nGMS IT Implementation Programme (England)
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Introduction
The GMS Payments Project has been established within the National Programme for IT (NPfIT) to implement the information systems that are required to support the new General Medical Services (GMS) contract for GPs which was approved in June 2003. The main requirements relate to the systems which will ensure that practices receive appropriate payments. However, there are other significant IT implications of the new contract including the ownership and implementation of GP clinical systems at a time when there is the transition to new “service provider” arrangements for NHS IT systems.
The project is also part of the overarching Department of Health nGMS Implementation Programme.
Project Objectives
The goal of the GMS Payments Project is to ensure that:
- Systems to support payments and the management of payments to practices under the new GMS contract are in place and can be used by the relevant people and organisations within England in line with agreed delivery dates.
- GMS Practices (within England) are paid correctly according to the GMS Contract.
- The GMS Payment Systems implemented in advance of NPfIT initiatives, support these initiatives with as little re-work as practical.
Project Scope
The scope of project implementation extends to:
- All GMS practices and PCTs in England.
- All clinical systems that will be required to capture quality framework data within these practices/PCTs, irrespective of supplier or version.
- National systems that support the management of the quality and outcomes framework information including the generation of payments.
- National payment systems
- Manual approaches that may be required for non-RFA99 compliant GP Practices relating to the Quality and Outcomes framework.
Systems for PMS practices are not currently in scope however the work required in this area is being reviewed with a view to bringing PMS in scope at the earliest opportunity.
The Project Team
The Project Team, which is based in Leeds, is lead by Steve Walker and includes:
|
Name |
Role |
Contact Information |
|
Steve Walker |
Assistant Programme Director, NPfIT |
See Fiona Emmett below |
|
Graham King |
Project Manager |
|
|
Fiona Emmett |
PA and support
Prime point of contact |
Fiona.emmett@npfit.nhs.uk
01132 806707 |
|
Jill Hepworth |
Business Assurance Manager |
|
|
Cheryl Cowley |
Business Assurance |
|
|
A team of business analysts, technical architects and testing manager |
|
NHSIA designers and developers for the NHAIS payments system |
In addition the project is working closely with:
- the Information Policy Unit (Malcolm Pearce)
- the Prescribing Support Unit (Dave Roberts, Tony Smith and Dave Clucas)
- the NHAIS Strategic Planning Group
- PCT and Agency staff
- Clinical and other system suppliers
What the Project Will Deliver
1. Changes to national payments systems including:
- Preparation payments
- Uplift
- Seniority
- Global sum and MPIG
- Enhanced service payments
- Adjustments
- Quality and outcomes frameworks payments
2. A national system to enable practices and PCTs to manage quality and outcomes framework payments information. The initial scope will be for GMS only but early consideration will be given to the need to support PMS arrangements. The working title for this application is the “Quality and Outcomes Framework Management and Analysis Sub-system” (QOF MAS – see below).
3. An interim aspiration utility solution to enable practices and PCTs to manage initial year quality and outcomes framework aspiration (see below).
4. Training and support products and services to ensure that practice and PCT staff are able to use the systems that are provided by the project.
The project will specify and, where appropriate, design, develop, procure and oversee the implementation of systems that generate payments under the new GMS contract. This will include full testing and certification of the required outputs from GP clinical systems.
Discussions on these arrangements have already taken place with the GPC of the BMA and with system suppliers and these discussions will continue.
The Quality and Outcomes Framework Management and Analysis Sub-System
The aim is to provide all practices and PCTs with easy access to a system which will enable them to monitor achievement against aspiration during the year and which will also generate QOF payments via the NHAIS system.
This will ensure that the rules and calculations, including prevalence, that turn activity into points and payments, are correctly applied for all practices regardless of the clinical system that the practice may be using. Another key benefit is that both practices and PCTs will be accessing the same data thereby avoiding the potential for confusion.
The Interim Aspiration Utility
In December 2003 PCTs will be provided with a utility to enable practices to record first year aspirations in a structured way which will be compatible with the QOF MAS. PCTs will be required to distribute these to practices and collate the information back from practices to timescales which will be defined shortly.
The utility will enable practices to easily enter aspirations against each QOF domain and indicator. Practices without computer systems will be able to record information on paper forms for input by the PCT.
We are currently discussing with system suppliers, including 3rd parties, reports that can be run on their systems so that the completion of the utility is as straightforward as possible.
Full guidance on the use of the utility will be provided when it is released along with a description of the end to end process.
What PCTs and Practices Should be Doing
Guidance has been provided previously (click here to view) on things that practices and PCTs should be doing now to prepare information and systems for the implementation of the new contract. These include:
- Carry out baseline survey of practice clinical systems
- Ensure that practices have RFA99 compliant clinical systems
- Establish disease registers
- Assess the accuracy and completeness of clinical coding. Some practices and PCTs have found 3rd party clinical audit software useful in helping with this task.
- Ensure that appropriate staff have easy access to clinical systems
- Undertake training needs assessment
- Review system management and information governance in practices in the light of the “Good Practice Guidance” recently published by the Department of Health, BMA and Royal College of General Practitioners
- Review existing templates and protocols in liaison with clinical system suppliers
It is not recommended that Practices and PCTs should attempt to create complex queries on their own practice systems in an attempt to generate the information that will be required to support the quality and outcomes framework. Clinical system suppliers and 3rd party suppliers have been informed of how this will be addressed at a national level and early versions of e.g. Read code sets have been published.
A full release of Read codes, including those required for the new contract, was published in October 2003.
The specification for the QOF MAS will include a clear generic definition of what data suppliers must make available from clinical systems. The project will not be publishing queries or sets of queries in a specific language e.g. Miquest.
Full sets of business rules and clinical coding definitions will be published in November 2003.
Funding Issues
PCTs should be providing 100% funding for the maintenance and minor upgrade of GP clinical systems in line with the requirements of the new GMS contract and recently issued guidance. Additional national funding has been provided to make good the contribution that was made by GPs under the previous reimbursement arrangements.
The national project is holding funds to pay for the national components of the new systems that are proposed to support the quality and outcomes framework as well as changes to payments systems.
Training and Support
The project will ensure that practices and PCTs are supported with training products and services so that they are able to use the systems and utilities described above. This should be complementary to the longer term IT training initiatives that PCTs should already have in place to help practice staff to develop the skills that they need to make best use of clinical systems and information.
Steve Walker
04 November 2003
