Re-configuring the Market:
Changing Relationships with Suppliers
in Primary Care in England
Rob Wilson
Centre for Social and
Business Informatics
University of Newcastle
Rob.Wilson@ncl.ac.uk
Bob Sugden
Centre for Software Reliability
and System Dependability
School of Computing Science
University of Newcastle
Bob.Sugden@ncl.ac.uk
James Cornford
Centre for Social and Business
Informatics
University of Newcastle
James.Cornford@ncl.ac.uk
Development of Primary Care Computing in England
• GP interest creates varied solutions
• Central funding creates exploitable market
• Theory and practice drive standardisation
with innovation and diversity
• ‘Ground up’ development
• Focussed via Standardisation
– Requirements for Accreditation (RFA)
RFA: Goals
• To promote the development and use of
information management systems that
deliver benefits for patients and clinicians.
• To facilitate the implementation of the
NHS IM&T strategy
• To ensure value for money
RFA: Focus
• Shared primary care Electronic Patient Record (EPR)
• Electronic communications - GP data exchanges with
other GPs, with other care providers, and with other NHS
organisations, via appropriate connections
• Data aggregation & analysis
• Decision support
• Management and administrative support
• Privacy and Safety - quality, data confidentiality, integrity
& medico-legal validity
• Open and compatible systems
• Common user interfaces (e.g. GUIs)
• National data dictionaries (e.g. Read3, Drugs)
• Supplier and organisational requirements - Training,
education, implementation and support services
RFA: Method
• Agree baseline standard by consensus
• Testing and approval
• Reimbursement for approved systems
• Complete freedom of choice for GP
practices and suppliers
RFA: Iterative development – who is in control?
NHS Funding
Users Best Practice
Suppliers Implementation
NHSIA Standards
RFA: Achievements
• Primary care possibly leads NHS in
standards of clinical record keeping
• Almost all practices now use computerised
record keeping
• E-Prescribing
• Registration and Lab links
• Decision support (PRODIGY)
• Data extraction tools (MIQUEST)
RFA: Problems?
• Shared care not considered
• Patient data transfer not supported
• GP ownership of data
• GP dominance of the process (suppliers as well)
• Varied solutions create inconsistencies
• Innovation ceiling. Leadership?
Solutions?
• NHS/DH ownership of data
• Patient data transfer explicit requirement
• Shared care objective
• ‘Information for Health’
• ERDIP
• NPfIT
NPfIT: Clear Objectives
• NHS Care Records Service (‘Spine’)
• Electronic Prescribing Service (useful)
• Choose '
n'Book (political)
NPfIT: Method
• Political imperative
• Mega funding
• ‘Top down’ architecture
• Large management infrastructure
• Reduce diversity (eventually)
NPfIT: Clearly structured and controlled
Political Imperative
Funding
Management
Suppliers
Users
NPfIT: Portfolio Model
NPfIT publish a useful diagram explaining
this in section 4 of the NPfIT publication
‘Initial guidance for existing system
suppliers’ available at:
http://www.connectingforhealth.nhs.uk/all_i
mages_and_docs/NPfITsuppliersguide.pdf
NPfIT: Approved Suppliers
• Southern Region LSP: Fujitsu Alliance (Fujistu, Cerner
(replacing IDX), BT Syntegra, Tata Consultancy
Services, PricewaterhouseCoopers LLP) £896m
• London LSP: Capital Care Alliance (BT Syntegra, Perot
Systems, IDX) £996m
• Northwest Region LSP: CSC, Hedra, iSoft, SystemC
£973m
• Northeast Region LSP: Accenture, Siemens, Microsoft,
iSoft, Newchurch £1099m
• East Region LSP: Accenture, Siemens, Microsoft, iSoft,
Newchurch £934m
• NHS Spine/ICRS NASP:BT Syntegra, Oracle, Sun
Microsystems, LogicaCMG, CSW £620m
• e-Booking NASP SchlumbergerSema, Cerner £64.5m
Primary Care Supplier Responses
• EMIS – no deal
• Torex – merger with iSOFT (Lorenzo
‘complete’ solution)
• InPS - Pharmacy links (Vision)
• TPP – Phoenix indeed! (SystmOne)
NPfIT: Stories from the front line
• BMA, RCGP (GP user choice)
• Suppliers and contracts
• Influence of CRDB and National Clinical
leads?
• Ability to deliver?
• Missing and unwanted functionality?
NPfIT: Closing the loop
• ‘Tactical short term use of existing
systems’
• Accreditation to ‘Spine compliance’
• ‘Freedom of choice’ in primary care
NPfIT: Spine compliance process
NPfIT publish a useful diagram explaining
this in section 5.2 of the NPfIT publication
‘Initial guidance for existing system
suppliers’ available at:
http://www.connectingforhealth.nhs.uk/all_i
mages_and_docs/NPfITsuppliersguide.pdf
Place Your Bets
• Monolithic integration
• Federation
• Organic development/Innovation
• Consensus/Ownership
• Standardisation
• Structure/Infrastructure
• New build/Evolution