IT in General PracticeChris Derrett

General PractitionerBarton House Group Practice

Stoke Newington

What sort of organisation?

12,000 patientsDiversity of age,education, culture and language

7 GPs , 3 nurses , full primary care teamTeaching GP registrars and undergraduatesRented health centre, inner city

General Practices are “small businesses”The majority of GPs are self employedPartners are ultimately responsible for organising

services, premises and staff.

What sort of IT?

We have been using computers in the practice for about 15 years

Clinical records now virtually paperless 26 PC desktops In house server linked to wider NHS by

relatively narrow band connection (512K)

IT now administered and funded by NHS We generally have to deal with minute to

minute IT problems ourselves

Where have we been? Bottom up development Minimal bureaucracy Plurality of GP computer systems Poor interconnection The implementation of basic gp system has

been enthusiastically taken up by many GPs Fast response Local control and bespoke features Responsive on-line help desk Few concerns re. confidentiality issues

Where are we going?

Top down More central control (enterprise systems) Fewer systems providers Many more interconnections Greater potential for economies of scale Multiple priorities Less flexible In theory greater data security(hardware) and

system stability Major concerns about reliability, security and

data confidentiality

Our experience so far.

Choose and Book (in theory)

• Choice discussed during the consultation– 5 Options– At least 1 private

provider– Clinical performance– Social convenience

• Booking at consultation– Immediate and

convenient appointment

What CfH says.• “The Choose and Book technology works.” • “It is being used in GP practices around the

country and feedback ……. is positive.” • “Having successfully resolved the teething

issues …… the National Programme …… is ready for the wider roll out of Choose and Book.”

• “…….. 100% confident about the availability and reliability of Choose and Book.”

http://www.connectingforhealth.nhs.uk/news/310105/ Dec 2005

No Worries there then

Choose and Book (uptake)

• First Booking July 2004

• By Dec 2005 – 67,820 C+B referrals in England – Yearly total of referrals 10 million

Choose and Book (in practice)Booking a hospital appointments is

not the same as booking a flight

Choose and Book (in practice)

• Choice agenda added later• Is on-line CAB Practical

within the GP consultation?

Choose and Book (in practice)

• Hospital systems are

not yet compatible so

need for call centres

• Poor communications between national and local implementation groups

• Problems with local and central demographic linkage

Choose and Book (in practice)

• Fails to allow clinical control

of priority

• System too complicated for many patients (e.g. those for whom English is not first language)

Choose and Book (in practice)

• Slow access

(lack of understanding of speed requirements)

• Unstable

(several system failures each week)

Choose and Book (to date)

Connecting for Health(CfH)

Connecting for Health(CfH)

If you are tempted?

Connecting for Health(CfH)

?

Connecting for Health(CfH)

Politician

Health service manager

Health care professional

Patient

Connecting for HealthThe Clinical Record Service (CRS)

• What do you regard as confidential?

• Should you have to opt in or opt out?

Connecting for Health(CfH)

What can be done?

Over to you