Who will own practice IT systems under the new GP contract?
Q The new GP contract proposes to end reimbursing GPs for 50% of the cost of clinical systems and that PCOs should meet these costs instead. Isn't that a retrograde step, because PCOs will own the equipment?
A The GP contract framework proposals state: 'To facilitate the use of IM&T within primary care, practices will no longer be responsible for the purchase, maintenance and running costs of integrated IT systems or for landline links between branch surgeries or between surgeries and hospitals.'
A system of 50% reimbursement of accredited systems was workable when the purchase and maintenance costs of computer systems were low. As most practices were spending similar sums annually, this money was being accounted for through the indirect expenses element of the Doctors and Dentists Review Body assessment - i.e. at no cost to the GP.
In recent years, the cost of computer systems and their maintenance has increased significantly and primary care organisations only have funding to meet 20-30% of that cost. As a result, many practices have decided not to continue with IM&T development.
This has meant that the system by which GPs recoup some of their expenses for IM&T through indirect reimbursement no longer serves the profession well.
The way forward is as the proposals suggest, with the full costs of the IM&T in a practice being borne by the PCO. The NHS is becoming more dependent on IM&T and it is only right that GPs should not have to bear the costs themselves.
Will PCOs tell GPs what IT systems they should have?
Q Is there a danger that if the new contract is implemented PCOs will think that as they pay for IM&T they can dictate what systems GPs should have? Might PCOs also consider that the data held on the practice computer should be accessible to PCO staff?
A This question really gets to the heart of many GPs' concerns. If IM&T is fully funded by the PCO it could be seen as being owned by the PCO; another way of looking at it is that the practice owns the computer but has received 100% reimbursement for its cost.
I would suggest that the organisation that has to insure the system will be seen as the legal owner - and that will be the practice. However, the concept of ownership is one of the many areas in the new contract that require further clarification.
Some PCOs have already tried to force practices onto one clinical system. However, the framework proposals state that 'Each practice will have a guaranteed choice from a number of accredited systems.' This statement should provide sufficient protection for GP's freedom of choice.
If any PCO states that they have a right to the data held on a practice computer, the response is quite simple - they do not. You should refer the PCO to the LMC and ask them to read the Data Protection Act, because clearly they are ignorant of the law of the land.
How can you transfer computerised patient data?
Q Inputting new patient data onto the practice computer system is highly costly in terms of staff time and just duplicates what has already been done in the patient’s previous practice. How can we transfer computerised patient records from one practice to another without having to input the data manually?
A Unfortunately, the simple answer is that you can't. The present system, which involves printing out the data and then entering it into a new system - often many times over - is unsatisfactory, and the ability to transfer patient notes electronically is a priority.
The NHS has commissioned work to find a solution. Technology is available that would allow text-based (i.e. not coded) electronic medical records to be transferred between GPs. The two issues currently being looked at are:
- Patient-identifiable information that is sent over the internet or NHSnet needs to be secure (and therefore encrypted).
- Transfer of coded electronic patient records.
Text transfer of an electronic patient record would mean that the record would be downloaded as a text file onto the receiver’s patient database. The information could be read but could not be used to create prescriptions. Neither could it be identified in a search of the practice population, for example to identify all patients with known diabetes.
Coded transfer is the only way forward. However, we will all have to be patient for a bit longer - a solution is not expected until 2004.