NHS England attempts (another) digital overhaul with £230m investment in IT

Derek du Preez | On April 4, 2014

The UK’s Health Secretary, Jeremy Hunt, made a rather bold statement last year. He declared that by 2018 he wants the National Health Service (NHS) transformed into a paperless organisation supported by new digital technologies – which if successful, could save taxpayers a whopping £4.4 billion a year. This gives an organisation that is now over 65 years old and which is sprawled across the country just four years to overhaul legacy systems and hop on the digital bandwagon.

A key milestone in this paperless agenda was revealed this week – NHS England pushed out a strategy document that outlines how it plans to invest £230 million in ‘high quality’ IT systems for General Practices. Something it hopes will go a long way to achieving Hunt’s vision. But, before we get too excited about this, let’s just remind ourselves that the government’s last attempt to overhaul IT in the NHS was a complete and utter disaster. Not only did it waste billions of pounds with suppliers, which frankly have failed to deliver bugger all, but UK taxpayer is still set to dish out hundreds of millions of pounds despite the project having being ‘canned’.

Not only this, but more recently the NHS has faced a backlash over controversial plans to extract, store and sell on ‘unidentifiable’ patient data from GP systems – a subject that Stuart has been following closely for a while now. Needless to say, health IT in the UK has a chequered past and the government has a lot riding on getting it right this time round.

Aim: Bettering the patient experience

The plan, or the ‘operating model’ as NHS England puts it, states that the money is going to be used to improve the quality of GP care by enhancing patients’ experience of services, support and encourage greater integration of care and provide efficiency benefits for practices by reducing paperwork, freeing up more time for the patients. All good in theory.

How to make a healthcare data sharing controversy worseYou’ve got to hand it to the UK government. If there was one way to make its plans to build a hugely…Feb 26 2014diginomica.com

The general idea is that the £230 million GP funding for IT will be distributed to Clinical Commissioning Groups based on patient population size (CCGs are groups of Practices that work together to plan and design local services across England). NHS England claims that this will ensure “equity across all parts of England based on a core IT service offer”. Alongside this, there will be a range of ‘add-on IT services’ which can be tailored and implemented to fit with local service improvement strategies – but more on that later.

Beverly Bryant, director of strategic systems and technology at NHS England said:

“Digital systems are the foundation upon which to build a modern, efficient and responsive health service. Enabling information to flow between care providers and between providers and patients will help achieve a safe, convenient and personalised health service for all.”

It is hoped that the investment will create online transactions for patients that include booking appointments, ordering repeat prescriptions and accessing individual health records online. It also supports the aim of implementing integrated digital care records across the NHS – the main stumbling block with previous projects – which should give health professionals access to patient information they need, without patients having to provide the same details to multiple agencies.

A push for localisation? 

One of the most interesting points to be taken from this announcement was highlighted by Tracey Grainger, programme head of Primary Care IT at NHS England. She said:

“These arrangements will continue to give general practice providers a choice of high quality clinical IT systems that are tailored to local requirements while enabling the flexibility and innovation we recognise the service needs. This is underpinned by an on-going commitment from NHS England to continue to support and encourage the development of a world class IT infrastructure across health and care.”

The salient point here being one of localisation. The strategy plan outlines that the IT investment will be split into ‘core’ IT services, which includes things like infrastructure, disaster recovery, service desk, training support, and ‘add-on GP IT services’ – which are discretionary and to be aligned with local CCG strategies. For me, this is the smartest thing I have heard so far.

One of the biggest mistakes from the previous National Programme for IT (the multi-billion pound disaster) was that the government tried to implement a monolithic, standardised system from the top down, with complete disregard for local requirements. Although all Practices and health services fundamentally provide similar care, they are also bound to have different business processes, capabilities and needs – as is the same with any other sector.

In fact, former NHS chief executive Sir David Nicholson said exactly this to a group of MPs last year when questioned on whether he thought it was possible procure a national IT project for health. His exact words were:

“The idea of ruthless standardisation has proved illusionary…the idea of managing change of that nature, from the top, centrally, simply is not possible.”

Verdict

1. Although I’m wary of being too optimistic – given that this is an IT health project in the UK – there are some things I like about this. Distributing money based on population size makes sense. Giving the money to CCGs to spend based on local requirements makes sense. Splitting the services into core and add-on makes sense.
2. However, I do think that the Health Secretary’s 2018 target for a paperless NHS is unrealistic. This is an organisation that is incredibly unique and incredibly complex. Not to say that good work can’t be done in the next four years, but let’s not rush it and let’s learn from mistakes of the past. The last thing we need is another few hundred million pounds of taxpayer money down the drain.

http://diginomica.com/2014/04/04/nhs-england-attempts-another-digital-overhaul-230m-investment/

Viewpoint: Dr John Ribchester: Why I support the King's Fund's primary care plans

By Dr John Ribchester, 28 February 2014

I am sorry to say that I have read BMA deputy chairman Dr Kailash Chand's critique of the King's Fund's report on commissioning and funding general practice with increasing concern and frustration, writes Kent GP Dr John Ribchester.

Dr Ribchester: 'The King’s Fund’s report advocates changing the commissioning landscape to enable family care networks.'

If his views are representative of the BMA, then I fear that the organisation will be following the ornithomimosaurs (ostrich dinosaurs) into extinction. As a lifelong exponent and supporter of general practice I would like to address his main concerns and explain why I support the tone and content of the report.

Dr Chand states that ‘primary care does not need another reorganisation’. The last major change to the GP contract was in 2004, with small scale changes commencing from this April. The change from PCTs to CCGs which came into force last April was of course a change in commissioning rather than something that had much effect on GPs as providers.

Admittedly, some GPs increased or developed a role in commissioning, but for most it was business as usual. It is surely widely accepted that continuing with GPs doing much the same as ever in an unchanging NHS is not a sustainable option either clinically or financially. A population of increasing size and age and a time of financial austerity is enough of a stimulus to require significant changes.

Recommendations within the King’s Fund’s report to reorganise general practices into large groups which can genuinely perform population healthcare planning and better community healthcare provision seem very logical. The sharing of expertise between the practices, economies of scale in managing fewer, larger practices and the ability to genuinely integrate with secondary care, community care, mental health services and social services can only occur once general practices are larger, whether this be through federations or mergers.

Dr Chand states that we should be focusing on tackling the serious workload and financial challenges faced by GP practices. I completely agree with this statement, but the point is this. Surely general practice would be in a better position to face these challenges once arranged into larger groups.

There is already a trend for CCGs to obtain smaller numbers of larger contracts from larger providers. This means that the small general practice does indeed face a financial challenge by being poorly equipped to attract an AQP or community contract.

I disagree that the model of GP family care networks is totally inappropriate and costly in rural areas. It is certainly true that, given the varying population, density and demographics across the country, one model will not be appropriate for all locations.

One would certainly not advocate siting a large provider unit in a rural area. However, the concept of practices collaborating in some way and sharing clinical and management expertise is equally applicable regardless of location.

I think my largest objection is to the statement that ‘there is a complete lack of evidence for the alternative of moving care closer to home’. There is a growing body of evidence nationally and internationally that this can produce a better experience at less cost.

The King’s Fund’s report itself studies four models and draws from experience of many others. Although not mentioned by name, Whitstable Medical Practice also provided evidence. Our model of community integrated healthcare has been evolving for a number of years.

Currently, 19 GPs look after a locality of 34,000 patients in collaboration with over 20 consultants and other healthcare professionals. Work streams have been developed to innovate in the care of long-term conditions, urgent care and community elective services. The result has been an enhanced patient experience, closer to home, with shorter waits and one-stop care where possible.

This has been delivered at less cost to the system and also to the greater satisfaction of the doctors, nurses and other healthcare professionals involved in delivering the model. Other super partnerships and federations report similar findings.

The evidence is out there and it is growing. One reason that there are not more innovators is that they are trying to develop new and better systems in a bureaucratic environment which is at best unhelpful and at worst oppositional. The King’s Fund’s report advocates changing the commissioning landscape to enable family care networks - otherwise known as community integrated healthcare. This is a concept which has been talked about for many years. Surely there could not be a better time to facilitate progress.

I agree with the statement that conflict of interests for GPs as commissioners and providers needs to be addressed. The report advocates managing this effectively which seems a better alternative than allowing it to block progress, which is all too often the case at present.

Transparency, honesty and scrutiny are the key to success. I find myself agreeing with Dr Chand’s statement that ‘to implement needlessly disruptive policies that focus more on structures than outcomes needs rejecting’.

However, this is not what the report is advocating. Instead it states that the GP contract should focus on outcomes and not inputs.

Finally, Dr Chand makes the point that new investment is required in general practice. I agree that we appear continuously to be asked to do more with less resource, something we all feel pressurised by. However, it is possible that the King’s Fund’s recommendations provide one answer to this. If more clinical activity is occurring in the family care networks then more finance will flow into them.

Economies of scale in running practices and also in providing shorter patient journeys with less duplication, hand-offs and omissions should all have the potential to produce savings which could in turn increase the amount of resource in a new version of general practice which has a leadership role in family care networks.

As the King’s Fund’s report states, simply doing more of the same will not be sufficient and therefore there is a strong argument for a better approach based on innovative ways of providing services.

This debate is advancing in our locality, and others that I have visited. Potential ornithomimosaurs please take note.

* Dr John Ribchester is a Kent GP.

http://www.gponline.com/Opinion/article/1282747/Viewpoint-Dr-John-Ribchester-Why-I-support-Kings-Funds-primary-care-plans/