I’ve have heard Katie Davis (no relation), the new head of the DH Informatics Directorate, speak twice in the last few days and on both occasions she has stressed the Government’s desire to create a vibrant market for the suppliers of Health IT systems. This is very much to be welcomed.
Current arrangements for the funding of GP Computing come to an end soon and at one of these meetings, in answer to a question from the redoubtable Dr Mary Hawking, Katie Davis gave assurances that there would be future funding for GP computing, but would not be drawn on the form it would take. This both reassured and worried me.
The cost of GP computing has always been fully met by the NHS (either directly or indirectly) but the way this funding has been delivered has had and will continue to have a critical effect on market dynamics and decisions about future funding will determine who “vibrant” this section of the market is with important ramifications for the whole market.
The UK wide 2004 GP contract gives GPs a contractual right to a choice of GP system and currently funding for GP computing comes from two central sources: Where GPs take solutions from the LSPs under the NHS NPfIT it comes from the NPfIT otherwise it comes via the GP Systems of Choice Programme (GPSoC) under a national framework contract which includes all of the current GP suppliers (for practical purposes this contract was available to all who wanted to participate at the time it was let.) In both cases the responsibility for managing the provision of systems at a local level in England lies with PCTs; there are other arrangements in the other home countries.
A number of things will happen over the next couple of years which have the potential to result in radical change for GPs in England.
1. The NPfIT LSP contracts come to an end in 2013; but are the subject of ongoing discussions that could lead to changes.
2. The GPSoC contract comes to an end in March 2013
3. PCTs cease to exist in April 2013 – assuming the Health Bill makes it through the Lords.
4. Finally, there is potential for changes in the GP contract
If properly coordinated these changes create an opportunity to ensure competition and innovation and a vibrant market. However, the history of such coordination on this issue is a very unhappy one and we need action now to ensure it happens.
There are a number of issues that emerge in my mind which need to be addressed:
• There must be coordination between the different parts of the DH/NHS responsible for these changes including, as far as it affects them, other home countries. The BMA and in particular the BMA/RCGP Joint GP IT Committee has a key role in making sure this happens.
• The local coordination role currently undertaken by PCTs MUST go to the Clinical Commissioning Groups (CCGs) not to the National Commission Board (NCB). As. I have said previously, and it is widely acknowledged elsewhere, successful IT requires frontline (particularly clinical) engagement. The shift of responsibility for IT provision from individual practices to PCT resulting from the GP 2004 contract undermined this engagement moving closer to GP and other clinicians via the CCGs with help rebuild engagement moving to the NCB would fatally undermine it.
However, while CCGs should hold the responsibility many are not equipped to manage the practicalities of this role and arrangements should enable CCGs, either singly or in local clusters, to contract out day-to-day responsibility to informatics services or Clinical Commissioning Support Groups in the public, private or third sectors.
•New arrangements need to secure access to GP data for analytic purposes (see my blog http://wp.me/s1orc5-110 )
•Transition arrangements for those with systems under LSP contracts should be such as to bring all GPs in to a common framework.
• We need to retain choice for GP practices and keep this enshrined in any renegotiation of the GP contract. I can see good arguments for a common choice at a local level, but on balance I believe that this should be by agreement between practices. I fear that if we remove choice at a practice level altogether we risk ossification of the market which will stifle innovation and competition
• New arrangements need to open to scrutiny, like GPSoC not secret like the NPfIT contracts
• We need to ensure that we don’t continue to lock the market to new entrants or just to those who offer a GP-Centric solutions. The future IT needs of GP practices may well be better meet by a new generation of multiple cloud based apps which make the current boundaries between care settings and the systems that serve them meaningless –We must not create artificial barriers to such potential new approaches. If we lock general practice in a bubble so that it can’t be part of wider solutions that cut across care-settings and organisational boundaries we risk doing damage across the whole UK Health IT market not just General Practice.
It is not clear whether the intention is to put a national framework in place but this would seem to go against much of what I’m hearing about local procurement of IT. I think there needs to be some national coordination and standards, but this not need go as far as formal framework procurement. I favour some central guidance perhaps with a model contract that can be amended for use at CCG level (probably done through share Clinical Commissioning Support Group or Local Informatics Services.)
Getting this right will be critical to the creation a vibrant market and time to do this is running out. I know that some work is going on but are we covering all the bases?
Deceleration of potential conflict of interest
I don’t believe that I have any material conflicts of interest in relation to the matters in the blog. Neither my future plans or those of any current client are directly effected by future decisions on the funding mechanism for GP computing.