England General practitioner Practice manager

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Premises, IT infrastructure and administrative support to enable the delivery of quality care

Problem

Primary care has experienced a decade of stagnating investment in vital capital assets including premises, IT and NHS administrative support. This has led to a severe deterioration in the fabric of general practice that now impairs the delivery of care to patients. Premises that are increasingly out of date or too small for the growing demands of clinical care prevent the development of newer systems for improved care.

Ancient IT systems running on slow networks are increasingly unable to cope with the demands for data transfer required for modern information sharing. This impacts daily on the delivery of care to patients.

Administration is a vital part of the fabric of general practice, and the catastrophic decision to outsource NHS backroom functions has led to serious problems in maintaining safe, reliable and up to date lists of doctors satisfying the requirements to perform in general practice. Frequent administrative errors in payments systems for surgeries threaten to destabilise an already fragile structure leading to problems in the delivery of care.

 

Impact

Restricted investment in GP premises leaves many unable to accommodate the latest innovations in care for patients. Slow and outdated IT systems cause delays in consultations and difficulties with data sharing, while old and unsupported hardware and software are vulnerable to attack, as with the recent “Wannacry” cyber incident episode, putting patient care and confidentiality at risk. Administrative support for GPs during the last two years has been a fiasco, putting patients at potential risk, destabilising practice finances and exacerbating the workforce crisis.

 

Actions

  • An immediate hardware and software refresh for all GP practices to address system failures arising from a decade of neglect, based on a guaranteed national minimum standard specification for hardware, software and support arrangements, that is jointly agreed with the profession and protected from local interference
  • A commitment to prioritise the replacement of all obsolete and unsupported systems that risk patient security
  • A commitment to extend the provision of electronic prescribing systems (EPS) for all practices, including dispensing practices, and to enable its use for all prescribed medication, including controlled drugs (CDs)
  • Recurrent and fully funded systems through GP Systems of Choice (GPSOC), such as front access modules like askmyGP etc. that expand the availability of new IT initiatives and provide all practices with opportunities to access digital platforms, where there is clear evidence of their benefit
  • A firm commitment to end the transfer of paper records and transition to the universal use of GP2GP electronic transfer of records system
  • A commitment to ensure that IT systems seamlessly integrate with existing GP platforms
  • Increase common access to patient records and data between those doctors involved in the direct clinical care of patients, both in and out of hours
  • Enhanced access to clinical information, advice and resources using the NHS portal, to encourage self-help and improve signposting for patients
  • Improved electronic advice, guidance and other clinical messaging systems between primary and secondary care clinicians, with data that integrates directly into GP records
  • Delivery to all primary care sites of the fully supported networks, connections, routers, hardware and software required to ensure superfast data connections at all times
  • The development and implementation of fully functioning back office support systems to support consistent and reliable services for patients and the profession
  • A commitment to prioritise a fully resourced digitisation program of all previous paper records (Lloyd George records) being held at practices, which will free up both practice premise space and time
  • A fundamental review of premises arrangements to remove “last partner standing” scenarios, reduce the risk of practices seeking alternative contractual models owing to premises problems, and remove any barriers discouraging doctors from becoming GP partners
  • Fully funded rental and maintenance costs for all practices
  • Increased and ongoing capital investment in GP premises and associated revenue costs

 

Outcome for patients

There is considerable potential to make efficiencies through the use of technology that would ease GP and practice workload and directly impact patients by increasing the amount of time available for appointments. Patients would benefit from more accessible and joined-up services, where increased expert clinical input and shared patient records would ensure a more seamless experience. Networks must be robust and quick enough to manage the data flows necessary.

Similarly, electronic prescribing would provide patients with easier and more convenient access to medications. Better premises funding structures would ensure the necessary general practice building stock to house extended primary care teams and deliver state of the art care within communities.

 

Next: Conclusion

 

Saving general practice

With an insufficient workforce, a funding plan that is no longer sustainable, a growth in population and a sea-change in the level of complex cases being presented, urgent steps need to be taken to save general practice.

Key areas