Clinical Systems In Primary Care
GP Systems of Choice is now a central part of Connecting for Health’s (CfH) strategy. CfH has become much more pragmatic, realising that current systems in GP practices remain the most effective clinical systems, delivering working systems on time.By using a number of small suppliers and smaller data centres, the NHS will protect itself against data leakage, such as the disasters of recent times: http://news.bbc.co.uk/1/hi/uk/7158688.stm · http://news.bbc.co.uk/1/hi/uk_politics/7104368.stm · http://news.sky.com/skynews/article/0,,91211-1298255,00.html It is possible that, as GPSoC evolves, GPs will retain their own servers and data, and use the NHS systems for off-site backups, rather than using off-site data centres.
Many people, particularly those working in some Strategic Health Authorities and Primary Care Trusts, still believe in the original unitary vision of the then National Programme for Information Technology (NPfIT). The fact that GP surgeries have the ability to choose their own clinical systems, or are able to retain their current suppliers, seems to attack the very foundation of Connecting For Health. Some bureaucrats still wish for the imposition of a single state-wide medical system.
GP system suppliers’ representatives have watched CfH change to its more pragmatic approach – using what works, rather than relying on delivery of vapourware. Some SHAs and PCTs need to catch up with the central team’s vision.
CfH thinking has come a long way. At the start Richard Granger (now ex-Chief Executive of CfH) gave talks to potential suppliers wherein he stated that all GP systems “were crap”. GPs would have to “get used to the idea” that ‘their surgeries would have to lose 40% of their current data and 40% of their current functionality in order to achieve the greater good: that of a common system across the entire NHS’. At that time he was thinking of vans driving around with the tin (as he called the computer hardware), preconfigured and bolted down, being delivered to GP surgeries connecting to central off-site databases.
But things have changed. The failure of CfH contractors to deliver new integrated systems was partly due to the complexity of clinical systems. GP systems were not seen to be “crap” after all, but working complex systems. Indeed the first “success for CfH” (actually that of the smaller suppliers) was the creation of the largest prevalence dataset in the world, and primary care quality survey – the QMAS database and Quality & Outcomes Framework (QOF). The success was delivered by the current small software houses – the then so called “legacy systems” which, within a year, got the system working and produced the world’s largest prevalence data set. Each firm was terrified that their competitors would get there first. That success may have convinced some within CfH and the Department of Health that small is beautiful, responsive, and can work to a common standard and deliver on time…
Those software houses with GPSOC contracts are now working to a common standard derived from national CfH specifications, and standardised secure communication, and they are now back in competition with each other.
When CfH started, it seemed to abolish competition: imposing giant US-led monopolies upon users and nearly killing off a thriving UK IT industry of small IT businesses. We have forgotten how close the NHS came to losing its GP systems suppliers altogether.
Competition between suppliers is more likely to lead to better, safer and intuitive systems which improve patient care. Government-imposed monopolies are never likely to improve computer systems, let alone deliver them on time. An imposed single system solution is more likely to set clinical information technology in aspic and do nothing to mollify justifiable data security fears.