Speculate to accumulate: will GPs get it right without IT investment?

The NHS Commissioning Board recently announced that CCGs are to be given £186m a year to invest in GP IT. But what does this mean and how will they spend it?

With the transfer from PCTs to CCGs yet to be completed, have CCGs got sufficient resource to not only manage this sum of money but know how to implement and procure IT support? Will they understand the benefits it could bring, not only to the CCG and individual clinician but also to the patient? With the Nicholson Challenge (of saving £20bn by 2015) still a key mandate for the NHS, how will investing help make significant efficiencies in the long run?

The Nuffield Trust suggests that there are two ways in which the NHS can achieve greater efficiencies. The first is that providers can cut their costs and improve productivity and value, getting more for less. The second is that commissioners can invest their money where it really adds value, through robust and evidence-based processes of setting priorities in a way that shapes new forms of service provision.

This is where IT comes in. There are many independent providers out there whose sole purpose is to design systems that help not only improve processes but save time and most importantly money. Yes, initially they require an investment but the possibility of long-term savings cannot be ignored.

CCGs need to take a long hard look at where improvements can be made. Take the referral process as an example. Here’s one scenario; a patient visits their GP complaining of pain in their knee (two week wait for an appointment). Based on an assessment, the GP refers the patient to an orthopaedic surgeon for further review (six week wait for an appointment). The orthopaedic surgeon assesses the patient’s knee and recommends physiotherapy in the first instance. The patient is then referred back to their GP to organise a referral for physiotherapy (two week wait plus six weeks for a physiotherapy appointment).

This process has taken up to 16 weeks to complete and the patient still has a sore knee! Had the GP Practice implemented referral facilitation software, then the GP may have picked up more specific symptoms prompted by the software, which would have led them to opt for physiotherapy as opposed to an orthopaedic consultation. This would have reduced the time the patient spent in the pathway to eight weeks – half of the original scenario. This would not only save both the GP and secondary care provider both time and money but also the patient is treated and leaves the pathway much quicker. This is not a criticism of the GP’s skills and training. The GP is after all a General Practitioner and it would be unfair to assume they are expert in all areas of medicine.

There are many other examples of how IT can support an efficient healthcare service. From electronic patient records to clinical decision support, the list is endless. What is certain is that every solution requires an initial investment and to achieve a return on that investment, the solution needs to have been fully researched and tested before it is procured. What is unclear, is whether the existing set up of the CCGs is sufficiently resourced to be able to confidently provide that service.

There is a risk that if CCGs make the wrong decision, the public will be scrutinising their every move. £186m is a lot of money in a time when there’s increasing pressure to save costs.

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