St Andrew s House Primary Care Division

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1 NHS Circular: PCA(M)(2003)13 abcdefghijklm Health Department St Andrew s House Primary Care Division Regent Road EDINBURGH EH1 3DG Dear Colleague NEW GMS CONTRACT GP CASH LIMITED ALLOCATIONS IM&T ARRANGEMENTS Summary 1. This Circular advises: a. finalised GMS-CL allocations for ; and, b. a first tranche of measures being taken to give effect to those elements in the new GP contract relating to the future provision of GP IM&T. 2. The first tranche of IM&T measures includes: the establishment of a co-ordinating team, based at the Common Services Agency, to provide leadership and coordination of NHS Board/Trust GP IM&T programmes within the arrangements laid down in the new contract; the rolling out of a preparatory practice mentoring programme to assess and develop practice IM&T skills, and to inform the design of ongoing training programmes to be provided in future by NHS Boards/Trusts; a recommendation that all NHS Board areas have GP IM&T advisors; the implementation of a national baseline audit of Scottish GP IM&T; status on contract coding initiatives; further investment to allow completion of PARTNERS registration roll out in branch surgeries; completion of an upgrade programme to RFA Scotland v.1 standard; 25 July 2003 Addresses For action Finance Directors, NHS Boards/Trusts For information Chief Executives, NHS Boards/Trusts Chief Executive, CSA Enquiries to: GP IM&T Policy Mr Stephen Tither Primary Care Division Room 1-ER St Andrew s House EDINBURGH EH1 3DG Tel: Fax: Stephen.Tither@scotland.gsi.gov.uk Implementation Arrangements Mr Stewart MacDonald CSA Trinity Park House EDINBURGH EH5 3SE Tel: Fax: Stewart.MacDonald@isd.csa.scot.nhs.uk Branch Surgeries, Communications Infrastructure and PARTNERS Roll Out Programme Mr Ron MacDonald CSA Trinity Park House EDINBURGH EH5 3SE Tel: Fax: ron.macdonald@isd.csa.scot.nhs.uk

2 revised reimbursement arrangements for GP IM&T costs and provisional amendments to paragraph 58 of the Statement of Fees and allowances; and funding allocations for GP IM&T for (firm), and (indicative). Background 3. The BMA announced on 19 th June that GPs across the UK had voted to accept the new contract negotiated by them with the NHS Confederation on behalf of the Government and the 3 devolved administrations. Investing in General Practice, published jointly by the BMA and the NHS Confederation on 26 th February includes at paragraphs a section on Modernising information management and technology in general practice. A further document Supporting Information for Scotland was issued on 16 th May 2003 by SEHD. The sections referring to IM&T are included in Annex A. 4. The pre-existing arrangements for the normal funding of GP IM&T are laid out at paragraph 58 of the Statement of Fees and Allowances to GPs in Scotland. 5. The Revenue Allocations letter issued on 7 th February 2003 advised NHS Boards/Trusts to plan on at least the same amount of funds being available for GMS-CL for as in the previous year, with further advice to follow on completion of contract negotiations. 6. PCA Circular 2003(M)2 announced on 2 nd February 2003 a pre-new contract 2.25m legacy upgrade programme in respect of practices whose IM&T systems were not RFA Scotland v1 compliant. 7. Since the publication of Investing in General Practice, there have been ongoing negotiations between SGPC, SEHD and the wider service on the implications for Scotland. This has resulted in the establishment of 4 working groups looking respectively at the issues of strategy, GP systems & choice, servicing and maintenance and training. Detail Revised GMS-CL allocations for Annex B details revised GMS-CL allocations for This includes an increase of 1.6m over the amounts advised in the Revenue Allocations letter of 7 th February This new money is being allocated in accordance with the new Scottish Allocations Formula (SAF), and may continue to be spent as previous ly on GP practice staff, GP IM&T or GP premises reimbursements. Establishment of a GP contract IM&T co-ordinating team 9. To assist NHS Boards/Trusts successfully address the challenges presented to General Practice by the new contract, SEHD has decided to establish a new co-ordinating team to be based at the Common Services Agency. The team will draw on its successful experience in co-ordinating the roll-out of previous GP IM&T initiatives, and share with

3 the service the advice emerging from the 4 working groups referred to above. Further advice on the issues surrounding GP choice will be made available in due course. 10. Its role will be to work in collaboration with NHS Boards/Trusts and to provide leadership and co-ordination for the implementation arrangements, encouraging innovation, and the sharing of best practice across Scotland. 11. The team will liase closely with the Scottish General Practitioners Committee (SGPC), and report on progress to the IM & T Infrastructure Programme Board, chaired by Professor Tony Wells, Chief Executive of Tayside NHS Board. 12. The team will issue regular News Letters to the service to keep it informed of developments. This will be edited in conjunction with SGPC. 13. SEHD will continue to co-ordinate policy development within the 4 country context of the new contract. 14. Contact details for the new team are provided at paragraph 32 below. Practice IM&T mentoring programme 15. This programme has been established to assess and develop practice IM&T skills. It draws on experience from a pilot programme in Lanarkshire. This is a one-off initiative to raise local awareness and inform the design of ongoing GP practice IM&T training programmes to be provided by NHS Boards/Trusts as part of the new contract arrangements. Each local programme is expected to draw on experience and lessons learned both locally and nationally, to produce programmes which best address local needs and demonstrate clinical buy-in. 16. Non recurring funding, outwith GMS, has been identified to support this programme. The CSA co-ordinating team will liase directly with each NHS Board/Trust to agree local programmes. General allocations to NHS Boards will subsequently be adjusted in respect of the level of funding approved. GP IM&T advisors 17. To maximise the benefits to General Practice and patients from the new provisioning arrangements for GP IM&T, clinical buy-in at both a corporate and individual practice level will be crucial. NHS Boards/Trusts should therefore ensure that they have robust arrangements in place to deliver this, and consider the experiences of those NHS Boards/Trusts who already have a dedicated GP IM&T adviser. Baseline audit of Scottish GP IM&T 18. The CSA co-ordinating team will, in conjunction with NHS Boards/Trusts, be instigating a comprehensive baseline audit of GP IM&T infrastructure in use across Scotland. Non recurring central funding, outwith GMS, is being provided for this. As well as establishing nationally consistent details on hardware, software, wiring and physical environment, this audit is intended to identify all potential liabilities in terms of operating

4 licenses and support, and to provide a robust basis for ongoing planning at both local and national level. Status on coding initiatives 19. Scottish Clinical Information Management in Primary Care (SCIMP) advise that updated versions of the contract codes along with explanatory notes are now available on the SCIMP website at SCIMP is also working with the Co-ordinating Team announced above on preparing advice on how to do searches, registers etc and on compiling the facilitators handbook for the mentoring programme. It is planned to have all this in a section on the SCIMP web site/ Good practice guide website entitled 'How To Prepare For The New Contract', to be issued in sections, with completion and publication currently aimed at end August. Completion of PARTNERS roll out in branch surgeries 21. The PARTNERS roll out programme has identified a small residual need for improved communications links for branch surgeries to enable completion of this initiative. Policy is that this will best be addressed by provision of 10Mb links to the branch surgeries concerned. Exceptional additional funding is therefore now being provided to cover the capital costs arising in these particular cases of new branch surgery connections. In the interests of equity, further funding equivalent to 25% of the capital costs for upgrades to this standard is being made available for other existing practices, where both the technology is available and Health Boards/Trusts can fund the balance of the cost, and where a need exists for the upgrade. The total level of funding available is detailed in Annex C. Health Boards/Trusts concerned should obtain CSA approval that a need exists for the upgrades and that these are consistent with the investment plans referred to in paragraph 31 below before the funds identified are drawn down. Once proposals have been reviewed, an appropriate adjustment will be made to each NHS Board s capital resource limit in respect of all the amounts agreed. Completion of upgrade programme to RFA Scotland v.1 standard 22. Annex D includes a final non recurring allocation outwith the new GMS allocations, based on NHS Board/Trust advice to Scottish Healthcare Supplies, in respect of the extra costs of practices, switching system supplier, as part of this upgrade initiative. NHS Boards/Trusts affected are invited to confirm that these funds can be used for the purposes stated Revised reimbursement arrangements for GP IM&T costs and provisional amendments to paragraph 58 of the Statement of Fees and Allowances to GPs in Scotland (the SFA) 23. Under the new contract, as new money is spent on providing new systems and upgrading existing systems, NHS Boards/Trusts will become responsible for providing a full supporting service including system maintenance. Further guidance on implementation arrangements will flow from the four working groups referred to above. 24. In the meantime until direct contracting arrangements are established, NHS Boards/Trusts are instructed to reimburse legitimate practice IM&T maintenance costs in full. The

5 terms of the existing GP computing scheme, detailed at paragraph 58 of the SFA, are amended as detailed in Annex E with effect from 1 st April 2003 until 31 st March % reimbursement of maintenance costs will be the first call on funds earmarked for GP IM&T. 25. Where local contracts fall due for renewal before NHS Boards/Trusts are ready to take on direct responsibility for maintenance, they are advised to ensure that practices only enter into new arrangements that are acceptable to them, for instance, in respect of the new contract term. 26. As for maintenance costs, any pre-existing reimbursement of lease or other recurring costs for GP IM & T should with effect from 1 st April 2003, be reimbursed at 100%. 27. The requirement for further reimbursements to practices under the existing scheme should fall sharply as the NHS Board/Trust takes on full responsibility for provisioning and support of new equipment. There may in the short term, however, be exceptional circumstances where reimbursement of practice costs may be more expedient than direct provisioning, for example memory upgrades to existing systems. Where this is agreed to be appropriate, reimbursement should be 100% of cost. All expenditure must, however, form part of the duly agreed local GP IM & T investment plans referred to below. Funding allocations for GP IM&T (firm); and (indicative) 28. In addition to the GMS-CL allocations for this Circular also gives details at Annex B of an additional ring fenced allocation for GP IM & T of 3m for and 8m for each of the following 2 years. These funds have been allocated on the basis of the new SAF formula. A further 1m for each of and , will be allocated following updates of the SAF later in This additional ring fenced allocation may be used only to support investment in GP IM&T, either for direct provisioning costs borne by NHS Boards/Trusts or, in the short term, for reimbursement of maintenance and recurring costs, and exceptionally other upgrade costs. 30. The amounts listed are firm for and are indicative for years and The Co-ordinating Team has been charged with ensuring that NHS Board/Trust investment plans contribute to a consistent national approach to investment in an enhanced and more effective infrastructure. NHS Boards/Trusts are therefore directed to provide the Team, as soon as possible and at the latest by 29th August, with their local GP IM&T investment plans for This should identify deployment plans for the totality of funds available for GP IM&T including the existing GMS-CL funds and new funds announced in this Circular. Once the plans have been reviewed, an appropriate adjustment will be made to each NHS Board's revenue resource limit in respect of all the amounts in Annex B. 32. In addition to the indicative allocations for and by NHS Board/Trust, a retention of 2m will be made for each year. This is intended to allow CSA, by agreement with the Service, to centrally provide equipment or services where

6 national arrangements would be more effective than local ones. Any unspent amount will be redirected into NHS Board/Trust allocations. Further information will be provided in due course. Further information 33. Any questions on the contents of this Circular should be addressed to: Policy Determination Stephen Tither, Implementation arrangements Stewart MacDonald, Branch surgeries communications infrastructure/partners programme completion Ron Macdonald, 34. A determination is hereby given for the purposes of regulation 35(1) of the National Health Service (General Medical Services)(Scotland) Regulations 1995 (as amended) that the Statement of Fees and Allowances for General Practitioners in Scotland shall be amended in the terms set out in Annex E with effect from 1 st April 2003 to 31 st March Action 35. NHS Boards/Trusts are requested to: bring the contents of this Circular to the attention of all GP practices in their area, and the Area Medical Committee for the attention of the GP sub committee; provide the CSA GP contract IM&T Co-ordinating Team, (fao Mr S MacDonaldcontact details above) with the information requested at paragraph 31; and, provide the CSA (fao Mr R Macdonald) with the information requested at paragraph 21. C KNOX Computing & IT Strategy Division H WILSON Primary Care Division

7 ANNEX A EXTRACT FROM Supporting Information for Scotland to Investing in General Practice issued 16 May 2003 by SEHD Modernising information management and technology (IM&T) (Chapter 4) 4. Scotland has taken a different approach to the provision of IM&T compared to the other UK countries due to the presence of the publicly-funded GPASS system, currently used by over 80% of Scottish practices. SEHD has undertaken that GPASS will be developed to meet the demands of the new contract, as well as the Ritchie review, whilst also ensuring that Scottish practices have a choice of RFA-accredited GP clinical systems. The option for GP practices to use UK-standard software under the contract will be supported, subject to that software being modified to work with NHSScotland's IM&T systems. 5. The IM&T provisions outlined at Chapter 4 of the contract formalise a four-country approach to IM&T but allow for implementation to be customised across the four countries to deliver compatibility with national and local IM & T strategies, which themselves extend well beyond GP IM&T. 6. Further work will continue with GPC/SGPC and NHSScotland working groups to ensure that detailed implementation arrangements are workable and build on existing Scottish arrangements, enshrining the spirit of the provisions outlined at Chapter 4 and delivering value for money. It is intended therefore to make optimum use of the Common Services Agency to co-ordinate and help deliver the new GMS IM&T challenges which NHS Boards will face in Scotland. 7. It will also be important to progress more effective co-operative arrangements across all the UK countries to help ensure that the demanding IM&T programme arising from the new contract is delivered in Scotland as expeditiously and beneficially as possible. The Scottish IM&T strategy will in due course be refreshed to include the arrangements set out in the new GMS contract 8. The Read Code guidance published on the BMA website has unfortunately been found to require further work. Specific guidance for Scottish practices is near completion and, when finalised, will be available to all Scottish practices on the Scottish Clinical Information Management in Primary Care (SCIMP) website.

8 ANNEX B NHS Board GMS-CL Allocation Additional GMS-CL Allocation 1 Total GMS-CL Allocation GP IM&T Ringfenced Funds (as ) Argyll & 7,389, ,904 7,542, , , ,623 Clyde Ayrshire & 6,964, ,940 7,102, , , ,946 Arran Borders 1,784,000 41,668 1,825,668 65, , ,526 Dumfries & 3,071,000 60,295 3,131,295 94, , ,544 Galloway Fife 6,455, ,922 6,572, , , ,916 Forth Valley 5,264, ,192 5,366, , , ,030 Grampian 10,479, ,293 10,667, , , ,661 Greater 18,969, ,507 19,321, ,675 1,476,468 1,476,468 Glasgow Highland 4,864, ,679 4,968, , , ,444 Lanarkshire 8,414, ,099 8,616, , , ,488 Lothian 15,769, ,905 16,037, ,363 1,126,302 1,126,302 Orkney 368,000 8, ,040 12,628 33,673 33,673 Shetland 464,000 9, ,031 14,184 37,824 37,824 Tayside 9,376, ,341 9,522, , , ,946 Western Isles 1,160,000 15,187 1,175,187 23,853 63,609 63,609 Total 100,790,000 1,910, ,700,000 3,000,000 8,000,000 8,000,000 Retention 1,000, ,000,000 2 Retention for national programmes 2,000,000 2,000,000 to be managed by CSA Note 1 - Distributed in accordance with the provisional Scottish Allocation Formula. 2 - the retained element will be distributed at a later date so that the full amount will then have been distributed in accordance with the updated SAF.

9 ANNEX C PROVISION OF 10Mb LINKS TO BRANCH SURGERIES The following non-recurring amounts are available for call down by the Health Board/Primary Care Trust concerned subject to approval by CSA that a need exists in accordance with paragraph of this Circular. Grampian 54,000 Greater Glasgow 144,000 Lothian 72,000

10 ANNEX D COMPLETION OF UPGRADE PROGRAMME TO RFA SCOTLAND V.1 STANDARD The following non recurring allocations based on NHS Board/Trust advice to Scottish Healthcare Supplies, are available to support the extra costs of practices, switching system supplier under this programme. NHS Boards affected are invited to confirm that these funds can be used for the purposes stated. Argyll & Clyde 3,600 Ayr & Arran 900 Dumfries and Galloway 20,000 Fife 900 Forth Valley 1,800 Grampian 75,000 Greater Glasgow 2,700 Highland 82,000 Lanarkshire 2,700 Lothian 49,000 Orkney 900 Tayside 2,700 Western Isles 3,600

11 ANNEX E AMENDMENT TO STATEMENT OF FEES AND ALLOWANCES- DIRECT PAYMENT FOR COMPUTING COSTS PARAGRAPH 58- MAINTENANCE COSTS The heading is to be replaced with: TRANSITIONAL SCHEME FOR DIRECT PAYMENT FOR COMPUTING COSTS Sub-paragraph 58.1 Sentence to be inserted at the start of the introductory paragraph to be replaced with the following: These are transitional arrangements and are only to be used where an NHS Board/Trust decides it is not yet in a position to directly provision the equipment or service concerned. It is anticipated that use of these arrangements other than for reimbursement of service costs will be exceptional and declining. The existing second sentence to read: The revised scheme will run from 1 April 2003 until 31 March Sub-paragraph 58.2 to be replaced with the following 58.2 These are transitional arrangements pending direct provisioning of equipment or services by NHS Boards/Trusts. This transition therefore represents abnormal circumstances and subsequent references that reimbursement should normally be at a rate of up to 50% of the cost incurred are now superseded and in the exceptional circumstances where reimbursement is offered this should be at the rate of 100% of cost incurred. Sub-paragraph 58.3 to be replaced with the following 58.3 This scheme is subject to a cash limit. All payments in respect of paragraph will be the first call on available funds, and will be met in full. When remaining funds are fully committed it may be necessary to suspend further payments. Sub-paragraph to be replaced with the following: Subject to agreement by the NHS Board/Trust, payment will comprise of a direct reimbursement of 100% of the actual maintenance costs paid in respect of practice computer systems.