Editorials

The costs of computing for primary care groups

Inequity persists between former fundholders and non-fundholders 

From next April about £38bn of public money will come under the direct influence of primary care groups. If these new organisations are to succeed in taking over much of the planning of local services there are inevitable resource implications in terms of people, time, and information systems. So far, however, ministers have offered remarkably little public recognition of the resource requirements, particularly with regard to the period up to next April. This is in sharp contrast to the endeavour put in at the beginning of fundholding, when a national specification for software was developed and extra money released to reimburse fundholders for computing and personnel costs.

All practices will be included in primary care groups, and much of the information required to inform commissioning will emanate from general practice. Yet even now the only official NHS information system available to all general practitioners remains the Lloyd George envelope of 1911. No doubt this was well suited for slipping into an Edwardian pocket to record a home visit but it is less appropriate for late twentieth century primary care, including planning services for populations of 100 000 people.

The very nature of primary care groups requires the interchange of information between different practices and organisations. It requires the coordinated extraction and analysis of morbidity, activity, and outcome data collected at practice level as a byproduct of normal clinical activity. There is thus a need for enhanced information systems throughout general practice, particularly since the new information strategy for the NHS contains a target to have connected "all computerised practices to the NHS network by the end of 1999."¹

Technically such connection will require practice systems to use PC workstations. About half the practices in Britain are currently using systems and networks that remain from fundholding and multifunds, which were bought using the additional resources provided by central government and which usually include PC workstations. These will remain suitable for use within the practices and most will also provide useful elements of the information infrastructure for primary care groups. Non-fundholders, however, having lacked the resources to upgrade, are still commonly using simpler systems with "dumb terminal" workstations. From April any claims for reimbursement of computer costs will have to compete with all the other calls on a primary care group's unified budget. Unfortunately many of the primary care groups that contain relatively small numbers of fundholders, and as a result have less advanced computer systems, are in inner city areas, where clinical and social needs are disproportionately high and where primary care groups will have particular difficulty in funding new infrastructure.

Without remedial action the fundholding scheme will leave a legacy of inequity in general practice computing that will disadvantage not only the non-fundholding practices themselves but also their patients and their primary care groups. ^{2 3} Unless ministers do something about this inequity before April they will themselves become party to it, in sharp contrast to their declared intention to promote equity for both patients and practices.⁴

The government has recently announced that £40m will be available for connecting practices to the NHS network, together with a further £20m to support the information needs of primary care groups.⁵ Use of these resources should reflect the the inequity and needs described above, while fundholders should be encouraged to use current budgets to upgrade their systems before April in preparation for membership of a primary care group. At the same time the development of support systems for primary care groups should be a top priority for the new NHS Information Authority. If the government's policies for developing the NHS are to succeed then primary care groups need appropriate information systems, and they need them now.

Andrew Willis, General practitioner (and former chair, National Association of Commissioning GPs). 

Northampton NN3 3DA (a.willis{at}virgin.net)

1. NHS Executive. Information for health: an information strategy for a modern NHS 1998-2005. Leeds: NHSE , 1998.
2. National Association of Commissioning GPs. Restoring the vision: making health the incentive. Nottingham: NACGP , 1997.
3. Willis A. The inequity of computer reimbursements between GP fundholders and non-fundholders: a problem for primary care groups. Nottingham: NHS PCG Alliance , 1998.
4. Secretary of State for Health. The new NHS. London: Stationery Office , 1997(Cm3807.)
5. NHS Executive. Information for health. Leeds: NHSE , 1998 (HSC 1998/168).