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Tackling the new IT enhanced service

You may already qualify for payments under the new IT DES, says Dr Neil Paul.

Conspiracy theorists will no doubt feel that the new information management and technology directed enhanced service (DES) for England is the DoH's clever attempt to persuade GPs to tidy up their data in return for a little money prior to it being taken out of their control.

The DES's key objective is to help practices to achieve accredited data quality standards that are fit for sharing in the NHS Care Records Service.

The DES is non-recurrent and worth £1.33 per patient in total, probably paid over a couple of years because it is unlikely that many practices will achieve the whole DES in 2006/7.

Several surveys have indicated that GP practices are reluctant to sign up to the DES. While the GMS contract allows you to decide what to do and what not to do, if you do not participate in this you may be marked a troublemaker - or even a failing practice that needs taking over.

The good news is that some parts are easy, there is apparently new money involved (about £70 million nationally) and you are paid for the bits you do.


1. IT adoption plan

This is all about acting as a proper business and a good employer. You have to agree to meet certain standards and implement certain processes.

For example, you will need to nominate a practice lead for Connecting for Health (CfH) and a Caldecott Guardian.

Practices are required to undertake a training needs assessment for all staff and have a linked plan. They must keep a log of all training undertaken.

You also have to agree to be connected to N3, the new NHS network and ensure all users are registered for a smartcard.

You may be doing much of this already and just need to formalise your system and keep better records. If so, this is easy money.

The money is paid up front at 40p per registered patient on agreement of the plan with your PCT.

2. Preparing data for accreditation

Practices must work towards data quality standards that ensure consistent coding, recording and problem 'significance' that will enable uploading of summary information to the CfH spine and GP-to-GP record transfer.

Taking on this component may prove controversial and a lot of work for some practices. GPs need to bear in mind the political and financial implications. The payment is 44p per patient.

3. Addresses and e-prescriptions

Possibly the easiest component to achieve, this is worth 27p per patient.

You will need to check that patients' address changes are processed quickly and that address details are validated at every patient contact, particularly on referral or incoming letter. This means more work for practices with high numbers of temporary or transient patients.

Additionally, you have to sign up for the electronic prescription service (EPS). Still under development, this currently seems to consist of allowing computer upgrades and using prescription paper with a space for bar codes. It could take two years or so for the system to become fully operational.

4. Centralised servers

This is possibly the most contentious component, particularly for those who see loss of their own computer server as loss of ownership and control.

Practices will receive 22p following migration to a CfH accredited host system.

Some practices have probably already achieved this or are about to do so. Others may not want to touch it. I would only change server if fully supported financially and administratively by my PCT and if there were valid reasons and real benefits for me and my patients.

You may already be doing some of this so make sure you are paid extra for it. Components two and four of the DES are more controversial, so practices need to think through the implications of going for them.

- Dr Neil Paul is a GP in Sandbach, Cheshire.

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