Leaked memo confirms doctors' fears that trusts must provide resources.
Health Service organisations in London have been warned that a failure to carry out a wide range of implementation measures for the £2.3bn national programme for IT may place the NHS in default of its £996m contract with local service provider BT.
Such a default could compromise future legal efforts by the NHS to lay unequivocal blame on the supplier for any contractual failures.
The warning was contained in a briefing paper which was distributed to NHS executives within the past two weeks. It summarised the contract with the BT-led Capital Care Alliance (CCA), which won a 10-year deal in December to run NHSIT systems for London's population of 7.2 million people.
But the paper also revealed that core services, which are funded centrally, exclude two of the most significant costs of implementing the national programme: training of doctors, nurses and other staff, and change management.
The document said trusts would have the opportunity to commission and pay CCA to train doctors and other NHS staff. It said centrally-funded core services "does not cover NHS-side change management which is the responsibility of London's care communities".
Marked "restricted commercial", the paper emphasised the need to engage clinicians and others in the implementation and deployment process. Lack of end-user involvement has been a factor in major IT failures in the past.
The paper set out the contractual need for trusts to provide "suitably skilled resources" to work alongside CCA. These included "clinical, managerial, administrative, technical and business change skills" to help the local service provider design, build, configure, tailor and test new systems.
Trusts would also be expected to undertake or provide data migration, interfaces, infrastructure - desktop and Lans - local helpdesks, infrastructure support staff, and deployment preparation such as contingency plans and user manuals.
But trusts last week told Computer Weekly they were unsure how they would fund replacement staff for clinicians and others who have to leave their usual duties to work with BT or the national programme teams, or provide all the necessary skills while meeting the government's clinical and other performance targets.
The British Computer Society's Health Informatics Committee has estimated that training, organisational and other changes could cost more than four times the £2.3bn allocated to the national programme.
The CCA contract contains a plan which makes the assumption that "all trusts will take up the CCA solution within the life of the contract, ie 2013".
The contract also undertakes to provide a minimum amount of work for the CCA - a point that is emphasised in the paper. Detailed implementation plans, which will be drawn up by trusts, will need to "ensure that the value of work planned to be undertaken within a year exceeds the minimum commitment". The paper added that the total spend per year "must not be allowed to fall below the minimum commitment".
A spokesman for the national programme said, "London's care communities are fully engaged with the national programme and will be agreeing their funding arrangements for local implementation resources as part of the detailed implementation planning process now under way and due to be completed in March."
Asked whether hospitals and GP's surgeries will be able to afford the training costs, the spokesman said trusts will agree funding for this as part of the detailed implementation plan.
In response to criticisms made by doctors about the long list of systems that will not be among the centrally funded core services, the spokesman said, "The range of functionality being provided by the local service provider will be unprecedented and will allow GPs to quickly access important clinical data that has either been historically unavailable, or only available with great difficulty or delay."
What trusts will have to provide
A confidential NHS document listed a series of "additional" services that trusts will need to fund, including:
- Helpdesk and operational IT support, including infrastructure
- Programme management of legacy system upgrades
- Radiology and pathology
- Scanning and retrieval of images
- Picture archiving
- Support for dental, social care, e-health and telemedicine
- Electronic booking of GP appointments.
Paul Cundy, chairman of the British Medical Association's GP Committee's IT group, said primary care trusts will be "disappointed that there is a lot that local service providers should be providing but will not provide". He added, "What is not being provided is an extensive list."
Cundy and other doctors also expressed concern that the consortia will be given substantial resources, but that they will deliver systems no more advanced than those currently in use by GPs.