GP Systems of Choice: a new deal for primary care IT

We have just seen a significant event in the most highly computerised sector of the NHS, with the completion of a new deal guaranteeing GP practices a choice of IT system.

The deal is not only significant for primary care. MPs and others interested in the future of the National Programme for IT in the NHS believe it could be a model for other sectors to follow.


September 2007 saw a significant event in primary care computing, with the completion of the GP Systems of Choice (GPSoC) initiative.

The deal gives practices and primary care trusts access to systems from a range of suppliers contracted to the National Programme for IT in the NHS (NPfIT), guaranteeing them IT system choice.

Three years in the making

The origins of the deal go back to the launch of a new contract for GPs in April 2004 (known as nGMS), which gave them a choice of IT system. "I think now we have delivered - and more - on what we came in to do."

Choice was seen as important because, by then, most GP practices had been computerised for several years. Many GPs were reliant on their systems for the day-to-day running of their practices and only wanted to undergo the pain of data migration to another system if and when they were ready.

GP representatives also argued that it was competiton between suppliers that had and should continue to drive innovation in primary care. Nevertheless, the guarantee created a major problem, since contracts with local service providers (LSPs) were just being agreed.

GPs felt they would be encouraged or even railroaded into moving to their LSP’s preferred solution or its alternative offering. Their options were narrowed further when it became clear that the LSPs’ preferred solutions were a long way off, potentially leaving practices with the Hobson’s choice of the alternative.

Details of the deal

Three years down the line, the GPSoC initiative means GPs can choose whether to stick with their existing system, move to one of eight suppliers on the GPSoC framework or move to an LSP solution.

NHS Connecting for Health’s GP clinical leads Dr Gillian Braunold and Professor Mike Pringle were instrumental in setting up the scheme, after being given the task of finding a solution to the choice problem when they were appointed by NHS CFH three years ago.

Dr Braunold says: “It was a very hostile environment and people had no choice. I think now we have delivered - and more - on what we came in to do. We’ve also had an enormous amount of support from NHS CFH to resolve what seemed to be absolutely intractable problems along the way.” "We haven’t won the hearts and minds of PCT staff who still think this single system thing works."

Eight system suppliers - EMIS, TPP, INPS, iSoft, Healthy Software, Microtest, Seetec and newcomer Waveform Solutions - have been accepted onto the framework. Five signed contracts two weeks ago, with the rest expected to follow next month.

Changing the landscape

GPSoC is bound to influence the GP computing landscape, which has already seen some change over the past few years. Before the nGMS contract was signed, systems were funded partly by practices and partly by primary care organisations (PCOs).

The 2004 contract passed responsibility for funding to PCOs, who became responsible for paying for hardware (servers, workstations, printers and so on) plus core clinical software and other clinical applications, core office applications, network infrastructure and connection to the Internet.

The attraction for PCTs of LSP-supplied systems was that all the costs would be met centrally, via the LSP contracts, rather than via PCT funding. Hence the concerns over choice.

The advent of the LSP contracts has seen some change in the supplier market. Before the nGMS contract was signed there were around 12 suppliers in the market, with three - EMIS, INPS and iSoft - enjoying more than 90 per cent of the market share.

Now, TPP, a relative newcomer to primary care IT, supplies systems via an LSP contract to more than 600 practices in the north. The existing major players continue to service their client base while, in some cases, agreeing contracts to also supply systems via LSP contracts.

Conflicts still ahead?

Although the signing of the GPSoC deal theoretically solves the problem of IT choice in primary care, there may still be conflicts ahead. Some primary care trusts plan to switch all their practices to an LSP-funded single system by 2011, as part of a strategy to standardise on one system across primary and community care in their health community.

The GP system supplier EMIS has by far the largest market share in English primary care computing, with almost 60 per cent of practices. Its National User Group (NUG) has led the campaign to win GPs a right to choose which system they use.

Outgoing NUG chair Dr Manpreet Pujara warned members at this month’s annual conference that the battle to secure IT system choice for primary care is still not over. "Clear technical standards will allow systems to be centrally accredited for use in the NHS, whilst giving local users the final say over which system is procured and how it is implemented. The GP Systems of Choice initiative is a good model for this approach."

Dr Pujara is in the process of writing to all NUG members about the implementation of GPSoC and to advise them that they must be prepared to fight to get the system choice they are guaranteed. He says: “We haven’t won the hearts and minds of PCT staff who still think this single system thing works.”

At the heart of the debate, therefore, is the question of whether primary care in future will continue with a variety of systems that are interoperable with secondary care or shift onto single systems across health communities. GPSoC itself recognises this itself by describing the highest level of its framework as a fully integrated system with the LSP Care Record.

Pointing the way to the future?

GPSoC’s key feature is that it enables NHS teams (in this case GP practices) to choose from a list of suppliers as long as they comply with technical and clinical standards for NHS IT systems. This could set a new path beyond primary care.

In September 2007, the Commons’ health select committee suggested that NHS CFH should switch as soon as possible from trying to preside over the local implementation of nationally procured systems to setting and ensuring compliance with technical and clinical standards.

Its Electronic Patient Record report says: “Clear technical standards will allow systems to be centrally accredited for use in the NHS, whilst giving local users the final say over which system is procured and how it is implemented. The GP Systems of Choice initiative is a good model for this approach.”

A similar approach has been recommended by both the Commons’ public accounts committee and the National Audit Office. And NHS CFH has already begun to go some way down this path with its procurement of a range of additional systems to the original LSP contracts.

These additional systems must be interoperable with NPfIT and able to support the delivery of Detailed Care Record systems. Having led the way on IT in the NHS for years, primary care could once again by setting the path for others to follow, this time on interoperability and system choice.

 Further Reading

• Review an article about the health select committee’s report
• The NHS Connecting for Health website has a section dedicated to GPSoC, with information about the deal and how to use it. This is available on the NHS Connecting for Health website.