News in brief
NHS delays e-Referral service launch until 2015: The launch of the new NHS e-Referral service has been delayed until spring 2015, the Health and Social Care Information Centre (HSCIC) has announced. ComputerWorld UK reports that the service was originally due to go live next month. It will replace the existing electronic booking system Choose and Book, which allows patients to book hospital appointments and has been used by the NHS for almost 10 years. However HSCIC admitted it still needs to test “how the service functions, how quickly it performs and how it operates with GP and hospital systems, as well as the NHS Spine”. It added: “We made the decision to delay the launch to ensure there is confidence that there will be no disruption to patient care for the 40,000 patients who use the service every day.” Achievements on e-Referrals so far include development of “new, modern, open-source based software” which it is currently testing, and infrastructure to host the new service. The centre hopes that the new service will ‘enable many more users in future’, cut waiting times in the NHS and make it more safe, secure and convenient for patients. HSCIC said: “We are also working on training materials, the design and appearance of the user screens and online help files and we will confirm the revised launch date by the end of November.”
A third of GPs live with EPS R2: A third of GP practices in England are now live with the Electronic Prescription Service Release 2 (EPS R2), the Health and Social Care Information Centre (HSCIC) has said. A spokesperson from the HSCIC told eHealth Insider (EHI) that it is aiming for more than 40% of GPs to be live with EPS R2 by the end of March 2015 and that “based on current progress we estimate that 70% of GPs will be live by end of December 2016”. EPS R2 allows practices in England to produce prescriptions electronically. These are digitally signed and sent to the pharmacy chosen, or “nominated”, by the patient. The service was originally due to be rolled out in 2007 but the first deployment at a practice and pharmacy did not happen until July 2009. Since then, progress has been slow but steady. “One of the challenges of the implementation of EPS has been enabling different parts of the health service to work together to make the service a success,” a spokesperson from the HSCIC told EHI. “However, we have been working hard to support stakeholders through this and where this happens there are benefits for GPs, pharmacists and patients.”
CQC to access patient records without their permission on new GP practice inspections: The Care Quality Commission (CQC) will be able to access GP records without patient consent, Pulse has learnt, as the regulator launches its new handbook detailing how practices will be rated. As part of the new inspection regime that was officially rolled out last week, CQC inspections teams – including the lay members – will have the power to review patient medical records ‘to assess the quality of care provided by the practice’. The regulator will not ask for patients’ consent before looking at the records, but it has said it will allow GPs to anonymise the records. The CQC has powers to access patient medical records, which falls under Health and Social Care Act 2008, and Pulse reported in 2012 that CQC inspectors routinely accessed GP records without patient consent during a pilot of 40 practices to test the regulator’s model for inspecting practices. But this is the first time the regulator has confirmed that accessing patient records will form part of the CQC’s new inspection regime of GP practices officially launched this week, which will rate practices as ‘outstanding’, ‘good’, ‘needs improvement’, or ‘inadequate’.
NHS England changes will ‘give CCGs freedom’: Job cuts and reorganisation at NHS England will free clinical commissioning groups (CCGs) to become local leaders, an internal document setting out the commissioning body’s planned reform has said. The Organisational Alignment and Capability Programme consultation document, seen by Health Service Journal (HSJ, subscription required), was shared with staff earlier this week. Overall, the organisation expects to strip out 300 posts and has notified 815 staff they will be “affected by change” either through being at risk of redundancy or potential major changes to their role. The document reveals plans for a major shake-up of NHS England’s medical directorate and confirms the creation of two new directorates focused on specialised commissioning and commissioning strategy as well as a new “field force” model in the North, South, and Midlands and East regions. More than 700 of the staff affected by changes are based in the regions and area teams, which will have 333 posts cut overall. With a 30 per cent cut in posts, the medical directorate will see the biggest reductions. Many of these roles will move into the specialised commissioning directorate, while the innovation and research function will move into the commissioning strategy directorate. The document confirms NHS England will cease its revalidation role and is still planning to transfer patient safety functions to its “delivery partners”. However, new organisations have not been identified to host these functions.
Accredited safe havens replicate the worst of care.data, warns watchdog: The new accredited safe havens (Ash) scheme will see confidential medical data housed in a network of regional centres across the country, in proposals that have been criticised for being an attempt to reintroduce a national database of medical records, reports National Health Executive. Ash would see medical data harvested from GP and hospital records covering the entire population, including information about health conditions as well as smoking and drinking habits, and uploaded to one of the new ‘accredited safe havens’. Medical researchers and NHS managers would then be granted access to this information for their work. According to the Department of Health, Ash is only intended to provide access to records that have been stripped of all personal details. However Healthwatch England has raised concerns that this new system replicates the worst of the care.data scheme, the postponed plan to digitise all medical records in Britain and store them in a single database. Healthwatch says that under the current plans, the Ash programme will go ahead without the additional assurances provided for care.data by health secretary Jeremy Hunt.
Northern Ireland consults on IT strategy: Northern Ireland’s Health and Social Care Board has launched a consultation process for its eHealth and Care Strategy, with a patient portal and online access to health records among the key proposals. eHealth Insider (EHI) reports that the five-year strategy focuses on how to use technology to modernise health and social services from 2015 to 2020. The consultation document outlines a range of planned projects, such as the development of a patient portal with trusted advice, self-care information and secure access to online services. The board will also provide patients with online access to their health records, while building on existing pilot schemes to reduce paper use and allow patients to interact with health providers electronically. It is also planning to “optimise” the current use of GP systems to provide online records access, prescription ordering and online booking, while encouraging the development and use of mobile health apps to “support, facilitate and extend the relationship between care professionals and users for self-care and management”. Valerie Watts, the Health and Social Care Board’s chief executive, said the strategy will set the direction for a new focus on helping people to make decisions about their own health and wellbeing, supporting new ways of arranging services around the patient, and improving information flow around the health and social care system.
Four care.data pathfinders chosen: Clinical commissioning groups (CCGs) in Leeds, Blackburn, Somerset and West Hampshire have been selected as pathfinders for the care.data programme. eHealth Insider (EHI) reports that the pathfinders will test different communication strategies with patients, explaining the benefits and risks of data sharing, before moving forward with the data extraction part of the project. The care.data programme will extract datasets from different organisations, starting with GP practices, and link them to an expanded set of Hospital Episode Statistics within the ‘safe haven’ of the Health and Social Care Information Centre. NHS England’s director for patients and information Tim Kelsey said there are “huge benefits to be had from this programme” and that this is the commissioning board’s opportunity to “make sure we get it absolutely right”. Phil Booth, coordinator of privacy campaign medConfidential said it is crucial that “patients are given the full picture”. In total, the four CCG areas represent 265 GP practices and NHS England is together with the CCGs “engaging with individual GP surgeries which are all at different stages in the process”. The pathfinders where chosen by a selection panel consisting of representatives from the BMA, RCGP, Healthwatch England and NHS England’s voluntary sector strategic partners.
Free NHS vital in era of genetic medicine, says England’s top doctor: A taxpayer-funded free-at-the-point-of-use NHS will be “more important than ever” in the future as genetic medicine transforms our understanding of people’s disease risk, England’s top doctor has said. In an interview with The Independent, Sir Bruce Keogh, medical director of NHS England, said that the “advent of genetics” would mean that doctors will soon know in great detail which individuals, from birth, are at risk from conditions such as cancer, diabetes and heart disease. Under an insurance-based, privately funded health system, this knowledge would mean individuals with a genetic predisposition would be doomed by their genes into having to pay high insurance premiums, he warned. “At a time when we are going to hear a lot of debate about is our NHS is fit for purpose? Has it passed its sell-by date? My answer is, no,” Sir Bruce said. As The Independent’s week-long investigation into the parlous state of the health service’s finances continues, Sir Bruce warned against allowing “the economics [to] drive us into a debate that leads people to question whether our NHS is fit for the future or not”.
Healthcare staff don’t know who head of NHS is: Almost a third of healthcare staff think Simon Stevens, the chief executive of NHS England, has had a negative impact on the NHS in England while many don’t know who he is, an exclusive Guardian survey of healthcare professionals has found. Asked: “Has Simon Stevens had a positive impact on the NHS?”, only 8% replied “yes” while 32% said “no” and 59% were unsure. Some 1,700 members of the Guardian Healthcare Professionals Network took part in the survey in June and July this year, just after Stevens took the reins at NHS England. Almost a third of the 400 people who made further comment on the impact he had had on the health service replied that they didn’t know who he was. Guardian Healthcare Professionals Network columnist Richard Vize wrote on Stevens’ appointment: “Given the enormity of the tasks facing him and the political and cultural inertia blocking progress, a bookmaker would give long odds on Stevens succeeding. But as well as intellect and charm, he has a deep understanding of healthcare policies and systems, a grasp of clinical issues which sets him apart from many managers and fine political judgement.”
‘Instagram for doctors’ to be launched in Europe: A new app has been designed to enable doctors to share pictures of their patients, both with each other and with medical students, reports the BBC News. Figure 1, as the app is named, is to be rolled out across Western Europe by the end of the year. So far, more than 150,000 doctors have uploaded case photos with the patient’s identity obscured. However, some experts have expressed concern about patient confidentiality. Patients’ faces are automatically obscured by the app but users must manually block identifying marks like tattoos. British GP and author Dr Ellie Cannon gave it a cautious welcome. “I think it’s potentially really useful to share photos with medical students and other doctors,” she said. “Obviously the potential pitfall is the confidentiality. Of course, they are anonymised but even uploading from a certain doctor may go some way to identify a patient,” she added. “And can a patient later opt out? We’ve seen with other sites the downsides of sharing too much.”
Clegg wants £500m mental health investment: The Liberal Democrats would seek to invest an additional £500m a year in mental health services if they formed part of another government, Health Service Journal (HSJ, subscription required) has revealed. Deputy Prime Minister Nick Clegg has said in an exclusive piece for HSJ that he wants “at least half” of his promised £1bn real terms NHS funding increases between 2016 and 2018 to be spent on mental health. The money would help in “completing the journey” to make “parity of esteem” for mental health services a reality, he said. “To fund this we’ve identified three tax changes that will, together, deliver an extra £1bn for the NHS, and I want at least half of that for mental health,” Mr Clegg wrote. He is also set today to announce at the Liberal Democrat Party conference an extra £120m funding for mental health services across 2014-15 and 2015-16, and the introduction of waiting time standards for the sector. His piece for HSJ wrote: “For too long, mental health has been a ‘Cinderella’ service. Forgotten, neglected, underfunded, stigmatised. In the last four years, Liberal Democrats have been working hard to put that right: writing parity of esteem into law for the first time, improving crisis care, extending access to psychological therapies.”
EHI Awards 2014 presented: Congratulations to Patient.co.uk, who won the award for the ‘Best Use of Social Media to Deliver a Health Campaign’, sponsored by Highland Marketing, at the eHealth Insider Awards. Other category winners included the ‘CCIO award for clinical informatics leadership’, which went to Dr Paul Upton of Royal Cornwall Hospitals Trust, and the new ‘rising start of 2014’ award, which went to David Newton of South London and Maudsley NHS Foundation Trust. An innovative sexual health clinic, Dean Street Express, which uses technology to offer a fast, automated service to most of its users, emerged as the overall winner. The Healthcare IT Champion of the Year award, which is decided by EHI readers, went to Dr Rick Jones, the former specialist advisor to NHS England’s National Pathology Programme, and a consultant at Leeds Teaching Hospitals NHS Trust. Sadly, Dr Jones passed away after he was nominated; but his friends and family asked for his name to go forward, and were present at the Roundhouse in London to hear that he had been the winner.
Opinions
Smart technology must be at the heart of any GP efficiency drive
Dr Mohammad Al-Ubaydli, founder and CEO of Patients Know Best, explains in The Information Daily that smart technology and digital healthcare innovation must be embraced by the whole of the NHS if it is to ease the strain on the already over-worked GPs.
“GPs have long been at the forefront of digital in the NHS. The first GP in the UK to use an electronic medical records system was also the first GP in the world to do so – back in 1975. NHS GP spending is 6-8% of the government’s healthcare budget, but GPs maintain digital records on 100% of their patients – more than any other NHS organisation. These records form the backbone of the NHS – GPs are the ones who know the patients and they’re the ones who everyone else relies upon.
“Today, the challenge is for GPs to work efficiently with all the other institutions helping NHS patients. Patients are treated or cared for by an ever-increasing range of healthcare providers, including hospitals, local councils, third sector or private sector providers, and of course the patient themselves. Patients with long-term conditions can self-assess and self-manage, they are providers of information and care. The only way to work with all of them is using innovative technologies and services. However, the whole of the NHS must embrace these new innovations if GPs are to deliver the care patients deserve – and politicians expect.
“New innovative services are making sure that patients are learning how to look after themselves better. Clinicians and GPs are experts in medicine – not teachers of behaviour change. But most NHS spending goes treating patients with long term conditions – those most at need of making a change to their behaviour: diet, exercise, taking the right pills, stopping taking harmful substances.
“So for me, it’s not a case of asking already hard working GPs to work even longer, it’s a case of looking at how the whole of the NHS can work smarter – using the latest innovations in healthcare that are already available. Patients deserve it, GPs deserve it and we will all benefit as a result.”
Health CIO profile: Neil Darvill
Director of health informatics at St Helens and Knowsley Teaching Hospitals NHS Trust, Neil Darvill, talks to eHealth Insider about his experiences in making the trust a pioneer in paperless healthcare and the need for leadership within NHS IT.
“I’m constantly disappointed by the standard of NHS IT,” he says. “Whilst I occasionally find it invigorating to see the wonderful things colleagues are doing, more often than not I scratch my head and wonder what the heck trusts are doing and how they can get away with it.
“Indeed, I have the greatest sympathy for the informatics staff in that situation. They are almost certainly hard-working and dedicated individuals trying to do their best.
“But they often find themselves in a fairly leaderless environment; one with no corporate engagement, no connection to the executives or to the board, no strategy, empowerment or development. As a consequence, these organisations end up with a service they deserve.
“I believe it is the board and executive management’s responsibility to empower themselves with a service – whether that be in-house, shared, outsourced or whatever – and to equip themselves with the capability they need to deliver their business objectives. All too often, I find that organisations’ business objectives are not connected to their informatics service – and that seems to me to be a really ludicrous way of going about things.
“Having said that, there are many good examples within the NHS of where that’s been overcome and I believe it’s the responsibility of our service and others like ours to help other organisations. For that reason, we try to be as open and supportive as possible by inviting them to share our experience.”
How integrated care can reduce A&E admissions
A recent frontline project has broken new ground in reducing accident and emergency admissions using integrated care to create efficient pathways for care, writes Claire Perry OBE, adviser to Integrating Care in HSJ.
“With the party conference season already confirming that the NHS, and integrated care in particular, is set to play centre stage at the 2015 election, there is timely evidence from Wandsworth that suggests that an integrated care approach can ease pressure on A&E departments. The project, which is part of a three year transformation initiative by Wandsworth Clinical Commissioning Group and Wandsworth Borough Council, has shown that its innovative approach is taking 30 patients out of A&E every weekday and 35-40 on weekends.
“A major challenge to the project is Wandsworth’s A&E patients seeking treatment in inappropriate places. This is the case across the country, as shown in Monitor’s latest report on first quarter performance of the foundation trust sector. The report found a staggering 2.7 million patients receiving emergency care in Q1 2014, with 0.5 million non-emergency inpatient treatments. The extra patients in A&E are inevitably contributing to the sector overall failing the government’s A&E waiting time target of seeing 95 per cent patients within four hours. A&Es have become a gateway to other healthcare services, but the Wandsworth programme has responded by building secure channels for patients into appropriate pathways for care.
“Our team knew we had to ensure that the clinical and management team could review the primary care data to update and adapt the model. This means that the CCG can monitor the impact of it’s out of hospital plan, including GP care planning, patient self-management, service redesign and telehealth. Sir Bruce Keogh has said that 50 per cent of people who call for an ambulance could be treated at home, which highlights the importance of delivering appropriate access to care. For this to happen integrated care is a necessary and challenging evolution because it can make efficient pathways for care available to relieve strain from the front line of healthcare, while also being agile in development and secure for patients.”
Highland Marketing blog
In this week’s blog Sarah Bruce explores the question – “Ebola and EPRs – a deadly combination?”
