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.
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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.