It’s now 18 months since the government launched its ‘Liberating the NHS’ white paper.
Although the Health and Social Care Bill that will formally enact the reforms has yet to complete its passage through Parliament, some of the changes are taking shape on the ground.
The NHS Commissioning Board has started work, strategic health authorities and primary care trusts have been formed into clusters, clinical commissioning groups are emerging, and some could be authorised to start work next year.
EHI Primary Care asked some of those leading the shift towards GP-commissioning what the year ahead will bring; and what it needs to bring in IT and information terms if the changes are to work:
Dr Chaand Nagpaul, BMA General Practitioner Committee negotiator and lead on IT issues
Next year, CCGs will need clarity and agreement about GP IT funding as the current GP Systems of Choice agreement ends in April 2013. Discussions have been complicated because, until recently, we were unclear about the organisational structure of the NHS in England - such as the place of commissioning support organisations.
We are now in the middle of discussing what elements may be delivered locally and what nationally. The discussions are quite complex because they are taking place in the context of such radical change. I don’t know when there will be an agreement but it needs to be well before 2013 so everyone has time to plan.
In the meantime, PCT clusters need to provide continuity of provision under GPSoC because as clusters become more remote and the IT workforce reduces practices are reporting a less responsive service.
Dr Calvert Han, IT lead for Guildford and Waverly CCG and a GP in Merrow
There will be more movement on information and technology over the next year. Data analysis will need to get better as more data comes out of hospitals regarding referrals and activity.
Historically, the PCT has managed this data and the challenge is interpreting this in ways that are understandable and practical to grassroots GPs. However, there is a role for private company management consultancy in both data collection and interpretation.
GPs and, increasingly, primary health care teams will be looking at data on their populations and making comparisons with other practices within the same CCG to predict A&E attendances or long-stay admissions. We already do this and are able to use community matrons to intervene with nursing and social as well as clinical interventions to minimise risk of admissions.
We are also looking at a pilot to manage patient demand for GP appointments, which involves data collection in ways that has not been done at this practice before.
Eventually, we hope to make comparisons with others in the CCG should our intervention be successful. The role of the senior information risk officer and Caldicott guardians will need to be shown to be more robust too in managing this change.
Dr Stewart Findlay, chair of Durham Dales CCG and a GP in Bishop Auckland
We are hoping to get authorisation in October next year and are currently embroiled in proving that we are capable of being authorised. I had hoped that we would have moved away from this kind of bureaucracy, which looks like world class commissioning all over again.
Our GPs are keen to get involved in commissioning and performance management of our providers, but this is distracting us. The Department of Health also seems to want detailed contracts for relatively small amounts of money, which is out of proportion to the risk of doing something.
We have allowed our public health colleagues to extract information from our practice systems, so we already have a lot of data about disease prevalence. We are using IT for referral management and a system called GP TeamNet which is helping us to share information across our three localities.
We have a very reactive IT department at the PCT. They are very responsive to our ideas and have also helped us to develop bespoke solutions. I think that next year they will become part of a commissioning support unit and we will buy their services in.
Dr David Jenner, national executive committee NHS Alliance, chair of Eastern (Devon) Consortia Chairs Board, and GP in Collumpton
I think anybody who is half willing will be authorised next year, as the government will look to get as many CCGs as possible authorised. There are real tensions around size of CCGs at the moment [the BMA recently called for CCGs to cover a minimum population of a million patients] and I think they will end up covering larger populations.
I think that is the right thing to do because the agenda is pretty massive and it makes sense to have bigger CCGs and then have smaller localities within them. My own CCG is in talks about that at the moment but I do not know if that will go-ahead.
In our area we have got good commissioning support information from our GP-led referral centre, which produces reports showing referral information by individual GPs. I think to start with we will buy in IT support from our commissioning support organisation, but in time IT is one area where you might want to look outside the NHS suppliers.
I think the Summary Care Record will also start to prove to be a white elephant with cloud-based systems coming into increasing prominence and allowing remote access to full records for patients and clinicians. I think next year might also see a backlash against plans for use of pseudonymised data.
Dr Steve Ollerton, chair of Greater Huddersfield Commissioning Consortium and a GP in Huddersfield
We are going full steam ahead at the moment and hoping to go for early authorisation in October. The CCG will cover 238,000 patients, but we are not feeling any pressure to join with another group at the moment. We are very lucky in that we have got good support from our GPs and are keeping them engaged.
The current plan is to have a data warehousing system covering Calderdale, Kirklees and Wakefield with different front ends for each area– it might extend to Bradford and Leeds as well but we are in talks about that at the moment.
We are also looking at referral management systems and have got three different ones presenting their solutions to us this month. The plan with that is that whichever one we choose will also cover Calderdale, Kirklees and Wakefield.
In our CCG, we have two-thirds of our practice on SystmOne and one third on EMIS - with those practices, including my own holding out for EMIS Web. But it seems to be taking a long time and I really hope EMIS sorts that out soon.
Roz Foad, chair of the British Computer Society’s Primary Healthcare Specialist Group
I am finding it difficult to hold onto a positive outlook for next year. What I would like to see happen is a proper, considered and consulted replacement/extension to the GPSoC arrangement for supporting GP clinical systems. I would like to see IT budgets ring fenced, but I hold out little hope for that.
I would like to see a determined attempt at the highest level to sort out the conflict between ‘no decision about me without me’ and the desire of some private and public organisation to get their hands on identifiable patient data for secondary purposes without worrying too much about patient’s right to consent or opt out. But above all, I would like to see technology used to manage the care of patients first and foremost, rather than seen as a means of identifying savings.
Dr John Lockley, GP in Bedfordshire and member of the Bedfordshire Clinical Commissioning Group
I am very enthusiastic about the possibilities for CCGs and we have got some very good people involved locally. I think that next year all CCGs will need to focus on collecting the minimum data needed to provide the most useful information and make sure clinicians are involved in decisions about what data is collected. With just £25 per person management costs, we will need to use time spent on data collection and analysis very wisely.
The only time a doctor can really make a change to their referral rates is when they have a patient in front of them, so they need the information to be available at that point. I am the primary care clinical co-ordinator for an invoice validation project that our CCG is involved with alongside five other primary care trusts in NHS East of England.
We’re using MedeAnalytics software to provide information to practices so they can quickly see which patients they need to target, and I can see that has huge potential for the future.
Adrian Down, practice manager and board member South West Lincolnshire CCG
We are working for authorisation and feel that we will be ready for it next year. An IT project that has really started to gain momentum is what you might describe as our ‘Facebook for doctors’ software. It is called FMYI and is a communications package for our CCG and the local health community. It allows our board to have discussions before meetings so that the meetings themselves can focus on decision making.
What is exciting about it is that we have not just restricted it to the board but opened it up to practices and others in the local health community so that our decision making is transparent and so that others can contribute to those decisions.
To start with, there were just the enthusiasts using it but more people are now taking part, others are asking to join and we are approaching a critical mass. At the moment, for example, we are using it to collect winter pressures information among other things.
We hope to open it up to our neighbouring CCGs soon, so we can discuss items that we will be working together on such as commissioning and contracting. Other items that we may be looking to invest in over the next 12 months include telehealth and the PathFinder referral management system.
Dr Amit Bhargava, GP in Crawley and chair of the Crawley Commissioning Consortium
At the moment we have involvement from all our GPs and everyone is fully supportive. On IT we are interested in the urgent care dashboard that has been developed in Bolton and see that as something we would like to invest in. We are also keen to stay at our current size, covering 120,000 patients, while working collaboratively with other local CCGs and hope we will be able to do that.
If we are allowed to get on with this without people meddling and changing the rules then I think we can do it. There is a general feeling, however, that we are being pushed from the whole rhetoric of localism to something which is more rigid and centrally controlled. If that is the case, I think - like others – that I might go back to my day job.
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