GP Engagement Events

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GP Engagement Events

• Progress to date and issues

2
Overview

• What has been achieved?
• What is happening now?
• What is coming?
• Issues on which we want your views

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What has been achieved?

• QMAS and QoF payments
• N3 the new NHS network 15,500 connections
• NHSMail 200,000 users
• Smart cards issued and used
• Patient Demographic Service

4
Choose and Book

• 10,000 bookings a day
• 61,000 last week
• 25 of first referrals to OPD
• Moved into another phase
• User groups
• End user communications
• Updates

5
ETP

• Over 4 million ETP prescriptions- messaging
  securely 5 of the total volume
• 85 Community pharmacists registered for smart
  cards
• 1710 practices enabled and half are actively
  using ETP ie 880 practices

6
GP2GP

• 35 practices now involved single supplier trials
  across Gateshead and Isle of Wight
• Croydon mixed economy due to start in January
• Attachments flowing with native document
  management systems
• Speeding up roll out end of year up to 500
  practices being recruited

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IMT Directed Enhanced Service

• 70 million over 2 years
• To encourage engagement with IT developments and
  Data Fit for Sharing
• Provides a contractual framework for the first
  time
• Enhanced services are voluntary
• Support training for all users

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Components of the IMT DES

• Four Parts
• Plan 40p/patient
• Data Accreditation 44p/patient
• EPS/addresses 27p/patient
• hosted system 22p/patient

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Hot issues on which we want your views

• GPSoC
• Summary Care Record
• Explicit or implicit consent
• Validation of summaries
• Detailed Care Records
• Sealed envelopes

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1. GP Systems of Choice (GPSoC)
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GPSoC Maturity Model
Level Minimum Functionality 0 QMAS, RFA99 and
Level 1 IG Compliance 1 QMAS, Choose and Book
and PDS and ETP version 1 2 Level 1 plus ETP
version 2 3 Level 2 plus GP2GP 4 Level 3 plus
fully hosted solution to CfH specification 5 Level
4 plus PSIS, SNOMED CT, Clinical Spine
Applications, the NHS CFH Diagnostic Requests and
Reports (Order Comms) and Provision of Care
6 Level 5 plus fully integrated to the NHS CRS
Level 4 integrated solution
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Retaining Practices Existing System

• GPSoC aims to fund the annual service charge for
  and upgrades to a practices existing system
• Annual planning round to agree scope and number
  of upgrades with suppliers and PCTs
• Upgrades for individual practices agreed based on
  a detailed 3 month planning horizon
• Risk and VFM checkpoint where data migration
  required for system upgrade

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System Compliance

• CAP-GP introduced as replacement for RFA 99
  currently being piloted
• Status of existing systems none currently
  higher than GPSoC Level 1
• Greater Transparency through publication of
• Compliance status
• Development roadmaps
• Progress through testing regime

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1. GP Systems of Choice (GPSoC)

• QUESTIONS
• Does this plan seem reasonable to you?
• Will it allow you to develop your practice IT?

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2. Summary Care Record
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Understanding the record

• The clinical encounter record
• Detailed Care Record (local)
• Detailed Care Record Summary Care Record
• (shared) including
• Pathway of Care Healthspace

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Understanding the record

• Summary Care Record used on first contact and as
  foundation to avoid repetition
• HealthSpace patient access
• Detailed Care Record shared for coordinated care,
  especially pathways of care

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Ensuring confidentiality and access

• Role Based Access Control (RBAC)
• Legitimate Relationships
• Audit and alerts
• Professional and contractual controls
• Physical Security

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Explicit or Implicit Consent?

• Explicit consent
• no summary care record until the patient has
  checked their summary and agreed
• Supported by BMA/GPC/RCGP
• Significant workload for general practices
• Lag until summaries available
• Was used and abandoned in Alberta, Canada

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Explicit or Implicit Consent?

• Implicit consent
• Public information campaign
• Then uploading of limited (problems, scripts,
  allergies) summary care record from all who
  havent opted out
• When patient attends, opportunity to check
  contents
• Still large workload for general practices
• Model used in Hampshire, Wirral and Scotland

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Current Practice

• Implicit consent (opt out) model used in
  Hampshire, Wirral and Scotland and in France
• In Scotland and Hampshire, a legitimate clinician
  can only see the record after asking the patient
  Consent to View.

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Accurate records

• Joint act of publication
• Data accreditation
• Verification
• Incremental growth in data to shared space

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2. Summary Care Record

• QUESTIONS
• What are your views on the best way of handling
  patient consent to sharing?
• How can general practice best handle the
  validation of summaries?
• Should we ask for Consent to View?

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3. Detailed Care Record
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Patients rights participation

• Opt out of Summary Care Record
• Edit Summary Care Record
• Comment on and add to Summary Care Record
  (Healthspace)
• Sealed envelopes

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Sealed Envelopes - Some Basic Assumptions

• Clinicians work in teams/work groups
• Confidential information needs to be shared and
  protected within the team
• Secrets not seen by administrative roles unless
  local customisation redefines for particular
  roles and with appropriate training

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Sealed Envelopes - Two levels of sensitivity
proposed

• Sensitive level
• Extra sensitive invisible level that is locked
  down and not available outside the clinical
  team/workgroup
• There are potentially significant clinical
  implications to choosing the extra sensitive
  level of which the patient needs to be aware
• The choice will be the patients in discussion
  with their clinician

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3. Detailed Care Record

• QUESTION
• Does this method for protecting sensitive
  information seem appropriate?

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REMINDER OF OUR QUESTIONS

• GPSoC
• Does this plan seem reasonable to you?
• Will it allow you to develop your practice IT?
• Summary Care Record
• What are your views on the best way of handling
  patient consent to sharing?
• How can general practice best handle the
  validation of summaries?
• Should we ask for Consent to View?
• Detailed Care Record
• Does the sealed envelopes proposal for protecting
  sensitive information seem appropriate?

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GP Engagement Events

• Progress to date and issues