The caged bird sings

Sally Dawson looks at how the Black Country Electronic Records Collaboration project has been freed to innovate at a local level

Small is beautiful, but large is reliable. That is the problem facing Alan Milburn, when it comes to procuring IT for the NHS.The government is currently engaged in a colossal effort to wire the NHS by 2005. The bill is estimated to top at least £5 billion - and delivering the promises in NHS Plan depends upon its successful implementation.This leaves the government with a paradox - it is keen to prove to the NHS that it truly believes in giving it the freedom to make its own decisions at a local level.

But the problem with procuring IT for organisation as large and diverse as the NHS is that it needs to be of a consistent specification so that it can communicate country-wide. This means that the government must impose a national standard.

So rather than just endorsing one consortia, the government will probably select several, leaving it to the NHS at a local level to choose. This compromise will ensure interoperability whilst leaving trusts room to innovate.

One such example of trusts working at a local level is the Blackberd - the Birmingham and Black Country Electronic Records Collaboration - project.A partnership of 13 trusts (including Birmingham Heartlands and Solihull Teaching Hospitals NHS Trust, Good Hope Hospital NHS Trust University Hospital Birmingham NHS Trust, Walsall Hospitals NHS Trust and Royal Wolverhampton Hospitals NHS Trust amongst others) across acute, community, mental health and dental hospital services, the collaboration aims to work together "throughout the life of the procurement project, sharing common resources, skills and intelligence as much as possible to ensure the fastest and highest quality process possible".

In doing so, Blackberd hopes to achieve best practice, price and benefits, with the final aim of a fully integrated electronic patient record (EPR) system within the 13 co-operating trusts. From a national perspective, the collaboration believes that it can then use the foundation architecture to successfully bolt on electronic prescription, booking and life-long patient record in keeping with the ideals of Sir John Pattison's Shifting the Balance of Power and Delivering 21st Century IT Support for the NHS.

An integrated Care Records Service (ICRS) is expected to be implemented in two phases, with elements of PCT services - such as intermediate care and dental hospital facilities - in the first phase, as well as access to ICRS from every GP practice and health centre. All other primary and social care services are expected to be in the second phase of ICRS work.

The scope of the first phase is expected to support a master patient index, patient administration, resource booking and enterprise-wide scheduling, integrated care pathways, protocol driven requesting and prescribing and results reporting and clinical noting.The degree to which other key departmental systems - such as theatres, maternity and A and E - are integral to the core EPR, and "the imperative (or not) for them to be common amongst procuring consortium members" is to be determined prior to short listing.As a contingency plan, the collaboration is prepared to split into different "readiness and implementation" groups at any of the milestones in the procurement process.

The programme, says Blackberd is "challenging but do-able" - and with a hefty £250 million price-tag, it is certainly ambitious. The collaboration is being closely watched by other trusts waiting to see how the process develops. It says that the large-scale of the investment should prove "relatively attractive to bidders, and not just with respect to the commercial aspect of the deal". It says its "unique" positioning with respect to the government's Delivery 21st Century Support for IT makes it unlikely that bidders would "pass over" Blackberd.

"The commercial case for the single solution approach is focused on the attractiveness to suppliers as a large commercial deal based on a single coherent and geographically compact health economy," the collaboration says, describing itself as a "relatively stable customer" compared with other procuring consortia with a more diverse base. This will also, it adds, increase the range of contractual options, and "hence increase the potential for public-private partnership".

If successful, the project could prove extremely lucrative to the IT firms participating as they could find themselves in a strong position for being chosen as a prime contractor in the national programme.Blackberd says that it expects IT companies will organise themselves into supplier consortia "typically covering product companies, companies providing integration and implementation services, financiers and lead contractors".Such a large collaboration has the advantages of local solution - with all the benefits of economies of scale and minimal duplication - which is still consistent with national strategy. The possible inclusion of support for legacy systems "up and through the migration to new solutions" has potential advantages, says Blackberd, including the transferral of risk to the supplier of any delays in implementation, providing an incentive to the supplier to stay on schedule and reduce costs through consolidation.

But, according to e-Health Media, there has been some controversy over any possible "dual identity" of its Prime Service Providers (PSPs), whereby some firms could become both the supplier and the prime contractor. This, it says, is "already proving contentious within the national programme". The issue here is whether best practice can be ensured if the same company setting the deadlines, tasks and budgets, also finds itself amongst the supplier consortium.

But Blackberd hopes that ultimately the benefits of its ambitious collaboration will be manifold - and that by freeing-up clinicians to focus on the quality and consistency of care, the result will be a much better experience for the patient.

New GP internet upgrade 'a joke'

The government's new IT upgrade for GPs surgeries is a "joke", a BMA IT expert has claimed.Dr Grant Kelly, the Chairman of the BMA's IT Committee, said that the new £45 million broadband connection, announced by Lord Hunt in February, will not provide a powerful enough connection to be useful for GP surgeries.The upgrade, which is funded by the NHS Information Authority (NHSIA), will give every GP practice a 256 Kbs fixed link NHSnet connection. NHS trusts, including Primary Care Trusts and Strategic Health Authorities, are also to be upgraded to a 2Mbs fixed link NHSnet connection.However, a 256 Kbs connection would not be powerful enough to access Electronic Patient Records (EPR) when they are implemented - a much vaunted part of the government's billion pound NHS IT strategy - or enable GPs to download large files such as x-rays.

"The vision is a poor joke," said Dr Kelly, a Chichester GP. "When EPR are implemented, our practice would have 27 different terminals wanting access to centrally held patient records, and you would need at least 4 Mbs to be able to do this."The government said that the IT upgrade for the NHS would "result in a faster and more efficient health service". But residential customers in urban areas were already being offered 4Mbs links for £20-£30 per month, he said. "Once again NHS contracting is lagging behind what is being offered in the community. At present it doesn't matter because we are still five to seven years away from implementing EPR whatever Downing Street thinks."The NHS must, Dr Kelly added, think of moving to one year contracts with its suppliers to take account of the continually changing IT picture.

The announcement follows a previous commitment by the Prime Minister to connect all schools and hospitals by 2006. The government said that the increased bandwidth would allow "large amounts of data, including images, to be remotely downloaded". It also claimed that waiting times could be cut through electronic appointments and messaging, and services improved through the introduction of electronic prescriptions. "It will also facilitate the wider introduction of telemedicine, where the patient can be assessed and treated remotely," it said.

"It's another mark of the progress being made to implement our IT programme," said Lord Hunt of the development.Roll-out of the bandwidth upgrade, by NHSnet suppliers BT and Cable and Wireless, is due to be completed by March 2004.