By Tony Collins
There’s concern in the NHS that Primary Care Trusts, which are due to be abolished next year, are putting GP practices under pressure to switch their IT systems to TPP SystmOne, a patient record system that is supplied by CSC under the National Programme for IT.
The conversions are being subsidised by taxpayers under unpublished NPfIT local service provider contracts. The concern of at least one aspiring Clinical Commissioning Group – which is one of the CCGs being formed under Andrew Lansley’s health reforms – is that GP system conversions to TPP SystemOne under local service provider NPfIT contracts could leave CCGs a legacy of financial commitments that are as yet unknown.
One CCG contacted Campaign4Change to express concern that it may have uncertain financial commitments when it begins to take on SystmOne commitments next year. On 1 April 2013 PCTs and strategic health authorities are due to be abolished and their responsibilities passed to authorised CCGs.
Aspiring CCGs are now taking a close interest in PCT financial commitments because the Groups are due to inherit any of their local PCT deficits incurred from 1 April 2011 to 31 March 2013.
At present, GP practices receive PCT funding whether they take replacement SystmOne patient record technology from CSC under the NPfIT or acquire new IT under a scheme known as GP Systems of Choice.
But the Group’s spokeswoman said that PCTs are putting pressure on GP practices to replace their systems with SystmOne. She said it’s because it can cost PCTs less – or nothing – for a GP switch to SystmOne under NPfIT-funded local service provider contracts. In comparison PCTs may have to pay costs such as hardware maintenance when GPs acquire systems under GPSoC.
Incentives for GPs to switch IT supplier
Our inquiries show that at least one PCT has received what it called “incentives” from its strategic health authority for GP practices to change computer systems, according to the PCT’s response to an FOI inquiry. The FOI response said: “The PCT can confirm that the incentives passed to [GP] practices to change computer systems as follows”.
It went on to say that its strategic health authority gave the PCT a £10,000 implementation fee [for each GP practice that changed its systems]. The PCT passed £3,000 of the £10,000 to the GP practice to part fund its implementation costs.
The PCT’s preferred GP system supplier was SystmOne, as supplied by CSC.
What happens when CSC’s NPfIT contract expires in 2015?
At that time Clinical Commissioning Groups may have to pay whatever costs are levied because GP practices with SystmOne could be reluctant to switch systems again, said the CCG spokesperson.
The Department of Health’s Informatics Directorate, which has subsumed NHS Connecting for Health, has confirmed that the prices it pays CSC for TPP installations are confidential.
Said a DH spokesperson “While prices within the LSP [Local Service Provider] contracts are commercially confidential we are in partnership with Intellect, the Technology Trade Association, to develop an open and transparent approach to costs and quality, as part of working to create a vibrant marketplace.”
A spokesperson for CSC said “Because we are in active negotiations with the government, we are not able to comment in depth on the programme until those negotiations have concluded.”
The spokesperson said the comments applied to TPP as it is “a supplier to us working on the National Programme”.
Department of Health response
When asked if GP practices are taking on non-transparent NPfIT commitments for TPP systems, the DH spokesperson said “If a GP practice chooses to take a system under an LSP contract they are made fully aware of the product they are taking and the length of the contract.
“We are committed to ensuring transparent and trusting working relationships between suppliers and their NHS customers.”
Asked whether GP practices that choose GPSoC systems cost the PCT more than TPP acquired through the LSP contracts, the DH spokesperson said “ It is up to the GP practice as to whether they choose a system through GPSoC or through the LSP contracts.
“The GPSoC PCT/ Practice agreement provides a mechanism for GPs to raise and resolve any concerns they may have.”
Centrally-funded incentives to PCTs to encourage GPs to switch to SystmOne as supplied by CSC under the NPfIT keep alive one of the original objectives of the national programme, which was to have health IT dominated by a few suppliers that would be under firm central control.
But that strategy creates an imbalance in the health IT market, inhibits open competition and leaves the NHS with unquantifiable future costs given that SystmOne is being supplied under NPfIT contracts that are secret.
Favouring central control, Labour created the NPfIT. In contrast the coalition favours decentralisation so it makes sense for GPs to have a genuine choice of suppliers, with the funding PCTs remaining neutral on the decision.
TPP SystmOne is good enough to compete freely in the open market. It does not need a leg up from the PCT or the Department of Health – just for the sake of keeping a part of the original NPfIT alive.
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If it were stacked in one providers favour so heavily you can guarantee that the others would complain. That they haven’t suggests a lack of credible evidence, complicity or disinterest or a combination of the three.
While the cost of SystmOne under the LSP contracts is not known, the cost under GPSoC is and is published at http://www.connectingforhealth.nhs.uk/systemsandservices/gpsupport/gpsoc/funding/suppliers : Under GPSoC CSC/TPP/SystmOne would appear to be the most expensive option: is there any reason to think it would be cheaper after the LSP contracts end?
EHI reported that the CSC bid for community and child health services under ASCC was rejected on grounds of expense and not being considered to be vfm.
I admit to being confused about the economics of this one: PCTs were given recurrent funding for GP IT under the new GMS contract – which also guaranteed GPs a choice of systems – and the nGMS contract guarantees support of core hardware and services as well as license fees.
“It went on to say that its strategic health authority gave the PCT a £10,000 implementation fee [for each GP practice that changed its systems]. The PCT passed £3,000 of the £10,000 to the GP practice to part fund its implementation costs.”
This sounds very much like bribery of the PCT to me (£3000 is well below the cost to a practice of changing systems), and I am not clear why the SHA concerned thinks that this is a good use of public funds – nor who inherits overspends from the SHA!
Could someone ask – under FOI – for the reasoning behind this SHA move? Yorkshire and the Humber SHA did minute in their Board papers a few years ago that they had avoided LSP penalties for failure to install sufficient LSP systems by over-delivering on GP systems: can SHAs still be penalised for failing to deliver numerous sites for installation of Lorenzo?
Just a moment,
have we not already seen how LSP’s behave on pricing of sub contracted software? RiO from Servelec direct £1.3 to £2 Million but from your friendly neighbourhood LSP (BT in this case) a mere snip at £9 Million – as reported to and by the PAC.
Does anyone really think that software is going to be cheaper from CSC or does anyone really think that CSC will not try to claw back every penny of their investment to date and future threatened profits by any means it can from the NHS. In the end the tax payer pays but at the cost of reduced service to the patient as where else will the money come from.
We want open transparent published prices for products and services bought by or sold to the NHS. It’s the only way to get real value for money and a vibrant innovative market place as proper competition will drive the price down. The customer will be able to look around and get the best product for the best price.
If two products do the same thing then in this austere time should not the cheaper product always be the one o go for. Why would you pay more? Why would you take something on without knowing its actual cost. Its plain lunacy.
If people are being ‘encouraged’ to take a product when they are supposed to be free to choose and its the DOH/CfH/NHS or some combination thereof should this not be referred to office of fair trading (http://www.oft.gov.uk/) and if it’s a US company the US equivalent ?
Is not the mechanism as described ‘restraint of trade’ (in both a UK and EU context)? As the market in non-acute solutions is ‘distributed’, I can think that other potential (and current) providers will not take this recommendation lying down – will be interesting to see the market movement that results — would you really think twice about entering into an inherited and not fully transparent contract with an organisation that may have (allegedly) lobbied (and somehow incentivised) higher level bodies to encourage use of its product ???