CCG IT: Local knowledge

The government’s suggestion that business intelligence for clinical commissioning groups should be provided ‘at scale’ – and quite probably by the private sector - has raised more than a few eyebrows.

Scepticism has been particularly acute in areas like NHS Oxfordshire, where a more local, in-house approach has already proved successful in meeting the needs of both clinicians and managers.

The primary care trust, together with practice managers and GPs, has developed the Oxford Commissioning Intelligence project, better known locally as SUS+, to provide insight into local NHS data.

SUS+ has been used for the last two to three years by PCT-based commissioners and individual GP practices, and now looks likely to be adopted as a key tool by the Oxfordshire Clinical Commissioning Group.

In its draft document, ‘Towards Service Excellence’, the Department of Health suggested that business intelligence and commissioning support might be best provided across a population of 5m, with just ten units in England.

But Andrew Fenton, chief information officer for NHS Oxfordshire, believes this is misguided. “I think there are huge risks in doing that, because you don’t often have a standardised data set,” he says.

“The specific elements of a CCG’s contract with a local provider covering local costings and outcomes have to be integrated into how you produce Payments by Results data.”

Doing it for themselves

The tone of ‘Towards Service Excellence’ also prompted the British Medical Association to warn that the DH was opening the door to private sector companies to come in and provide commissioning support. Again, though, the Oxfordshire experience might be instructive.

The Oxfordshire Commissioning Intelligence project came about after attempts to develop a Thames Valley data warehouse and to use a commercial alternative in the middle of the last decade.

In 2006-7, the PCT responded to demand from practices for a more locally-intuitive system and decided to develop its own capability, working with local practices and Oxford-based company Quiet Mountain to produce SUS+.

The resulting system integrates datasets including Secondary Uses Services data, provider service level agreement monitoring (SLAM) data, referrals, daily information on acute admissions, acute contracts and GP commissioning budgets.

Its first release included generic dashboards, which have since been enhanced with scorecards and key performance indicators that can be used to support contract monitoring.

The system presents two views of its data controlled by a security model. Staff in Oxfordshire’s 82 GP practices are able to see a patient-level view; while a pseudonymised view is available for comparative reporting and analysis.

SUS+ was built using Microsoft’s business intelligence infrastructure. It uses the SQL Server 2010 database, SharePoint sharing technology and PerformancePoint display capabilities in a virtualised server infrastructure that is run from the Oxford Radcliffe Hospitals NHS Trust.

Fenton says this provides a high level of performance and security and makes it scalable. He adds: “It is a complete end-to-end solution, combining the best of back-end database design and data quality management with front-end functionality for commissioning users.”

Fenton says practices have also been able to use SUS+ to support the Quality and Productivity indicators in the Quality and Outcomes Frameworks. These reward practices for analysing their data, including first outpatient referrals and emergency admissions, and next year will incentivise GPs to analyse A&E attendances.

The system now has more than 300 registered users across primary and community services, with interest increasing substantially in the last year as practices have begun to get to grips with their role in commissioning care and making efficiency savings.

A SUS+ User Group provides input on user requirements and feedback on the usability of the system which Fenton argues ensures the tool is open to rigorous testing and scrutiny.

Fenton adds: “We are clearly not going to end up with GPs or practice managers becoming advanced data analysts, but it is about them knowing the questions they want to ask and specifying the requirements.”

Doing more with less

Andrew McHugh, medical practice director for the Horsefair Surgery in Banbury and a CCG board member, was among Oxfordshire practice managers who went to the PCT asking for a better system than the commercial solution they had been using.

He says: “Both packages use the SUS dataset but we told the PCT we wanted something that was much more intuitive and SUS+ has grown organically from within the health economy.”

McHugh says what he likes about SUS+ is its flexibility. It can show what is happening in a variety of ways, such as by outpatient referrals, in-patient episodes, age, treatments, outcomes and so on.

As a result, it can help with decision making under the quality, innovation, productivity and prevention agenda. “SUS+ is going to give us really useful information on how we meet the needs of our patients within the restricted financial situation we will have to operate in.”

McHugh says the CCG also now hopes to use SUS+ to change patient pathways in the county by asking practices to review their emergency acute admissions for ambulatory care and see where they could have been avoided.

He added: “My personal view is of a future when clinical commissioning is informed by IT. We need to make sure that the efficiencies that are being made in some practices are not being offset by some practices becoming outliers in other areas.”

Like Fenton, he also emphasises the important of the local approach and the granularity that adds to business intelligence information.

He adds: “For example many people think Oxfordshire is uniformly wealthy but in Banbury, where we work, two wards are in the lowest quintile of deprivation for the whole country. You need business intelligence with sufficient granularity to show that.”

Doing an NPfIT on BI

The most recent development for SUS+ is the addition of the GP urgent care dashboard, first piloted in Bolton and now being rolled out to 12 other areas across England.

In Oxfordshire, the dashboard is being used by five practices in the south west of the county, but over the next month to six weeks it start being used by all Oxfordshire practices plus A&E teams, out-of-hours clinicians and community and acute teams.

Fenton says SUS+ has a flexible development roadmap that means it can be scaled sideways - by adding more data sets - or upwards - by presenting additional KPIs and management dashboards custom built for commissioners at the practice, the CCG or the commissioning support organisation-level.

Neighbouring Buckinghamshire, of which Fenton is also CIO, has also been very positive about the system and is looking to make use of it. Fenton argues that such an incremental approach makes much better sense than the large scale model currently under consideration at the DH.

“In time, commissioning support organisations may well cover a bigger area - and one would expect greater consolidation of technologies, with scaling-up of systems that are strong in the market or in-house NHS systems.

“However, it makes more sense to use an existing service where it is available than to procure a new one. Large scale data systems a new for reasons that are not dissimilar to the [National Programme for IT in the NHS] experience.”