CCG survey: money worries

The importance of IT to delivering the goals of clinical commissioning groups was the one thing that respondents to EHI Primary Care’s latest survey agreed on.

More than three in four GPs, managers and others involved in emerging CCGs rated IT as ‘vital’ (76%) while another fifth (21%) rated it ‘very important’ or ‘important.’

However, the vast majority of the 64 respondents also reported that they were working without an IT budget, that lack of funding was a major concern and - most important of all - that lack of clarity from the centre about the future direction of NHS informatics was making decision making difficult.

One huge question in search of an answer is the future of GP system funding once the GP Systems of Choice scheme ends in 2013.

Bob Lewis, a practice manager in South West Oxfordshire, said: “We don’t know what is going to happen about GP funding. Is that budget going to be protected, who is going to administer it and under what criteria?”

Dr Arjun Dhillion, an IT lead for Ealing Clinical Commissioning Consortium, added: “Clarity just on GPSoC would make life a lot easier.”

Free for all will not be free

Dr Dhillion says he believes primary care “could get eaten alive in less than 18 months” if a decision is made to allow an entirely free market post-GPSoC.

He felt this would encourage suppliers to substantially increase their prices to customers wholly dependent on their clinical systems and largely conservative about switching providers.

Unfortunately, when GP Mary Hawking pushed the head of NHS Informatics, Katie Davis, on just this point at EHI Live 2011, Davis was unable to say anything except that she understood the concern - and she would get people an answer as soon as possible.

Perhaps before the NHS information strategy, about which Davis was careful to dampen hopes, while admitting she had no idea when it would appear. At the very least, CCGs need guidance on how funding will work and who will hold the purse strings.

Dr Dhillion would like to see central procurement with a set of standards, but less bureaucracy for suppliers so they are not forced to spend large amounts of time achieving compliance with central requirements. He also wants to see some central mandate for interoperability.

He adds: “I think it’s been a managed market for so long that it’s going to be difficult to de-manage it now.”

Looking for support

The survey found that concerns about future funding were the biggest worry for CCGs, but they also highlighted loss of IT expertise from primary care trusts and other shared services as a potential problem.

Andrew Neal, an IT manager for a Hampshire practice and a former PCT employee, said he feared a return to the ‘bad old days’ when there was a huge variation in the systems used in practices, with many running software that was several years out of date.

He added: “Over the past few years we have all been brought up to a level which might not be perfect but it is a good solid foundation. What is going to happen with that if we go back to where we used to be and every practice can do what it likes?”

Another key question is where CCGs will be able to get IT support from in future, with almost 50% of survey respondents indicating that they would consider going outside the NHS for some services.

The government has acknowledged that commissioning support is a key issue for CCGs, and one that it is working on. But Dr Peter Green, chairman of the Medway GP Commissioning Consortium, says much of the detail has yet to be worked out.

He adds: “My understanding is that the debate at the moment is around what CCGs can afford to do and what the restrictions may be.”

He suggests that CCGs may be faced with redundancy costs if they decide not to use their cluster or strategic health authority NHS IT service.

But he is unclear whether, for example, a Kent-based CCG could opt to use an NHS IT service in Doncaster and then still be responsible for its local cluster or SHA redundancy costs.

The development of NHS-based commissioning support units would certainly make sense to a cash-strapped NHS unlikely to want to spend even more money on redundancy payment. Even so, some of the survey respondents seemed keen to start testing the water outside the NHS.

Dr Peter Rudge, chair of the Sentinel Clinical Commissioning Group in Plymouth, says his CCG hopes to use the local authority for its IT support in future, having been very impressed with it in comparison with its existing, hospital-based IT support service.

He adds: “I would be very open to the market on this but at the moment I don’t see any reason to rush off down the private sector route when we have a potentially good service closer to home with the local authority which is more than willing to engage with us.”

It is clear CCGs will have a lot of negotiating to do around this area and some human resources minefields to negotiate - which might be why most respondents could stick with the service they know, at least for now.

Reinventing the wheel

Alongside these immediate concerns, the survey also found that CCGs are worried that they lack opportunities to share information with other CCGs and to benefit from others’ experience. Respondents said they were worried that 266 emerging organisations could all end up ‘reinventing the wheel.’

Dr Mike O’Neill, IT lead for Nottingham West Consortium, said his area had developed a bespoke data analysis solution over the past six or seven years, which takes data from sources including the Secondary Uses Service and SLAM.

The tool delivers information in a variety of views to the CCG, the primary care trust and practices, and has been a key element in supporting substantial changes in referral patterns by individual GPs and practices. Yet he has little idea how his bespoke solution compares with others.

He adds: “It's extremely hard to say how advanced we are. When we did some work with the NHS Information Centre they said they hadn’t come across anything like ours before; but it’s hard to know because there is so little communication and discussion on these things.”

Dr Dhillon also rues the tendency to work in silos rather than share information solutions. He adds: “We really need to learn how to share this information rather than saying something isn’t 100% right for us so we’ll spend the next three years trying to reach that 100% with our own solution.”

Even so - and in marked contrast to the surveys that EHI PC ran of SHA and PCT staff as the reforms were still being debated - the responses showed enthusiasm for what might be achieved by the new NHS and for using IT to support these plans.

The majority of respondents (74%) said they believed IT would help them deliver better clinical information for GPs and more clinical information sharing (66%). Respondents also said they believed IT would help to deliver reduced admissions to hospitals (66%), new patient pathways (60%) and better analysis of demand and trends (58%).

Dr Mike O’Neill said he believed CCGs would allow “huge room for innovation” and enable clinical commissioners to move much more quickly than they had in the past. He argued that in such a world IT had two critical roles to play.

“It can help nail the behavioural change by clinicians and then support that change with fast interfaces that link information in an intuitive way and deliver it to clinicians at the decision point.”

For now, most CCGs must wait and see how much funding and freedom they will have to put their own IT-backed initiatives into practice.