Tuesday, July 06, 2010

Central servers

Is it just me? I fell distinctly uncomfortable with the prospect of universal, centrally held servers.

Oh, I can see the advantages, sharing info between practices, easy transfer of records etc.

However, as the data controller, how can I guarantee control when I don't physically have access to the server? I am less than reassured by the presence of robust audit trails etc, as that sort of thing is very useful after a breach has occured but useless to prevent such a breach occuring in the first place.


That is the article that has got me thinking (again) about this. I understand that EMIS Web will be the only EMIS product with accreditation for EPR2. That is a shame, as many practices will not wish to change just for that, and EPR2 is one part of the CfH schema that may actually be of use and benefit to practices. It appears that INPS will be keen to see a move to their new system, though of course Vision 3 will remain compliant.

There is a part of me that hopes that IT spend will be part of the devolved budget that comes through with the commissioning changes. GPs could once again then start driving the process of development rather than reacting to it.

Another example of where control needs to be wrested from the PCOs.

Tuesday, January 26, 2010

Practice Boundaries: a proposal

Text of a press release follows:

BMA sets out its proposal for how to reform general practice boundaries

The BMA today (Tuesday 26 January 2010) sets out its solution for how to reform GP practice boundaries* and make it easier for patients to see a GP in a place and at a time that is more convenient.

The government wants to abolish practice boundaries by October 2010 and the Conservatives have said they want patients to be able to register with the practice that best suits them (near their home or work). A government consultation on practice boundaries is to start shortly.

The BMA paper, Reforming General Practice Boundaries, explores the possible consequences of completely abolishing practice boundaries and suggests a solution which, while not a total abolition, would significantly improve choice and access for patients without the huge cost, upheaval and unintended consequences that completely free registration would cause.

Dr Laurence Buckman, Chairman of the BMA’s GPs Committee, said:

“Complete free choice of registration is a good idea in principle and we want patients to be able to choose the GP surgery that is right for them. However, we don’t want it to come at the expense of continuity of care or for it to lead to increased risks for vulnerable patients and a widening of health inequalities.”

The BMA believes that total abolition of practice boundaries could have a number of unintended consequences. Examples of issues that would need to be addressed in advance of completely free registration include:

* How to reform the home visiting system so continuity of care for patients, who are registered with practices far from their home, isn’t affected
* Current IT projects, such as the electronic patient record transfer project, would need to be accelerated so GPs could have access to full patient records in order to make safe clinical decisions
* How to avoid widening health inequalities – this could happen if frail people or those without access to private or affordable public transport are not able to access practices further from their home, while others can
* Systems would need to be put in place to protect and track ‘at risk’ patients who could be vulnerable if they are regularly re-registered at practices not within their social services boundary
* Funding arrangements for GP practices would need to be reformed to ensure that, with increased movement and changing patient demographics, funding for all practices is fair and equitable
* Popular practices that had reached the limit of physical capacity would need to be helped to improve their premises in order to match patient demand
* Primary Care Trust (PCT) funding would need to be completely changed in a way that would take into account the impact on hospitals and social services. This would be extremely complex if the patient lived in one trust but registered in another.

The General Practitioners Committee’s solution is to combine a series of local improvements with a national change in the current “temporary resident” arrangements. Local solutions should include permitting the widening of the boundaries of all practices in an urban area so patients have greater choice, the introduction of videophone and webcam consultations, as well as formally allowing patients who move outside a practice boundary the option of staying with their GP. The change in the temporary resident arrangements would mean unregistered patients could be treated by a distant practice on an ‘ad hoc’ basis whenever necessary, while their normal GP practice would still oversee their care. It would have the added benefit of encouraging patients, who might otherwise inappropriately attend A&E, to go to the nearest GP surgery instead.

Dr Buckman added:

“Getting rid of practice boundaries altogether is fraught with difficulties. Having worked through various alternatives, we believe this solution is the best option for the health service at this point in time. Not only will it be the most cost effective solution, it will also serve patients far better. They will get more choice and are less likely to be adversely affected by the new set of problems that total abolition would create.”

Monday, January 04, 2010

An explanation

Hello, been a while.

Someone noted that I haven't blogged for a while. I thought I should explain.

I have been busy. I am now very much part of the establishment, being Chair of East Sussex Local Medical Committe. Additionally, in June of last year, I was elected to the General Practitioners Committee of the BMA for a year. I am not sure whether I will get re-elected this year, time will tell.

As a result, given I do not (and have never) blogged anonymously, I partly have no wish to cause our negotiators difficulty by commenting publically on matters political, but mostly I have less time to post and comment.

Consequently, my blog has fallen by the wayside almost entirely. I spend sufficient time discussing medico-politics during the day, one way or the other!

On which note, I'm hoping to start using my camera more as a means of relaxation, so you might get some photos on here, interspersed perhaps with the odd bit of politics.

(By the way JD, it was nice to be missed. Thank you. That also to the few dozen people (or at least aggregators) who have persisted in checking my blog every week.)


This is a test post from flickr, a fancy photo sharing thing.