Email
When the Department of Health asked the leaders of GP practice-based commissioning pilots carried out under the former government what they thought of the experience, information emerged high on the list of wants. Only 51% of leads rated as good the format and quality of information and data they received from primary care trusts (PCTs); 42% said the same of its timeliness.
Yet the government's white paper setting out plans to move the English NHS entirely to GP commissioning makes scarcely any mention of the need for information technology to plan health needs, measure outcomes and to manage the contracting process.
To judge by the white paper, there is little sign that senior policy makers have given any thought to filling the information hole left by the abolition of PCTs, let alone to the demands of new GP-led innovations. Yet as a recent Department of Health report Sustaining innovation in telehealth and telecare makes plain, information is vital if commissioning is going to lead to innovation. "Commissioners need a certain level of evidence to adopt a new approach to care, particularly when they may have to decommission or redesign an existing activity to accommodate it," it says. "This requires sophisticated systems for assessing population needs and making appropriate commissioning and decommissioning decisions."
For firm signs of how the government intends to fill the information gap, we must await the new information strategy to be published in the autumn. Some indication of what the strategy will need to tackle appears in a document published in July by the IT trade association Intellect.
The paper, Care commissioning in England – an Intellect perspective on the challenges ahead, warns that commissioning as a discipline is still a relatively new process, with PCTs still in the early stages of developing strategic capability. If GP consortia are to take on the role, they will access to information about the health of their populations and performance of their healthcare providers in a much more seamless way than today. It proposes that systems to support GP commissioning will:
- Provide access to data residing in provider organisations' system, directly or indirectly, in anonymised form.
- Set standards for data, based on existing initiatives such as the Secondary Uses Service and the proposed NHS Interoperability Toolkit.
- Enable business intelligence and data mining. Administrative and clinical data currently locked up in isolated data stores could be made available as a web service to commissioners and be put to use detecting patterns and trends "to enable funding for prospective care instead of the current situation of contracts being funded by retrospective episodes of care".
Commissioners will also need support for assessing the risks of different decisions and modelling the outcomes. The Intellect paper stresses the need for support in contract negotiation and managing performance.
With an eye to the political wind, the Intellect paper stresses that these functions can be achieved largely with existing systems: "These are not 'big ticket' new investments," it says.
From gap to gateway
In one sign of IT suppliers anticipating the new world, the two firms responsible for systems in 75% of GP practices, Emis and INPS, have announced a joint venture known as Healthcare Gateway, through which their systems will interoperate. The Medical Interoperability Gateway would exchange electronic discharge summaries and other documents.
One commissioning decision that will frequently come to the fore in the new climate is when and how to embrace telemedicine and telecare. Over the past few years, the vast majority of such initiatives have been led by PCTs. A new Department of Health study of these schemes casts doubt on whether the costs and benefits of different breeds of telecare are well enough understood for GPs to go it alone. The DoH briefing paper on the topic warns that for telehealth and telecare to survive and thrive in a cold financial climate, the use of such technologies "needs to be integrated into commissioning plans and local area agreements rather than being stand-alone programmes or pilots".
But it adds: "The process of scaling telehealth service remains a barrier to innovation, technology adoption and service transformation. New procurement models and risk-sharing will be needed to support local business cases unless there is significant take-up through the consumer market."
All this amounts to a major challenge for the debutantes of the GP commissioning world. While the findings from the practice-led commissioning leads may suggest that almost any innovation will be an improvement on the service they feel they get from PCTs, it is quite likely that perceptions of the usefulness of PCTs will rise when the new regime is in place - especially among the sceptical mainstream of general practitioners.
;
Comments