Health officials want to pay GP practices to use new
national systems, as part of efforts to counter flagging enthusiasm
among some doctors towards the NHS national programme for
IT.
The payments are being negotiated by officials of the NHS
Confederation, under authority from the Department of Health, in
talks with the British Medical Association over the terms and
conditions of a revised contract with GPs.
Arrangements are expected to be finalised by the end of this
year, in good time for the revised GP contract to come into force
in April 2006.
GPs generally support the overall aims of the NPfIT, which
includes a national Care Records Service of shared electronic
medical records, a system to book hospital appointments online, a
broadband infrastructure, e-prescriptions and the electronic
exchange of records to other doctors when patients move home.
But delays in deliveries of integrated systems, the uncertain
performance of e-booking systems, and concerns among GPs that they
will have to lose control over local systems, have contributed to
scepticism and distrust of the NPfIT among many doctors.
Family doctors are self-employed practitioners whose income is
determined in part by a points system for meeting clinical,
administrative and other targets. Under proposals put forward by
health officials, the payments to use national systems would be
under the points-based system, lump sums or staged payments under
the Directed Enhanced Services category.
If the proposals are agreed before Christmas as expected, GPs
could receive payments according to the level of commitment they
make to the NPfIT, with staged amounts for preparing to use
systems, and further sums for preparing data for use in the NHS
Care Records Service. Extra payments could then be made for using
systems such as the care records service.
GPs have been paid an average of about £3,000 per practice per
year for 2003-2004 and 2004-2005 for improving the quality of their
electronic medical records. This may be replaced with larger
payments for using national systems.
GPs have said that incentive payments will encourage them to use
national systems, but only if the amounts cover the extra work
involved, for example in preparing patient data to be uploaded to a
national data spine for sharing medical records electronically.
A Department of Health spokesman said, "Discussions are ongoing
and we will make an announcement in due course."
Payment scheme meets criticism
Paying GPs may be welcomed by many doctors as encouragement to
use new systems, but it will be regarded by others as an inducement
to use what they may regard as sub-optimal technology.
Liberal Democrat shadow chancellor Vince Cable said, "If the NHS
IT project is not to be an expensive flop there must be a sense of
ownership by GPs and NHS users. If GPs are having to be bribed to
use it, this suggests an appalling failure of planning and
management."
GP Lisa Silver said incentive payments would not remove her
concern that crucial patient records could be lost during
electronic transfers. She also said she would be reluctant to give
up the use of her "deep and detailed" local data on patients.
When the last GP contract was negotiated it failed to take full
account of the NPfIT, and Connecting for Health, the agency that
runs the national programme, has had only a limited armoury to
counter widespread scepticism and distrust of the scheme.
British Medical Association and the Department of Health
officials declined to comment on the incentive scheme because talks
are continuing.