N Yorks GPs protest over system choice

27 Nov 2007

GPs claim their PCT is acting outside the GP Systems of Choice initiative by outlining a plan to encourage all practices to move onto the local service provider solution TPP’s SystmOne.

North Yorkshire and York PCT ‘s IM&T strategy states that the introduction of SystmOne will be “actively promoted and supported by the PCT” giving consideration to the objectives of the strategic health authority, the principles of GPSoC and the best interests of patients.

It adds: “The way forward is to support the incremental use of the NPfIT primary care system (SystmOne). Planning and progress for this should be underpinned by an appreciation, achievement and evaluation of the respective benefits to patients of the integration of primary, community and secondary care record services.”

The strategy says around 80% of the 102 practices covered by the PCT currently use the GP system EMIS with only four currently using SystmOne but outlines the SHA plan to see 100% of practices in the region on TPP by 2011.

Dr Brian McGregor, a GP in York and a director of district's LMC, said the committee first heard about the strategy at a liaison meeting with the PCT at the beginning of this month. It went before the PCT board for approval five days later.

He told EHI Primary Care: “First of all we believe it is factually incorrect as it presents SystmOne as the NPfIT solution when our understanding is that this is only an interim solution and the ultimate aim is for practices to move onto Lorenzo primary care. That could mean practices that move to SystmOne having to go through a second change.

“We also think it’s not for the PCT to promote one system over another which is something for practices to decide for themselves.”

Dr McGrgeor said the LMC feared that practices would be forced into changing systems against their will and said it was “even more galling” that a local primary and secondary care intranet in the York area, linking EMIS practices with York District Hospital, was already delivering the vision of primary and secondary care linked services that the strategy involved.

Dr McGregor said the intranet, set up two or three years ago, now delivers 1000 plus letters sent electronically direct to patient records every day and access to a shared care record was planned soon as well as possible links to the intranet for practices using other GP systems.

The IM&T strategy states that the PCT recognises the progress made in information sharing using the hospital system (CPD) and a pilot of EMIS Web.

But it adds: “These are not strategic solutions for the PCT and the expectation is that these will over time be replaced by equivalent NPfIT services.”

The strategy says significant emphasis is placed on the use of SystmOne across community, mental health and primary care services because it is a proven system with significant take up across Yorkshire, Humber and the North-east and East of England, because it offers certainty of integration with primary, community, child health and secondary care, because the software is funded via CfH and implementation costs met by the SHA and it can co-exist with legacy solutions allowing a roadmap to be drawn up to suit PCT variations.

Dr McGregor said GPSoC documents issued to all practices include a statement that those signing up to GPSoC are committing themselves to migrate to the fully integrated LSP solution when that is available. He said the LMC’s advice to practices was not to sign the document until that statement had been removed.

He added: “My personal view is that nobody should be changing systems at the moment unless there are very very good reasons for doing so.”

Dr McGregor told EHI Primary Care that it had asked the BMA at national level to take up its concerns about the PCT approach and was also taking up its concerns with the SHA.

A spokesperson for the PCT told EHI Primary Care that the PCT would be issuing a statement following liaison with the SHA but has yet to do so.

Meanwhile in Sheffield PCT, another trust covered by Yorkshire and Humber SHA, practice managers claim they were told by the trust that the PCT would receive £10,000 funding per practice from the SHA for every practice that moved to SystmOne.

One practice manager told EHI Primary Care: “It was made clear that money would be made available for moves to TPP.”

Ian Atkinson, director of performance at the PCT, said that the funding available to the PCT from the SHA was to meet data migration and training costs and would not disadvantage practices wishing to stay with non-LSP solutions.

He told EHI Primary Care: “In no way are we as a PCT in the business of getting GPs to adopt one system. If GPs choose to move to TPP there would be funding from the SHA to support the costs in the same way as there is GPSoC funding for other systems. What we would like to do is have a transparent debate about the merits of the different systems.”

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Yorkshire and Humber SHA plan TPP-based EPR

Reader's Comments

Wrong about GPs having to change to Lorenzo

ian.leonard@southend.nhs.uk

28 Nov 07 09:01

WIth 75% of our GPs on TPP I would be concerned if the LMC's assertion that all TPP GPs would have to move to Lorenzo was correct. I have been assured by CSC that TPP is now a strategic product and it will fully integrate with Lorenzo in secondary care settings. Several colleagues have already had demonstrations of how this integration would work. In addition to GPs, our Child Health system is TPP, our local prison uses TPP and we have just commenced the deployment of TPP to all of our Community staff. Of course we would like the patients of all of our GPs to benefit from the ease of referral and continuity of care that the integrated, one patient, one record TPP approach brings and so we will encourage but not force GPs on other systems to move over. Surely we would be failing in our duty if we didn't.

change to tpp only helps the pct control freaks

28 Nov 07 18:17

they say that the need tpp so that our records can be shared by podiatrists etc. so it will be worth it to go through the upheaval and data loss etc. It is *****cks. the pcts like it because they dont like independent minded firms like emis - just like they dont like independent gp's. Our nurses and health visitors were all on our emis system until the pct made them change to tpp - so now we have to change to tpp so we communicate electronically ie like we used to!! TPP and emis are chalk and cheese - changing would be a nightmare.

This is a serious discussion forum

30 Nov 07 17:46

What a shame to see typical alpha-male spleen spreading over from the usual doctors rant boards to this serious discussion forum. PCTs do not hate independence. They do hate this kind of narrow-minded, self-interested bile in the face of their attempts to deliver better care for the populations for whom they are responsible.

Have you asked the District Nurses, physios, health visitors, School Nurses, prison staff and podiatrists who are using SystmOne. The ones I have spoken like it.

Does even the faintest possibility ever entered your self-engrossed, self-serving conciousness that the third of GPs in Yorkshire and Humber who have chosen (I repeat chosen) to switch to TPP might have seen some thing that you have missed. Perhaps what they see is properly integrated electronic records are actually good for patients.

True it is a serious discussion board

03 Dec 07 09:16

It is true this is a serious discussion board and the 'Lady' that wrote the last entry should speak to the community staff in Hambleton & Richmondshire who despite having received training are not using electroinic systems mainly as they do not have access to the system when seeing patients and do not have sufficient time/resources to enter data at a later time. I agree that the use of one system across the PCT is a great idea but resources need to be put in place for it to happen and this will not happen with an organisation that sole purpose is too cut resources to the bone in order to recoup losses from an antecedent PCT

That ain't no Lady

03 Dec 07 14:04

How interesting that your previous poster assumed that someone objecting to inappropriate macho behaviour must be a woman.

Last time I checked I was fully male, though my GP may have chosen some wierd Egton code to record it on their EMIS system which coulds cause confusion at a later date!

Re That aint no lady

03 Dec 07 15:05

You seem to have missed the point. You are the one who suggests that this is a gender thing by assuming that the previous post is a male.

The point is that resources are not in place to support the staff and therefore community staff are not using the system in our PCT, making it almost impossible for those relying on the system for patient information to find it and to work as effectively as they would wish.

Still ain't no Lady

03 Dec 07 17:13

I did not assume that the contributer was male. The tenor of the "contribution" was of the type found being posted on the rant boards usually, I think you would have to agree, by male doctors.

To the more important issue. How was it that nurses who used to be able to post records into the EMIS system, accessible only within the physical practice are now more restricted in when and where they can record. Presumably they are still in the practice the same amount of time as before. Are they being prevented for some reason from using existing equipment to access the new system or are we not comparing like with like.

I have watched EMIS fail to develop a usable community module over the last 15 years. How do the partners in the practice explain its imposition of a system onto other professionals which so clearly fails to meet their needs. Presumably the GPs got the information they needed and that is all that matters.

Re Still ain't no Lady

04 Dec 07 08:44

I accept that most rants on this website are by GPs who do not like being told what to do, however how when most rants are anonymous how can anyone say they are from males I don’t know apart from going on the basis there are more male GPs than female.

The truth is the majority of community never have used an IT system, and until they are given proper resources they never will. It is all well those at the top saying this system is super - and from what I am told it is - but if the staff we need to use it can't then we can put every GP in the country on it and we still will not have a system that is any good for sharing patient data.

A large proportion of staff who see patients will not use it and those requiring information will continue to have to accept bits of paper as the only way of getting the information they need.

(Post edited by EHIPC)

The "not a Lady" is not for turning but ...

05 Dec 07 11:46

...consensus may be starting to emerge.

The reason why the SHA, most PCT informatics staff and a rapidly increasing number of GPs see SystmOne as the strategic solution is because it is the only system we have seen which has the inherent capability to deliver an integrated primary care record while at the same time providing a reasonable user experience for GPs.

Nobody can disagree that there is an enormous challange in equiping community staff with the tools and skills to use the system, particularly in the cash strapped PCTs, but at least with SystmOne we can begin the process. Many areas like Bradford and NE Lincs have made big steps forward already and are seeing real benefits to clinicians and patients.

Is it worth it for your particular practice. The GMS contract has given the GP the right to decide that.

However you have to agree that more and more GPs are taking the view that the benefits in the medium term of a shared record out weighs the short term pain of data migration and retraining

gp2gp is great - but doesnt work with systemone

12 Dec 07 11:45

we now have gp2gp working - despite an absence of interest by the pct it guys. So we have transferable electronic records, but only for emis and vision. It would be perfect if TPP were cooperating. But they arent - surprise surprise - after all if we had transferable records for all systems there is hardly any logical reason to change for a hosted local lsp solution. Surely the GPC and CFH should be pushing hard to get this attitude changed.

re: doesnt work with systemone

12 Dec 07 13:07

You will find a major issue is that one cannot translate CTV3 (a.k.a. "Read Version 3") codes used in TPP system back into Version2 Codes used in InPS and EMIS systems.

Imagine you are translating the English word "snow" into Inuit. (V2 to CTV3) It could be bodged albeit they may think you intellectually challenged.

However try translating each of the n different kinds of snow in Inuit back into a single word in English (CTV3 to V2) - you are stumped. It's not an 'attitude' - it is an all too conveniently ignored fact!

Now throw in SNOMED which has 10 times n different words for snow.

Now throw in coding systems which specifically summarise the conditions on ski slopes and airport runways respectively rather than snow per se (ICD n, OPCS 4n).

Now throw in data models which instead describe physical states of water using entirely different parameters.

And welcome to CfH interoperability %-)