TARGET 9/6/04 – The NPfIT and You (Information and Technology Solutions: Assessing and addressing your own and the teams IT needs.) Dr Phil Griffin (IM&T Clinical Lead)

Who Said This? “By 2010, every NHS patient in England will have an individual electronic NHS Care Record” Dr John Reid, Secretary of State for Health, 8th Dec 2003

A Brief History of Time Pre-1997 – The Dark Ages Pre-1997 – The Dark Ages 1997 – All Change 1997 – All Change 1998 – “Information For Health” 1998 – “Information For Health” 2001 – “Building the Information Core” 2001 – “Building the Information Core” 2002 – The Wanless Report 2002 – The Wanless Report More money. Lots more money More money. Lots more money Central management of a National Programme Central management of a National Programme Delivering 21 st Century IT Support for the NHS Delivering 21 st Century IT Support for the NHS 2003 – The National Programme for IT is born and History starts 2003 – The National Programme for IT is born and History starts 2004 – Clusters are born and a DOCTOR gets involved! 2004 – Clusters are born and a DOCTOR gets involved!

WHAT DO THE FOLLOWING HAVE IN COMMON? £265,000NPfIT Richard Granger

Acronym Assassination DON’T say “EPR” DON’T say “EPR” DON’T say “EHR” DON’T say “EHR” DON’T talk about the “HRI” DON’T talk about the “HRI” Only say “IfH” if you’re really old Only say “IfH” if you’re really old Forget “ICRS” (as of 2/12/03) Forget “ICRS” (as of 2/12/03) If you’re hip and happenin, say: If you’re hip and happenin, say: NHS Care Record Service

NPfIT A £2.3bn programme over three years to deliver four key elements: A £2.3bn programme over three years to deliver four key elements: NHS Care Records Service NHS Care Records Service Electronic appointment booking Electronic appointment booking Electronic Transmission of Prescriptions Electronic Transmission of Prescriptions Underpinning IT Infrastructure (N3) Underpinning IT Infrastructure (N3) Best use to be made of the existing asset base Best use to be made of the existing asset base NPfIT is about patients and those who care for them, not technology

NPfIT Basic Structure The design and roll-out of the NHS Care Records Service has been organised into two parts: Services that are common to all users nationally will be the responsibility of the National Application Service Provider (NASP). Services that are common to all users nationally will be the responsibility of the National Application Service Provider (NASP). Services delivered at a more local level will be the responsibility of five Local Service Providers (LSPs). Services delivered at a more local level will be the responsibility of five Local Service Providers (LSPs).

LSP Clusters

Phase 1 - by end 2004 Booking of outpatient appointments online Booking of outpatient appointments online NHS and access to online knowledge NHS and access to online knowledge Electronic laboratory and radiology results Electronic laboratory and radiology results Some clinical communications e.g. GP referral letters Some clinical communications e.g. GP referral letters Basic “spine” functionality Basic “spine” functionality Providing simple functionality and making best use of existing systems

Phase 2 - by end 2006 Access to a more detailed patient record including: Access to a more detailed patient record including: specialist results specialist results GP prescribing record GP prescribing record hospital discharge summaries hospital discharge summaries Digital imaging Digital imaging Computerised referrals and requests Computerised referrals and requests Migrating on to active and interactive functionality

Phase 3 - by end 2008 and continuing Working towards full integration of health and social services including: Working towards full integration of health and social services including: decision support software decision support software screening screening community wide prescribing community wide prescribing computer support for care planning computer support for care planning Supporting advanced features e.g. telemedicine Supporting advanced features e.g. telemedicine Continuing development and enhancements

The Care Record Service A mix of local and national IT services proving a cradle-to-grave NHS Care Record. A mix of local and national IT services proving a cradle-to-grave NHS Care Record. Summary patient record; personal health information and demographic data Summary patient record; personal health information and demographic data “ The Spine” “ The Spine”

The Care Record Service Applications at a local level provided by Local service Providers (LSP) Applications at a local level provided by Local service Providers (LSP) Accenture (£930 million) Accenture (£930 million) Common national applications provided by National Application Service Providers (NASP) Common national applications provided by National Application Service Providers (NASP) BT (£620 million) BT (£620 million)

The Care Record Service The NASP will provide software and support for summary patient record, and implement consistent security and confidentiality principles. The NASP will provide software and support for summary patient record, and implement consistent security and confidentiality principles. A Transaction Messaging System (TMS) and an Access Control Service (ACS) A Transaction Messaging System (TMS) and an Access Control Service (ACS)

The Care Record Service The Local Service Provider (Accenture) will act as system integrators, supplier managers and programme managers for the clusters The Local Service Provider (Accenture) will act as system integrators, supplier managers and programme managers for the clusters They will ensure systems are spine- compliant and deliver hardware and software replacements and implement core local training They will ensure systems are spine- compliant and deliver hardware and software replacements and implement core local training

Got it? If not, just remember… The Care Record Service is a really, really GOOD IDEA.

E-Booking (oh no!) Choice is a main driver behind eBooking Choice is a main driver behind eBooking Patients will choose from a number of options including which hospital, and when, they would like to attend Patients will choose from a number of options including which hospital, and when, they would like to attend Booking will be made at point of referral Booking will be made at point of referralOR Later on through a Booking Management Service (BMS) Later on through a Booking Management Service (BMS)

E-Booking Contract with Atos Origin Contract with Atos Origin First bookings this year, then six phases First bookings this year, then six phases All surgeries by Dec 2005 All surgeries by Dec 2005

Three Other Things… Electronic Transfer of Prescriptions Electronic Transfer of Prescriptions N3 – bigger, faster, better N3 – bigger, faster, better NHSmail – a lifelong secure address for all NHS staff. NHSmail – a lifelong secure address for all NHS staff. So me at

The Bluffers Guide to the National Programme Know the 4 areas – NHSCRS, eTP, e-Booking, Infrastructure Know the 4 areas – NHSCRS, eTP, e-Booking, Infrastructure “NPfIT” = “En Pee fit” “NPfIT” = “En Pee fit” Remember the small “f” or lose all street cred Remember the small “f” or lose all street cred Practice saying “LSP clusters” and remember “East Midlands and East of England”. (Forget the rest) Practice saying “LSP clusters” and remember “East Midlands and East of England”. (Forget the rest) Mug up on Accenture Mug up on Accenture Express enormous sympathy to any Celtic friends Express enormous sympathy to any Celtic friends Ask you colleagues if their systems are “spine-compliant” Ask you colleagues if their systems are “spine-compliant” Say “NHS Care Record Service” a lot, especially in meetings Say “NHS Care Record Service” a lot, especially in meetings Let as many people as possible know you’ve got an NHSmail address and actually use it Let as many people as possible know you’ve got an NHSmail address and actually use it

What does this mean for General Practice? the LSP: the LSP: Phased introduction of “new solution” over few years Phased introduction of “new solution” over few years Spine compliant Spine compliant Central servers Central servers Info across N3 Info across N3 Data exchange with acute trust/community clinics etc; support SAP Data exchange with acute trust/community clinics etc; support SAP

What does this mean for General Practice? Choice of solution between two (nGMS says three) Choice of solution between two (nGMS says three) Second TBA by October Second TBA by October In theory no compulsion to change. BUT…… In theory no compulsion to change. BUT…… Contract also states “no loss of functionality” Contract also states “no loss of functionality” BMA Guidance BMA Guidance

So What’s Going On Locally? The SHA has control The SHA has control The Chief Information Officer is therefore a Very Important Person (Mike O’Brien) The Chief Information Officer is therefore a Very Important Person (Mike O’Brien) The LIS Project – evolved and perished The LIS Project – evolved and perished ISSGs (4 quadrants + 1 SHA) ISSGs (4 quadrants + 1 SHA) The Herts Health Informatics Service (HHIS) is expanding and evolving The Herts Health Informatics Service (HHIS) is expanding and evolving June Dodds is our Project Manager June Dodds is our Project Manager No GPs want to join in yet No GPs want to join in yet

Even More Locally… We have 14 Practices: We have 14 Practices: 9 EMIS 9 EMIS 3 IPS 3 IPS 1 Torex 1 Torex Some are paperless Some are paperless We have numerous scattered community sites, some poorly connected We have numerous scattered community sites, some poorly connected NSF-driven PCT initiatives especially CHD NSF-driven PCT initiatives especially CHD All main GP surgeries are on the NHSNet All main GP surgeries are on the NHSNet All have pathology messaging All have pathology messaging We have an IM&T manager and a Data Quality Facilitator (Assorted Roz/s’s) We have an IM&T manager and a Data Quality Facilitator (Assorted Roz/s’s) Our PCT IM&T Strategy is done Our PCT IM&T Strategy is done Our Data Quality Strategy is done Our Data Quality Strategy is done Our IM&T Committee meets regularly and with Hertsmere Our IM&T Committee meets regularly and with Hertsmere We have strong links with the SHA ISSG We have strong links with the SHA ISSG We have implemented Network Managed Services We have implemented Network Managed Services

What Have We Got To Do? Increase funding earmarked for IM&T Increase funding earmarked for IM&T Get the Community staff and branch surgeries connected Get the Community staff and branch surgeries connected PCT ownership and full funding of Primary Care IM&T PCT ownership and full funding of Primary Care IM&T Convergence of Primary Care data quality Convergence of Primary Care data quality PCT-wide standard auditing PCT-wide standard auditing Move away from practice-based servers Move away from practice-based servers Evolution towards the Care Record Service in co- operation with our LSP Evolution towards the Care Record Service in co- operation with our LSP Development and enhancement of support and maintenance Development and enhancement of support and maintenance

OK – HOW??? Invest Invest PCT-wide standards in Information Governance PCT-wide standards in Information Governance Work with the HHIS on the community and branch surgery networking Work with the HHIS on the community and branch surgery networking Expand Network Managed Services to all PCT practices, along with other PCTs Expand Network Managed Services to all PCT practices, along with other PCTs MSD Audit Tool MSD Audit Tool Data Quality Strategy Data Quality Strategy Training Training Understand the New GMS Contract Understand the New GMS Contract

A Vision of the Future… Money. Lots and lots of money Money. Lots and lots of money A true broadband NHSnet infrastructure A true broadband NHSnet infrastructure Standardised medical record coding across the NHS Standardised medical record coding across the NHS All clinicians have access to the information they need to know All clinicians have access to the information they need to know Practices free to use whichever front-end they like, from a nationally approved list Practices free to use whichever front-end they like, from a nationally approved list Standardised note summarisation Standardised note summarisation Patient record held in Primary Care and on the “Spine” Patient record held in Primary Care and on the “Spine” Messaging in from secondary care Messaging in from secondary care GP to GP transfer seamless and 100% via the “Spine” GP to GP transfer seamless and 100% via the “Spine” Web-based access to medical records for patients and health professionals Web-based access to medical records for patients and health professionals Many web-based services for patients Many web-based services for patients GPs able to web-access secondary care databases and vice versa GPs able to web-access secondary care databases and vice versa E-everything – booking, prescribing etc. E-everything – booking, prescribing etc.

Will It Work? There is a real need There is a real need There is real central strong drive There is real central strong drive There is available funding There is available funding The benefits are almost incalculable The benefits are almost incalculable There’s political will, possibly motivated by… There’s political will, possibly motivated by… …a General Election …a General Election

"Patients will see a modern, IT-enabled NHS, every time they come into contact with the service. They will benefit from coordinated, convenient and integrated care that places them at the heart of the NHS.” Director General of NHS IT, Richard Granger said: "Patients will see a modern, IT-enabled NHS, every time they come into contact with the service. They will benefit from coordinated, convenient and integrated care that places them at the heart of the NHS.”

For Coalface Clinicians Proceed to “paperless” record keeping Proceed to “paperless” record keeping Use the new GMS Q&OF to improve your coding Use the new GMS Q&OF to improve your coding Consistent data recording across the practice Consistent data recording across the practice Information Governance Information Governance

Information Governance How does the practice handle, share and secure confidential information? How does the practice handle, share and secure confidential information? Caldicott Guardian Caldicott Guardian Written protocols Written protocols Staff training Staff training Audit and review Audit and review Use the toolkit… Use the toolkit…