of the systems on offer.

However, the agency also makes it plain that ultimate decisions about migration to an LSP solution, while resting with practices, must also align with NHS plans.

A CfH spokesperson told EHI Primary Care: “NHS CfH see the LSPs and the GPSoC framework suppliers continuing to provide systems to the GP community with practices making a choice to migrate to an LSP solution when they believe that it provides the benefits that they are seeking for their patients. In line with the provisions of the nGMS contract the choices that practices make over time will need to be consistent with local delivery plans.”