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What happens to practice IT from April 2013?

Fiona Barr examines the new arrangements for supporting GP computing in England when funding passes to the NHS Commissioning Board and CCGs.

There will be changes to practice IT support but no extra funding (Image: iStock)
There will be changes to practice IT support but no extra funding (Image: iStock)

Switching on the consulting room computer is probably the first thing that every GP does in the morning, confident that the practice system will work and, if not, that problems will be resolved quickly.

However in England from 1 April 2013 funding and support for this vital business function is changing as PCTs are scrapped and the current GP Systems of Choice (GPSoC) framework ends.

GPSoC is the scheme through which the NHS has been funding the provision of GP clinical systems in England. The NHS Commissioning Board (NHSCB) is taking over responsibility for GP IT support and has effectively delegated that responsibility wholesale to CCGs.

Impact on GPs

In the meantime the GPSoC Framework is to be ‘re-procured’ (put out to tender) with a new-look system. 

South-west London GP Dr Paul Cundy, joint chair of the GPC/RCGP IT committee has been involved in crafting the new arrangements and is confident they will work. ‘How will GPs be affected by the changes? Hopefully not at all,’ he says.

However, GPC negotiator Dr Chaand Nagpaul is more cautious. 'Responsibility has been delegated at rather a late stage and CCGs are still waiting to find out what resource they will have for this task,’ he says.

‘Hot potato’ treatment

GPs and CCGs on the ground are also keen to get more details on the new system. Dr David Jenner, a GP in Devon, and senior policy adviser to the NHS Alliance, says GP IT has been delegated to CCGs ‘like a hot potato’. 

He adds: ‘It’s crucial that the NHSCB also devolves significant amounts of budget along with the responsibility.’

Funding will be divided into core and mandatory services and discretionary services according to a NHSCB document on the new arrangements Securing Excellence in GP IT Services, published in December 2012.

The NHSCB has said it will fund all core and mandatory services and ‘some’ discretionary services (see box below).

No new money

Funding will be based on 2012/13 spending and will not exceed ‘flat cash 2012/13 expenditure’. In other words, there will be no new money for IT. However, Dr Cundy says the NHSCB has made a commitment that there will be no change in IT support for the first two years.

CCGs can choose from whom they commission GP IT services after April. The NHSCB document suggested agreements should be in place by the end of 2012, but that has proved a highly ambitious timescale given that by the third week in December CCGs were still waiting to find out about funding.

Dr Nagpaul says: ‘I expect most CCGs will block book (contract) the functions to commissioning support units as there is a very short time scale for doing anything else.

‘But in the long term CCGs need to try and develop a locally sensitive GP IT function.’

In-house or out-sourcing

CCGs can opt to bring the service in-house or use an outside provider. Northern, Eastern and Western Devon CCG looks like it might bring the service in-house, although Dr Jenner says ‘it is yet to be fully decided’ how GP IT support will be contracted from April 2013. 

PCT staff involved in GP IT support are also losing their jobs as trusts are scrapped, so the future workforce could lack numbers and expertise and have a dented morale.

Inadequate information

Another CCG IT lead, who did not want to be named, said more information is desperately needed by CCGs on GP IT support. 

 ‘It is interesting how often central government releases information that it thinks is comprehensive, yet those at the periphery can't make head nor tail of, because - as in the present instance - the people at the periphery don't know the exact timescale and they don't know the actual amounts of money,' he says.

‘This makes makes planning rather difficult.'

GPSoC replacement

While CCGs await their budgets for GP IT support, the procurement to replace the GPSoC framework, currently providing systems to 81% of practices in England, is due to be launched early in 2013.

Dr Cundy says there will be a new, modular approach to the contracts with funding split into core and optional elements, and suppliers paid only for the elements of systems actually used by practices. 

Dr Cundy adds: ‘For example iSoft’s Synergy system has an appointments system built in but most iSoft practices use FrontDesk for appointments, which is a separate system. In future suppliers won’t be paid for elements not used which is a much better arrangement.’

GPs’ confidence

Dr Cundy says the DH is clear that IT continuity is vital for GP practices and that the existing GPSoC framework will be rolled on beyond March until the new arrangements are in place.

While many plans are in place for IT beyond March 2013 a lot of work still needs to be done to put those plans into action and to guarantee GPs’ continued confidence in the IT that supports practices and patient care day in and day out.

After March 2013
  • The NHSCB will be accountable for primary care IT from 1 April 2013 and will delegate responsibility and funding for GP IT to CCGs.
  • The NHSCB will set standards, maintain national infrastructure and manage the GPSoC framework and its replacement.
  • CCGs will receive funding for ‘core and mandated services’ including IT maintenance, GP clinical systems, N3 support, software licences, support for services such as Choose and Book and the Summary Care Record and information governance.
  • CCGs will also get some funding for ‘discretionary services’ including interoperability initiatives such as internet communication engines (ICE), web portals, data warehouses and add-on applications
  • Funding for 2013/14 will be based on spending on IT support in 2012/13.
  • Support might be delivered in-house by CCGs or by a commissioning support unit or by a third party provider.

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