nGMS and PMS Learning Exchange Programme Information and IM&T – The GMS Payments Project South East Gatwick February 2003
2 Agenda Background and Context The Contract – IT Implications –Funding –Ownership –Minimum Functionality Specification and Business Case Guidance –Service Level Agreements The GMS Payments Project –NHAIS Payments – The Exeter System –QMAS (National QOF Management & Payments System) –Legacy systems and GMS compliance –Suppliers –Training PMS
3 Background GMS Payments Project is part of NPfIT Scope: –Changes to GP systems –Changes to payment systems –Implementation of national QOF system –Training and support for new and changed systems Project Board (chaired by Chris Town) and working groups Project Team of NPfIT and NHSIA people
4 Context - NPfIT Aim To deliver a 21 st century health service through the efficient use of information technology Improve quality and convenience of care by ensuring that those who receive care have the right information, at the right time. Implement projects vital to the NHS modernisation programme using IT to directly improve the patient experience and clinical care.
5 Funding for GP Computer Systems £20m released to PCTs 05/11/03 In addition to £50m in existing baselines All SHAs submitted claims for additional funding (vary between £0k and £18k per practice) £30m new capital funding announced 29/01/04 Claims reviewed and agreed with CIOs – revalidate with CIOs 10/02/04 Letter to PCTs due w/e 13/02/04
6 The New £30m Capital funding –Items purchased are PCT assets –Need for PCT inventory of practice systems Priorities –Replacement of pre-RFA99 legacy –Uncomputerised practices –Prescription printers Replacement of minor/major upgrades with a definition of Core and Non- Core/Optional items Choice of systems is part of the new contract
7 Core System Components HeadingNote Clinical system serverThis equipment should be fit for purpose to support appropriate, efficient and effective access to clinical information and supporting applications. Memory and storage capacity should be sufficient to meet the immediate and foreseeable requirements of the practice. WorkstationsNormally to be available in consulting rooms and appropriate administrative areas. Memory and storage capacity should be sufficient to meet the immediate and foreseeable requirements of the practice. PrintersNormally to be available in consulting rooms and appropriate administrative areas. Dual bin cut sheet feeder to enable printing of prescriptions and other documents. Backup devices and applications Virus protection software Clinical applicationsCore clinical software (RFA 99 compliant) and associated applications and licences e.g. Read codes NHSnetConnection and usage Network infrastructureIncluding agreed branch surgery connections Core office applicationsUnder national agreements Staff should be able to access the clinical system and NHSnet via terminals or workstations from their normal working location within the practice (including branch surgeries as defined in the GMS contract). Each consulting area should normally be equipped with a printer suitable for the printing of prescriptions and letters. PCTs will be expected to meet purchase, maintenance and appropriate upgrade costs in full and these should be prioritised against other calls on the IM&T allocation
9 Funding for GP Computer Systems £20m released to PCTs 05/11/03 In addition to £50m in existing baselines Full £70m (ave. £8,000 per practice pa) should be allocated for GP IT before claiming additional funding 13 SHA s submitted claims for additional funding by 19/12/03 - deadline extended to 31/12/03 Claims being assessed to ensure equity and validity Practices must not be denied funding for core items (DH paper available)
10 Ownership of Systems & Transition Arrangements Still under discussion with BMA/NHS Confederation Status quo until there is agreement and guidance is issued 4.30 as new money is spent on providing new systems and upgrading existing systems, PCO ownership of the asset and the responsibility of the PCO to provide the full supporting service, including maintenance, future upgrades, paying for running costs of the new integrated systems and training, will be established at the same time.
11 Minimum Functionality Specification & Business Case Guidance GPC guidance list : –Core items which should normally be fully funded –Non-core items which may be optional (? GP contribution expected ?) –Items that will be funded centrally e.g. e-booking DH has similar list which will be used to assess PCT additional funding claims Draft guidance available on how PCTs and practices should prepare business cases (4.34) 4.41 Work is continuing to develop a minimum functionality specification for practice systems that defines the information requirements to deliver integrated care and meets the requirements of the new GMS contract.
12 Service Level Agreements Draft template SLA developed with Scotland Recent input from PCTs To be discussed with: –GPC and NHS Confederation –Local Service Providers –Suppliers 4.30 IM&T services will be delivered to the practice based on a Service Level Agreement setting out in detail the responsibilities of the system suppliers. 4.33 These will be based on a national template, allow local enhancements and additions to support future developments, and ensure that practices will receive higher quality IM&T services whilst preserving choice. 4.38 …. a national template SLA will be developed to support the development of future primary care IT systems providing practices with assurances on training, maintenance and support.
13 NHAIS (Exeter) Changes 2003/4 Quality preparation payment (Oct 2003) Uplift to SFA (Oct 2003) Seniority payments (Dec 2003) 2004/5 (from April 2004) Quality preparation payment (last one) Global sum Minimum Practice Income Guarantee Quality and Outcomes Framework Aspiration Other payments Contingency Plan
National Quality and Outcomes Framework Management and Analysis Sub-System QMAS
15 QMAS – Principles Not patient based data Single national system ensures: –High trust and transparent –Prevalence calculation –Changes to QOF scheme can be supported –Payments calculated on a consistent basis for all practices –Single feed to NHAIS payment system –Practice and PCT access to same information based on access rights –Reduced dependence on individual suppliers –Value for money Pre-populated with IAU data
16 Other achievement data – web interface QMAS – Inputs and Outputs QMAS Central Server PCT Payment Agency NHAIS Confirm Achievement Automated Manual Achievement data from clinical system GP Practice BACS Payment
17 QMAS – Single Information Source PCT GP Practice QMAS Central Server
18 QMAS Implementation Timeline GP System Certified Practice on Grey List GP System Installed QMAS Implemented Grey List Implemented GP System Commissioned Practice on White List Submit 1 st Adhoc Report Report Loaded CBT, User IDs & passwords issued GP QMAS Logon QMAS CBT issued From Jan/Feb Aug 2004
19 GP Systems & 3 rd Party Applications GP systems –Only QOF pay components tested & certified i.e. interface with QMAS –Suppliers should deliver added value for practices (drill down and clinical audit) – not tested. –Will not calculate payments 3 rd Party Applications –Will not calculate payments –Can help review and clean data –Will not be procured nationally –May form part of a GPSS integrated solution
20 Read Codes, Queries and Data Extraction DOH GMS contract web site contains: –Logical query specification –Business rules –Exception reporting PCTs and practices should not develop local codes and queries for GMS payments National specifications for suppliers to extract data from clinical systems to support QMAS
21 Training & Implementation Support NHSIA train NHAIS users QMAS CBT training for all users by QMAS supplier Option for classroom training for PCTs –Global Sum payments etc –Annual Achievement processes Implementation managed through QMAS supplier and GP system suppliers PCT and practice pilots of QMAS before national roll out QMAS link may be installed in practice systems before activation Tracking database monitoring Need local input and involvement
Practical Steps (nGMS and PMS) Make good use of the Quality Information Preparation Payment (QUIP DES) and Quality Preparation Payment funding Set up and maintain disease registers in line with good practice guidance Improve recording of clinical data using preferred clinical codes for the quality and outcomes framework Review exception reporting Improve sharing of clinical data both inside and outside primary care
23 Other Primary Care Challenges Systems support for: –nGMS - essential, additional and enhanced services –PMS –Alternative providers e.g. voluntary, commercial sectors –Direct PCT provision of care PCTs inherit full commissioning responsibility for prison health services by April 2006 Development of Dental Services Improved systems integration of e.g. Walk in Centres, NHS Direct, Out of Hours Improved information for patients Better access to patient records