Digital IT Strategy
2017 - 2019
Contents Page
1.0 Foreword
Page 3
2.0 Introduction
Page 4
3.0 Approach
Page 5
4.0 Strategic Context
Page 6
5.0 National and Local policy drivers
Page 7
6.0 GP Systems of Choice
Page 10
7.0 Vision
Page 11
8.0 Values
Page 12
9.0 Education and training
Page 12
10.0
Information Governance
Page 13
11.0
CCG GP Practice Agreements
Page 14
12.0
General Practice IT
Page 14
Fig 1.0 ‘The Power of Information’ Areas for Development
Page 15
Fig 1.2 Informatics Vision and Ambitions
Page 16
Fig 1.3 Power of information Areas
Page 17
13.0
Local Strategies
Page 17
13.1
Right Care Right Here
Page 17
13.2
Business Intelligence to support Commissioning
Page 18
13.3
Primary Care Commissioning Framework
Page 18
13.4
New models of care
Page 18
13.5
Transformation plans as part of GP Five Year Forward View
Page 18
13.6
Data Quality
Page 18
13.7
Medicines Management
Page 19
13.8
Continuing Health Care
Page 19
13.9
Safeguarding
Page 19
14.0
GP IT Technology
Page 20
Fig 1.4 Strategic Model to Support Future Models of Primary Care
Page 20
15.0
National & Local Requirements for Primary Care GP IT
Page 21
15.1
Electronic Shared/Single Care Record
Page 21
15.2
Electronic Document Management
Page 21
15.3
Patient Text Messaging Services
Page 22
15.4
GP2GP Messaging
Page 22
15.5
Electronic Prescribing Service
Page 22
15.6
Patient Access to Electronic Records
Page 22
15.7
Agile Working
Page 23
16.0
Governance & Programme Management
Page 24
17.0
Prioritising Transformation Change
Page 24
18.0
Connected Integration for Integrated Care
Page 25
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1.0 Foreward
‘IM&T is a key enabler for Sandwell and West Birmingham Commissioning Group.
To realise all our commissioning ambitions to improve patient care, the use of technology will improve
our internal processes and most importantly provide better access to our services by patients by
realising the better use of technology.
What is certain in healthcare and in the NHS is that there will always be change. The NHS needs to
constantly evolve to take advantages of the opportunities that both new clinical knowledge and
innovative technologies can offer.
The NHS five year forward view, published in late 2014 places a commitment for all in the NHS to work
differently and more decisively to seize new opportunities that exist.
At the heart of the 5 year plan message is to move forward with integrating services and ensuring
patients are able to take more control of their own health and pathways of care. It is recognised that
there is no 'one size fits all' approach within England to do this and local regions are encouraged to
develop solutions that fit the local structures that have the potential to exist.
Sandwell and West Birmingham CCG commits in its Operating plan to develop primary care and also
support new integrated ways of working within the locality in order to provide residents access to safe,
high quality, effective care, delivered locally.
This Digital IT Strategy is to set out the direction of travel the CCG will take over the next 2 years with
respect to IT.
Innovation in information technology is a key enabler in improving care and supporting professionals in
the process of caring for patients and the CCG is committed to supporting the change required through
the use of IT wherever possible.'
Dr Inderjit Marok, GP and Governing Body IT Sponsor
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2.0 Introduction
Supporting the NHS against new demands and national driver requirements requires digital
reform. The key role that digital transformation plays is widely recognised in plans set out both
locally and nationally. Since the early introduction of computerised health records, the NHS has
continued to invest in technology transformation and especially in the way that patient care is
delivered more effectively, promptly, efficiently and both reactively and proactively. The new age
of digital in more recent years has allowed patients to exploit the use of growing technology to
live more means of social interaction. Social media and access to information more promptly and
easily continues to play a big role in the way in which society is evolving.
The NHS is also evolving in such a way that one of its primary aims is to focus on exploiting the
‘information revolution’. Better use of digital technology, plans for integration, increasing
interoperability, and efficient use of data has the power to support people to live healthier lives
and use care services less. It has the capability of transforming the cost and quality of services
when they are needed deliver an overall better patient experience whilst reducing unnecessary
demand that could have been dealt with via other equally effective means and methods.
The CCG will use this strategy framework to make the information revolution outlined in “The
Power of Information” a reality, delivering substantial benefits for our key stakeholders, so that:
Patients and the public have information to help them understand how to improve their
own health, to know what their care and treatment choices are, and to assess for themselves
the quality of services available;
Health professionals have information to better understand the needs and health history of
the people they treat and how their individual clinical behaviour affects the outcomes and
quality of service for patients; and,
Commissioners have information to understand the needs of the population they serve, and
how well different services and treatment work.
This strategy aims to promote:
A culture of transparency, where access to high-quality, evidence-based information
sourced and compared internationally, nationally and locally about the quality of care is
openly and easily available;
An environment in which clinicians are encouraged and empowered to evaluate their
decisions against the latest evidence and peer behaviour;
GPs need ready access to information that helps them understand and make informed decisions
about the type of care and support that is best suited to individual patients, patient groups and
the health economy as a whole. This includes the ability to compare the relative quality and
efficacy benefits of different pathway options for patients.
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This strategy needs to deliver:
The widespread use of modern technology to make health and care services more
convenient, accessible and efficient;
Information systems built on innovative and integrated solutions and local decision-
making, within a framework of national standards that will ensure that better quality
information can move freely and safely around the system.
The CCG needs to exploit opportunities provided by new technologies, such as
‘Cloud’ technology
Cost effective and efficient web-based storage and hosted software solutions
Hand-held devices which allow input and access to records at the point of care
Online tools and services for patients, the public and professionals
To take full advantage of new technology and new information:
Users need support and training. Greater recognition of the importance of information
and informatics skills for all those working in health and care will be critical within and
across organisations.
Clear leadership and focus to grasp the opportunities afforded by modern technology will
be required.
All organisations serving the same community need to adopt common standards and
strategies. There may also be economic benefits of combined procurements for major
systems.
3.0 Approach
In order to establish a clear set of priorities and objectives for the strategy, this strategy has
undergone input from senior managers, executive team and lead clinicians to ascertain where
critical strategic issues for the business could be better supported through the use of digital
technology. The individuals selected below were chosen on the basis they were either:
Senior Managers or representatives with a business interest in Sandwell & West
Birmingham CCG
Senior Clinical Leaders with an interest in IT and sufficient grounding to comment
technically on solutions and fit together with issues affecting the wider health economy
Those with a leadership responsibility for IT
The strategy has also undergone review and input from the CCG IT Strategy group and the
ongoing review and update (when appropriate to do so) will be primarily discussed and
mandated via this group in the first instance.
In order to establish a clear set of priorities and objectives for the strategy, national policies were
reviewed. The purpose of this was so that deliverables whereby IT held some and/or influential
levels of responsibility for enablement could be included in the CCGs overall objectives of digital
IT transformation over the next 5 years. Influencing factors included timescales for delivery, IT
dependencies, understanding what is required of Sandwell & West Birmingham CCG, its member
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GP Practices and the also care providers who serve our patient population to ensure these
deliverables are realised were all taken into consideration.
An assessment against the Universal Capabilities defined in the Digital Roadmap to identify any
specific gaps, including comparison with neighbouring CCGs IT strategies, was also completed.
The outputs of this will be fed into the Local Digital Roadmap (LDR), working in collaboration
across the footprint for economies of scale on key priority projects as well as using it strategically
to supplement LDR and incorporate their strategy into ours.
This document also sets out the following key elements that will be necessary to support the
effective delivery of GP IT:
The operating arrangements including financial procedures and associated controls;
Governance arrangements, including roles and responsibilities;
The leadership required to achieve excellence;
The responsibilities that NHS England will carry out directly in relation to Primary Care
Enabling Services
This document also provides a useful referencing framework detailing:
Core and mandated GP IT services (available to all general practices)
Enhanced primary care IT services (optional service funding dependent)
Transformational primary care IT services (supporting new models of care)
Primary Care IT Enabling Services
General practice business support systems (GP practice funded out of scope)
4.0 Strategic Context
The CCG has its own unique challenges. It has a diverse, rapidly changing population covering a
population of approximately 525,836 residents that, historically, comes from an industrial
background but has more recently seen the growth of ethnic minority groups.
This strategy aims to identify the priorities and the high level digital transformational
requirements across the CCG. Local digital roadmaps, based on requirements and
recommendations of the Sustainability and Transformational plans (STP), are recognised to hold
a significant impact on the IT Strategy for the next 3 to 5 years. The strategies other primary aims
are to deliver better use of technology across primary care and corporate estate and contribute
towards the wider population served across the bordering health economies. This includes
recognition of the impact the CCG may have on other local health community organisations such
as social services (local authority) and commissioned community services.
It is intended that this strategy will be used to obtain the agreement of the CCG Governing Body to
a direction of travel. The strategy will also provide a series of mandates to begin initial
programme development work to meet the CCG’s strategic objectives.
The CCG digital IT strategy will also be responsive and living document which provides a process
for on-going development and framework against which the informatics delivery programme can
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be prioritised and assessed. The strategy will be subject to an annual refresh to ensure it remains
relevant to CCG strategic objectives and national policy whilst continuing to be ambitious and
innovative in the light of the wider informatics and technical development environment.
This strategy is driven by CCG’s strategic objectives to improve quality of care, patient health and
care outcomes, reduce inequalities and increase productivity and efficiency.
5.0 National and local policy drivers
The introduction of reforms in the NHS recommended changes to the NHS encompassing the
following domains:
Putting Patients and public first
Improving healthcare outcomes
Autonomy, accountability and democratic legitimacy
Cutting bureaucracy and improving efficiency
The health and social care bill was developed in support of this and was published in March 2012.
In addition to core changes in commissioning arrangements the Act placed an emphasis on a
number of other areas including huge improvements in efficiency and the way in which the NHS
both manages and uses information. Increasingly patients will have a far greater say in making
informed decisions about their care. The Department of Health sought to add further clarity
around Information Management and published The Power of Information, which set a ten year
framework for transforming information for the NHS, public health and social care.
The intention is for clinical staff to access, contribute to and choose to share health and care
records, supporting a culture of ‘no decision about me without me’ for the patient. Better use of
information and innovative technology can help professional teams to prioritise more face-to-face
support where that is needed, and can also enable local areas to design integrated health and care
services, and improvement strategies that reflect local need.
Implicit within these service enhancements is an aspiration to ensure communications between
the NHS and its patients is “Digital by default”.
The success of The Power of Information depends as much on a culture shift – in the way patients,
users of services and professionals think, work and interact – as it does on data or IT systems. It
depends on making the shift to give patients more control of our health and care and on
recognising that collecting and sharing of good information is pivotal to improving the quality,
safety and effectiveness of patient care, as well as patient experiences of care.
The NHS Five Year Forward View was published in October 2014. It takes a longer term view to
consider the possible futures and the choices the NHS faces. It sets out how the health service
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needs to change, showing why change is needed and what it will look like. It argues for a more
engaged relationship with patients, carers and citizens so that we can promote wellbeing and
prevent ill-health. It sets out a vision of a better NHS, the steps we should now take to get there
and the actions we need from others.
Delivering the transformational changes set out in the Forward View and the resulting annual
efficiencies could, if matched by staged funding increases, close the £30 billion gap by 2020/21.
There are viable options for sustaining and improving the NHS over the next five years, provided
the NHS does its part.
The NHS Five Year Forward View makes three main arguments:
1. Future health of millions of children, the sustainability of the NHS and the economic
prosperity of Britain all now depend on a radical upgrade in prevention and public health.
2. When people do need health services, patients will gain far greater control of their own
care, including support for unpaid carers and better partnerships with voluntary
organisations and local communities.
3. The NHS will take decisive steps to break down the barriers in how care is provided
between family doctors and hospitals, between physical and mental health, between
health and social care.
It also acknowledges that England is too diverse for a one size fits all approach, that radical new
care models will be required, including integrated out of hospital care in the form of
multispecialty community providers and integrated hospital and primary care providers.
The General Practice Forward View, published in April 2016, sets out a plan, backed by a multi-
billion pound investment, to stabilise and transform general practice. It has been developed with
Health Education England and in discussion with the Royal College of GP’s and other GP
representatives. The plan also contains specific, practical and funded steps to grow and develop
workforce, drive efficiencies in workload and relieve demand, modernise infrastructure and
technology, and support local practices to redesign the way modern primary care is offered to
patients.
During February 2016 NHS Employers and British Medical Association’s General Practitioners
Committee (GPC) announced changes to the GMS Contract. There have been a number of key
changes including further development of data collection and specific targets for EPS, electronic
discharge summaries and patient access to records.
Personalised Health and Care 2020 is a vision developed by the National Information Board,
published in November 2014. It is a framework for action that will support frontline staff,
patients and citizens to take better advantage of the digital opportunity. It sets an expectation for
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the NHS to be paper free at the point of care and for care professionals and carers to have access
to real-time digital information on a person’s health and care by 2020.
It is clear that ‘digital’ technology has a significant role to play in sustainability and
transformation. This includes delivering primary care at scale, securing seven day services,
supporting new care models and transforming care in line with key clinical priorities. Local health
and care systems have developed Sustainability and Transformation Plans (STPs) and they
included setting out plans and ambitions on how they will harness the opportunities that digital
technology offers.
In September 2015, a three-step process began to allow local health and care systems to produce
Local Digital Roadmaps (LDRs) that support STP plans. The LDR set out how it will achieve the
ambition of ‘paper-free at the point of care’ by 2020. The first step was the organisation of local
commissioners, providers and social care partners into LDR footprints. The second step was for
NHS providers within LDR footprints to complete a Digital Maturity Self-assessment. Both of
these steps have now been completed and Sandwell & West Birmingham CCG has submitted its
Local Digital Roadmap to NHS England. A signed off LDR was also a condition for accessing
investment for technology enabled transformation.
To achieve this NHS England has recently updated the GP IT operating model 2016-18 Securing
Excellence in GP IT Services. This document provides a description of the specific arrangements
that NHS England will put in place for GP IT services to:
Inform general practice of what to expect in terms of the provision of GP IT services;
Provide a framework which ensures digital technology fully supports and enables new
models of care, service integration, extended working and new forms of primary care
organisations;
Underpin the IT provision required to build on local accountabilities for digital primary
care and for Local Digital Roadmaps (LDRs) and strategies ensuring these become
embedded within local commissioning responsibilities and plans;
Define the role of NHS England and its arm’s length bodies in supporting this operating
framework;
Provide assurance that quality and value are being maintained and delivered consistently
across primary care services within the NHS.
This document also sets out the following key elements that will be necessary to support the
effective delivery of GP IT:
The operating arrangements including financial procedures and associated controls;
Governance arrangements, including roles and responsibilities;
The leadership required to achieve excellence;
The responsibilities that NHS England will carry out directly in relation to Primary Care
Enabling Services
This document also provides a useful referencing framework detailing:
Core and mandated GP IT services (available to all general practices)
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Enhanced primary care IT services (optional service funding dependent)
Transformational primary care IT services (supporting new models of care)
Primary Care IT Enabling Services (NHS England funded RA, IG, clinical safety and NHS
mail support)
General practice business support systems (GP practice funded out of scope)
6.0 GP Systems of Choice
The GPSoC-R framework governs procurement of GP clinical systems with a range of national
suppliers, including a number of tiers, some setting out centrally funded components and others
where items have been tested and certified with a centrally negotiated approach to procurement.
The revised framework brings about a number of changes including:
An improved alignment between primary care IT and the national strategy for Primary
Care
Improved levels of engagement between all parties in designing and continually
improving the procurement framework
Incentives for use of systems as opposed to remuneration linked to deployment targets
Commoditisation – e.g. national procure certain line items – at least one provider for
national infrastructure
Achievement of equity (whilst ensuring that people operate within governance standards
and meet minimum specifications)
Delivering value for money
Determining a “maturity index” to help identify areas of greatest need
Ensuring the GMS contract obligations are fulfilled
Local CCG level responsibility for the management of GP Primary Care IT budgets through
a yet to be finally determined process of delegation from NHS England
It is widely recognised there are some significant national challenges with the current
arrangements for supporting GMS IT in General Practices. These include an inequitable
distribution of budgets, a separation between budget holders and service commissioners which
causes confusion, a lack of clarity on responsibility for some items, capacity and capability issues
at a locality level, confusion around complimentary items and legal ownership of assets and
depreciation. These issues all currently affect the CCG and its general practices to a greater or
lesser extent.
The GPSoC-R framework provides a tiered procurement solution. Core (mandatory) services are
included in a Tier one or “Core Service Provision” offering. This is the standard core service
offering specified in the Securing Excellence in GP IT Services Operating Model. SWB CCG will
ensure member GP Practices have the opportunity to utilise products in GPSoC-R Lot 1, we will
review what is available and not miss opportunities to achieve our strategic aims.
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The future arrangements for funding have meant a re-baselining of local GP IT budgets. The effect
of this combined with a suggested real terms increase on overall funding for GP IT is unknown,
but given the increased expectations around Primary Care IT and particularly the delivery of
Patient Online will inevitably mean the pressures around managing Primary Care IT budgets will
not subside.
7.0 Vision
Our vision is simple to understand but more challenging to deliver - Healthcare without
boundaries. Our mission is to work across boundaries to improve the health of the communities
we serve, and the quality of health and social care services provided to those communities.
We will do this by:
Giving patients and the wider population the opportunity to benefit from healthier
lifestyles
Bringing appropriate elements of care closer to home
Designing services to meet the needs of the local population.
There are two key strategies which provide the drivers against which the informatics programme
needs to be prioritised and assessed:
The CCG’s Strategic Commissioning Plan 2012-2017 describes the CCG ambitions and
how they will be achieved. It flags up Informatics as a key enabler.
The Department of Health Power of Information Strategy (2012) sets a ten-year
framework for transforming information for the NHS, public health and social care. The
strategy has identified the four key areas for strategic Informatics, which have been
developed to provide a set of Ambitions for our CCG Informatics Strategy
The vision of SWB CCG is “Working together with our partners and communities to improve long-
term health and wellbeing of our citizens, through clinical excellence, innovation and person-
centred leadership – best care, best place, best time…”
As a principle Sandwell and West Birmingham CCG wishes to increase the use of digital
technology in the delivery of healthcare services to patients in order to bring about
improvements in the quality, safety and the efficiency of the NHS services it commissions on
behalf of the population we serve.
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More specifically the CCG will strive to:
Provide secure access to high quality up-to-date clinical information accessible at the point of
care, improving interoperability of systems across the health care, legitimate relationships;
Implement the strategic aims of national policies to empower patients and support
healthcare professionals deliver new models of care;
Ensure that the IT programmes are fully aligned to enable and support the clinical needs
and priorities of and member practices;
To support our members in having 21st century IT provision and support in primary care
and support users with their IT skills to utilise this provision;
Review new and future technologies, introducing these at the appropriate time in a well-
planned and managed implementation to ensure strategic benefits are realised;
Commitment to achieve national targets;
8.0 Values
Sandwell and West CCG has identified a number of core values against which it has assessed
priorities for investment in Information technology solutions. In no order of importance or
priority they are:
Strive to utilise information to aid commissioning and shared with all relevant parties,
whilst observing the Data Protection Act and being vigilant of Information Governance
Risk stratification to shape services appropriately, commissioning, patient care, reduce
costs
We will share IT knowledge about best practice, training, new innovations, IT skills
amongst members and practices
9.0 Education and training
Sandwell and West Birmingham CCG recognises the need to ensure users of IT systems are
appropriately trained in order to ensure the systems can be used safely and appropriately and
that the CCG is able to extract the maximum return for its investment for the benefit of patients.
This strategy requires the introduction of new systems and processes covering a range of areas.
For the introduction of new systems to be a success it is imperative that our users are
appropriately skilled and trained in their usage.
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As the project to develop and implement each new system commences an appropriate training
needs analysis will be undertaken to ensure the necessary resources to support the training
required are available. Staff will be provided with training from a variety of sources including:-
On-line training material
Supplier based on site training
Off-site workshop style training
Self-study\learning
10.0 Information Governance
Information Governance (IG) provides a framework to bring together all the legal rules, guidance
and best practice that apply to the handling of information. Due to the range and complexity of
the standards and legal rules, the Department of Health has developed sets of information
governance requirements which enable NHS and partner organisations to measure their
compliance.
In order for the CCG and the General Practices within its boundary to comply with NHS
Information Governance requirements the CCG (via direct NHS England support arrangements)
will provide training and support in the following areas:
General awareness training;
Information sharing management protocols;
Caldicott requirements guidance;
End to end data protection compliance;
Freedom of Information Act compliance;
IG audits and Toolkit completion support;
Development of yearly IG improvement plans;
Incident management support;
Data Protection;
The IG Toolkit is a DH policy delivery vehicle that NHS Digital is commissioned to develop and
maintain. It draws together the legal rules and central guidance set out by DH policy and presents
them in a single standard as a set of information governance requirements. It is an online system
which allows organisations to assess themselves or be assessed against Information Governance
policies and standards. All developments proposed within this strategy will meet IG standards
and be implemented to ensure maximum IG Toolkit ratings.
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11.0 CCG GP Practice Agreements
The CCG will provide annual opportunities to review the GP IT service that member practices
receive. This will include:
Feedback about of the performance of the IT services;
Exploring ways to improve and develop IT services
Implementation plans for new services;
IT training initiatives;
Support for business continuity and disaster recovery arrangements;
These reviews will be conducted through a variety of methods, including electronic survey, to
maximise consultation with, and responses from, the membership. The network events will act as
an additional forum to discuss any IT requirements or concerns. Any IT issues requiring
escalation can be escalated to the CCG IT Lead and IT Account Manager.
12.0 General Practice IT
Responsibility for the operational management of primary care IT services is delegated to the CCG
from NHS England. Funding to support this has also been delegated, currently at 2012/13 levels.
The approach to be taken by the CCG is that we will invest in primary care IT if we foresee a
demonstrable improvement in either the quality of service provided or commissioning outcomes.
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The following initiatives are proposed over the next 3 years:
Fig 1.0 The Power of Information Areas for Development
‘To realise the enormous potential benefits of informatics to improve patient outcomes and experience, and reduce inequalities
by ensuring that high quality information is available anywhere and when required, supporting good decision-making by
clinicians, patients and managers.’
The Power of Information Areas for Development:
Information about
Connected information
Better access to better
Quality Driven
me and my care
for integrated care
information
Information Systems
We will develop patient
We will aim to avoid islands
We will improve the quality
We will establish
centered information
of information and instead
of management information
governance processes to
systems, around the GP
make relevant and real time
and reduce costs by deriving
ensure we can work
s
record.
clinical patient-centered
it from linked clinical
collaboratively with the
information available along
information to provide an
local health community and
ition
We will develop
the care pathway and across
integrated picture of service
continue to support the
b
m
information and
care boundaries to provide
provision, quality and patient
business needs of the CCG.
A
knowledge systems
seamless high quality and
experience.
which enable and
safe care.
We will enhance the
empower patients to
We will deliver a single point
common IT communication
become proactive
of reference for clinical and
infrastructure.
partners in their health
commissioning knowledge
and care.
and guidance to help deliver
care that is based on best
practice clinical knowledge.
Delivery
GP Systems Hosted,
The CCG will use national
Use Aristotle to provide
Implement an internal IT
Methods
federated if required
systems that are
intelligence on our patients
governance process
with data sharing.
appropriate and mandated
Use risk stratification tools to
Work collaboratively with
Links to acute providers
Use Summary Care Records
help ‘plan‘ our services and
the local health economy in
commissioning models
the midlands and beyond
Links to Community
Use Your Care Connected
providers
local enhanced record
Establish links with our
system
local acute, community and
Links to health and social
social services
care
Links to Public health
Links to 3rd party
commercial providers
This strategy is primarily about achieving transformational change and building on the current
systems and infrastructure whist reviewing and recommending new technologies; however its
success depends critically on the following elements being in place:
Robust IT Infrastructure that delivers information where needed
Sound governance arrangements
High quality information management and good quality data
Training and awareness to ensure information and systems are used effectively
Sound project management and procurement processes
Working in collaboration with other NHS organisations.
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Section 7 “Getting the Essentials Right” looks at how these elements need to be maintained and
developed in respect of:
Primary Care Support and Development
CCG Corporate Business
Common IT Infrastructure
Governance and Programme Management
Section 10 “Prioritising Transformational Change” outlines the programmes of work required to
achieve the CCG’s Informatics Vision and Ambitions. These projects will need to be prioritised by
the CCG.
Fig 1.2 – Informatics Vision and Ambitions
Information about
Connected Information
Better Access to
Quality Driven
me and my care
for Integrated Care
Better Information
Information Systems
Online Access to
Your Care Connected
Aristotle
Review SWB CCG
Records and Services
infrastructure
for patients
Use of Summary care Records
Care co-ordination system to
Point of Care Decision
Virtual Desktop
share Advanced Care Plans
Support
Infrastructure for
Corporate CCG
Health Information
Safeguarding systems
& Primary Care
Portals / Web sources
(i.e. Route2Wellbeing) Continuing healthcare
systems
Primary Care Offer
Electronic Documents
Use of SUS
Quality Outcome Framework
Management
Electronic Prescribing
Aristotle
DES/LES /CQRS
GP2GP
GP Systems
Diagnostics, electronic order
Public Health Requirements
communications and
integrated results messaging.
Two way Text messaging
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Fig 1.3 Power of information Areas
Power of Information Areas
CCG
Information about me
Connected information for
Better access to better
Strategic
and my care
integrated care
information
Objectives
Keeping our
Information for patients to Integration and analysis of clinical Information for commissioners to
local
support lifestyle choices.
data across care boundaries to identify
health
needs
and
population
provide
information
about inequalities.
healthy.
effectiveness
of
care
pathway
provision
Providing
Information
to
signpost Information
about
patients
is Information to signpost professionals
accessible
patients to most appropriate available where and when required to most appropriate service choices.
care.
service choices.
to
support
scheduled
and Information to support planning and
unscheduled care.
commissioning
Providing high
Patients have access to Integrated clinical records which Managers,
commissioners
and
quality care
information
about
their support continuity of care and avoid planners have access to good quality,
health and care to enable unnecessary
and
inappropriate relevant information which shows
them to be pro-active interventions.
outcomes across care pathways
partners in care.
Involving
Patients
should
have Integrated information is needed to Patients and the public have access
patients and
improved
options
for produce outcome information for to good quality information about
the public
communicating
with patients about the whole care the performance of services as well
clinicians and commissioners pathway.
as information about their own
health and care.
13.0 Local Strategies
SWB CCG as part of their commissioning plans intends to support a number of local strategic
developments which should change the landscape for clinical service delivery in the next 5 years.
This will involve a number of service re-design across the local health economy and are outlined
below:-
13.1 Right Care Right Here
This programme is a partnership between the NHS and the Local Authority in Birmingham and
Solihull. It is committed to improving healthcare in the Sandwell and heart of Birmingham areas,
ensuring that care is delivered in high quality environments closer to where people live. It is also
striving to make Sandwell and the heart of Birmingham healthier places to live and work. It
supports the development of a new hospital within the west Birmingham area which will
eventually require the consolidation of the current City Road Hospital and the Sandwell Hospital.
This programme will also look to re-provision services possibly focused on more Primary care or
community led services.
To support the above programme the informatics will need to considered very carefully and in
particular the development of a shared electronic patient record.
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13.2 Business Intelligence to support Commissioning
SWB CCG is currently data rich but information poor. The ability for clinicians and commissioners
to access accurate information is imperative for a successful CCG. We will seek to continually
improve the operational effectiveness of systems already in use.
13.3 Primary Care Commissioning Framework
The scheme represents a joint pledge by practices and the CCG to work together to enhance
primary care, improve quality and deliver consistent and fair services for our patients. The
standards we have designed reflect areas where we know performance could be improved and
the experiences of patients and clinicians. Our members told us that these initiatives should be
brought together into a single, easy to administer scheme that is realistic but challenging.
13.4 New models of care
Throughout the new models of care programme, individual organisations and partnerships were
invited to become vanguard sites. These Vanguards will have the opportunity to work with
national partners to co-design and establish new care models so that the NHS is sustainable for
the future and better able to meet the needs of patients, tackling national challenges in the
process. Sandwell and West Birmingham CCG will support the implementation of the benefits
and lessons learnt from the New Models of Care Programme.
13.5 Transformation plans as part of GP Five Year Forward View
Formerly known as the Prime Ministers Challenge Fund the £150m fund across two waves will
help improve access to general practice and stimulate innovative ways of providing primary care
services. Sandwell and West Birmingham CCG will support the implementation of the benefits
and the lessons learnt from the Prime Ministers GP Access Fund.
13.6 Data Quality
SWB CCG is committed to improving data quality in all areas, in particular within Primary Care
and through our commissioning agreements with local service providers.
The CCG, in partnership with the commissioning support unit, will develop a data quality
programme for General Practice to ensure data quality principles are correctly applied and that
General Practices within SWB CCG are compliant with appropriate legal and NHS governance
requirements. GP Practices will work CARAT (Clear, Accurate, Relevant, Accessible and Timely)
principles. SWB CCG will also provide a continual reminder to GP practices of the 8 principles of
the data protection act:
1.
Fairly and lawfully processed;
2.
Processed for limited purposes;
3.
Adequate, relevant and not excessive;
4.
Accurate and up to date;
5.
Not kept longer than necessary;
6.
Processed in accordance with individual’s rights;
7.
Secure;
8.
Not transferred to countries without adequate protection.
Whilst all General Practices use their Clinical Systems for the capturing of contemporaneous
notes on patient consultations this strategy will not only reinforce the importance of this work,
but further enhance it. New developments including protocols to support the consistent
recording and management of disease registers, templates for data capture, receipt of electronic
clinical correspondence, guidance on clinical coding and developments to enhance the current
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scope of current clinical messaging arrangements will all
help improve the depth and quality
of the clinical record held in General Practices.
SWB CCG will support General Practices by undertaking a baseline audit in each surgery and
agree a number of actions which will form part of an overall development plan to be reviewed
annually.
13.7 Medicines Management
SWB CCG recognise the importance of providing coherent advice to its member Practices and
regularly review prescribing policy based on national standards and local health economy patient
requirement.
13.8 Continuing Health Care
This service currently utilises a standalone database to capture patient information. The data is
captured on paper and retrospectively entered onto the system, care plans and assessments are
then generated from the system.
13.9 Safeguarding
SWB CCG has developed a large network to help with safeguarding issues across the west
midlands and actively use a number of incumbent systems to gain intelligence on patients; cases
are considered using conference facilities. There is however a strong need to integrate systems
where possible and extend the use of the national Summary Care Records systems and also the
newly deployed ‘Your Care Connected’ service. Also by using better BI tools and intelligence
across different service providers will help reduce risk to patients and also provide earlier
intervention if required.
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14.0 GP IT Technology
GP Practices operate under a number operating models outlined below:--
Standalone Practices, single system
Formal/informal: collaboration, separate GP systems with joint working
Federated model: multiple sites, single GP system, data sharing agreements, back office
administration consolidated
All clinical systems are hosted solutions provided by EMIS, TPP, and INPS and were procured via
GP System of Choice arrangements. The local infrastructure that resides in each practices consists
of a mixed economy of managed Domains or local work grouped domains.
All sites have structured cabling linking back to either Cisco POE switches or standard CISCO
switches. The wide area connectivity is provided by N3/NGa provided nationally.
Some group of practices have installed local private data circuits between sites that provision
VoIP and local data transfer.
SWB CCG is supporting future GP technical operating models which enable future Primary care
services to improve efficiencies and improve back office workflow, this should be coupled with
improved Business Intelligence capability. SWB CCG will provide support to the emerging
‘Accountable Care Organisation’s (ACO) which will allow more autonomy for primary care. The
key enabler for making sure ACO’s are successful is by having robust IT services which are
flexible, secure and quick to mobilise.
Fig 1.4 Strategic Model to Support Future Models of Primary Care
Patient
User Interface: Single Sign On, Integrated Desktop Management
Interface
-Texting
Integration and Application Layer: Active Directory, VDI options, Anti-Virus, Software
-Mobile Apps
management and deployment, BI Tools,
-Video
Data Sharing Models
Consultations
-Telehealth
EMIS Web
TPP
INPS
-Remote BP,
Back office
Weig
ht
Applications
management
-E-Prescribing
Underlying Infrastructure: data and voice technologies, secure data storage,
& repeats
resilience, backup technology
- Online appts
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15.0 National & Local Requirements for Primary Care GP IT
Responsibility for the management of primary care IT services is delegated to the CCG from NHS
England. Funding for GP IT support for 2015/16 and beyond is now provided to CCG’s by NHS
England based on population size.
There is also an additional central pot of transitional money available which CCG’s can apply for if
it can be demonstrated that running costs are higher than the budget available. The approach to
be taken by the CCG is that we will invest in primary care IT if we foresee a demonstrable
improvement in either the quality of service provided or commissioning outcomes.
15.1 Electronic Shared/Single Care Record
Numerous organisations play key roles in the delivery of care – and so effective communication
between GP and provider is extremely important; as is the sharing of data and records so that we
can support better and seamless delivery of care. We will therefore expect all providers to
contribute to the development of a
single care record in Sandwell & West Birmingham CCG.
This will build on the nationally mandated summary care record, and will be a locally defined
patient record with the ability to combine primary care, secondary care, community care and
social care information.
Better communication is at the heart of improving the care for our patients. A centralised
electronic shared care record will help create a safer and more joined up NHS in Sandwell & West
Birmingham CCG helping make vital information more accessible at the time of need.
Your Care Connected is the pan Birmingham, Sandwell and Solihull solution for local record
sharing. Phase 1 will make a summary of a patients GP record available to NHS Service providers
involved in the patient’s care, subject to the patient’s permission to view the record.
15.2 Electronic Document Management
EMD enables GP practices to quickly process electronic documents and provides instant access to
information. This enhancement of access for General Practices to clinical information generated
in local Hospitals and other providers is a high priority for the development of local system
interoperability. This will improve the efficiency of GP practices and the quality of discharge
letters from hospitals. Sandwell & West Birmingham CCG will continue to work with local
hospitals to maximize the use of this technology to achieve maximum efficiencies across the
health economy.
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15.3 Patient Text Messaging Services
Automatically sending electronic appointment reminders to patient’s mobile phones is proven to
reduce non-attendance in General Practice by between 26% and 40%. Mobile phone users (90%
of adults own a mobile phone) have constant access to their devices and SMS messages can be
received nearly instantly – usually within four minutes.
Sandwell & West Birmingham CCG will continue to take advantage of nationally agreed SMS
tariffs to promote the use of this SMS technology and explore the use of social media as a means
to effectively communicate with patients in ever changing technological landscape. SWB CCG will
procure a two way text messaging solution for the GP Practices and fund its use for up to 3 years.
15.4 GP2GP Messaging
GP2GP enables patients' electronic health records to be transferred directly and securely between
GP practices. It improves patient care as GPs will usually have full and detailed medical records
available to them for a new patient's first consultation. Within Sandwell & West Birmingham CCG
each of the current GP Clinical Information Systems are GP2GP compliant and we will support
practices to ensure the technology is used to maximise nationally recognised efficiency gains.
GP2GP version 2.2 is all about increasing the number of transfers and bringing improvements to
the process. It will introduce two main changes to existing functionality. Version 1.1 of GP2GP
prevented transfers where electronic health records (EHRs) exceeded 5Mb in size, or contained
more than 99 attachments. Version 2.2a provides a solution to this restriction, allowing systems
to send and receive larger sized messages including increased numbers of attachments.
For patients that re-register at a practice (returning patients), v2.2b will transfer their record via
GP2GP and when received, and allow it to be fully integrated into the clinical system.
15.5 Electronic Prescribing Service
This
enables prescriptions to be sent electronically to a dispenser of the patient's choice, making
the prescribing and dispensing process safer and more convenient for patients and staff. The
deployment of EPS to GP practices and pharmacies in the area will enable a better and more
efficient service for patients. Sandwell & West Birmingham CCG will continue to support practices
to implement this functionary where required. Changes are required to both prescriber and
dispenser contracts and these negotiations are led by NHS England.
15.6 Patient Access to Electronic Records
The NHS and care services are undergoing rapid transformation of business and communication
opportunities enabled by digital technology. In England, General Practice remains at the forefront
of opportunity, with a widespread deployment of electronic record systems, paper-lite practices
and a history of adopting and adapting new technology for direct clinical and business benefit.
The ‘Power of Information’ and NHS Mandate specify the policy requirements to deliver
electronic booking/cancellation of appointments, repeat prescription ordering, secure electronic
communication and record viewing. Multi-professional, patient and supplier input into the RCGP
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led patient online road map provides an evidence based template on which to incentivise the
delivery of these policy aims, focusing on benefits for patients, supporting clinicians and practices
and the wider care services.
The ambition for General Practice is to enable new, efficient, convenient ways of working through
technology to support patients to safely and independently manage and take more responsibility
for their own health issues and choices. There are many ways of delivering this including the
wider spectrum of Digital Primary Care. It is expected that the delivery of new technology will
enable and encourage clinician and patients to interact in different ways that enhance the patient
experience and begin to relieve the pressure on clinicians from the traditional service models.
Underpinning the ambition for ‘digital options’ to become universally available in the General
Practice environment, is a need to sustain the momentum for introduction of technology.
Evidence based implementation of innovative new pathways will drive professional and public
support for convenient, safe and effective new options as replacements for face-to-face contact.
There is clear evidence that online services have potential to increase capacity and efficiency. But
part of the implementation challenge is persuading practices of the value of these potential
benefits versus the effort and cost required to realise them. Mindful of variation in appetite and
capacity between practices, as well as competing priorities, there will be a national support and
training offer, that will be developed in partnership with the profession and taking account of the
of the recommendations in the RCGP Roadmap.
Sandwell & West Birmingham CCG will work with compliant system suppliers to progress
practices to switch on the following functionality for all practices (where available):
Online patient booking of GP Appointments;
Online repeat prescriptions;
Online access to a patient’s own medical record.
15.7 Agile Working
The CCG’s Remote Working policy provides the ability for CCG staff to work off site as required.
To facilitate this, the ability to work effectively off-site is required. Sandwell & West Birmingham
CCG will continue to make use of Cloud based technology such as Microsoft Office 365 to further
strengthen a collaborative approach that is robust, cost effective, and meets the requirements of
the wider health economy.
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16.0 Governance & Programme Management
The CCGs within Birmingham, Solihull and Sandwell have created a single IT Programme Board
where key strategic projects are discussed and agreed. The M&LCSU as the incumbent IT provider
attend the meetings and provide project updates and also operational progress and/or issues.
This Board discusses and agrees programmes of work that are of interest for all the CCGs
presents such as the deployment of the new e-referrals system. The Board is chaired by one of the
GP IT leads.
Within each CCG local IT Boards operate and predominantly discuss local programme of work
and progress for locally agree work priorities.
Birmingham, Sandwell and Solihull Governance Diagram
Birmingham, Solihull,
Sandwell & West
Birmingham IT Programme
and Operations Board
Sandwell and West
Birmimgham South Central
Solihull CCG
Birmingham Cross City CCG
Birmimham CCG
CCG
IT Board
IT Board
IT Group
IT Group
17.0 Prioritising Transformation Change
Being able to access, add to and share health records can help patients take part in decisions about
their own care.
A key objective “The Power of Information”1 is for all patients who want it to have secure online
access to GP records and services by 2015. A first step towards making all this happen is to ensure
patients have access to online transactional services such as appointment booking and ordering
repeat prescriptions online. The CCG needs to develop a better understanding of the potential risks
and benefits of patient online records access, including access to test results, letters and
consultations. Local pilots across a range of GP system will help inform the CCG approach and the
support required for GP practice members and patients.
Online access for patients needs to bring efficiency benefits to practices from reduction in
administration and better use of clinical time.
The CCG will work with patient reference groups, providers, technology suppliers and information
governance specialists to ensure that public awareness campaigns are put in place alongside
technology changes to ensure patients can make informed decisions about how their information is
shared and processed.
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Patients also need access to knowledge and information about their condition, lifestyle choices and
the healthcare and services available to them. The CCG will expand the existing range of
information services and work with provider and commissioner partners to signpost patients to:
Local information on services commissioned by CCGs;
Information to support informed choice including quality and outcome measures; and
National, accredited knowledge bases on health and conditions
The use of technology to consult with, support and monitor patients outside the consulting room is
growing both in extent of use and the functions it can provide. The CCG will evaluate the potential
for Telehealth and assistive technologies to support better patient self-care.
18.0 Connected Integration for Integrated Care
Integration of information across care pathways is a key theme of this strategy; it is an essential pre-
requisite for joined-up and high quality clinical care but also underpins the delivery of meaningful
information for patients and for managers.
Initiatives are being taken forward nationally to ensure clinical systems for the future will be
interoperable, using framework specifications such as the Interoperability Toolkit. These nationally
defined standards will allow information to move freely between services and organisations in the
local health community and enable systems to connect up, rather than every organisation using the
same technology or product, so that:
Clinicians will have tools which enable them to reference patient data, where consent has
been provided, along the whole care pathway, unconstrained by organisational
boundaries.
Providers of healthcare services will be able to increase their efficiency, for example
from reduced duplication of work, by being able to view all the relevant health records for
those patients under their care. This ability will also enable providers to improve quality
of services, for example by minimising the risk of errors and improving the continuity of
services provided.
Patients will benefit from the quality improvements in the services provided to them as
well as experiencing increased continuity of care.
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