Primary care trusts and information
“No rest is given to the atoms in their course through the
depths of space. Driven along in an incessant but variable movement,
some of them bounce far apart after a collision while others recoil
only a short distance from the impact.” What Lucretius considered
to be true about the nature of the physical universe could be
equally well observed of the current state of the Health Service,
with yet another organisational initiative following hard on the
heels of the last definitive pronouncement. Scarcely have primary
care trusts (PCTs) come into being, grappling with their role as the
fundamental building block upon which the entire commissioning and
managerial process of the Service is to rest, when the Secretary of
State appears to be hinting at the creation of foundation PCTs, and
even foundation general practices.1
The pressures on PCTs at present are very great. They face the
growing pains encountered by all newly formed organisations; they
are attempting to pilot their services for the years immediately
ahead through a maze of national targets (which must be given
precedence) whilst offering patients choice, and meeting local
priorities; they are enjoined to develop closer links with local
authorities, where the priorities, pressures and ethos often differ
quite markedly; and in information systems they have a substantial
role to play in implementing the infrastructure and the applications
critical to the success of the National Strategic Programme.
Against the background of this complex and challenging agenda,
this issue of the Journal looks at progress in computing in
primary care trusts. Although organisational and procedural turmoil
often has a debilitating effect on the creation and expansion of
information systems, most PCTs have the advantage that computing in
general practice is widespread; there is a reasonable degree of
connectivity with NHSnet; most staff are comfortable with the use of
computers in their everyday work; and a high proportion of patients
are accustomed to their doctors’ use of a computer during a
consultation. Many PCTs, therefore, do not need to overcome one of
the major cultural barriers to the introduction of information
systems, that of novelty and the fear of technology. On the other
hand, as Alwen Williams, Chief Executive of the Bexley PCT and her
colleagues point out in their article, the combined effect of
central initiatives and uncertainty about the rate at which those
initiatives can be funded and achieved leaves PCTs with a dilemma:
to what degree is it prudent to await the fruition of programmes,
such as the Integrated Care Record Service, or do local
opportunities, resources and needs dictate the emergence of ‘interim’
solutions? The Bexley article examines this dilemma, and describes
the inclusive approach that has been taken to resolve it.
Although there is widespread familiarity with information systems
in general practice, there is not necessarily uniformity. In his
article, Trevor Wright, Director of Informatics for North and North
East Lincolnshire PCTs, describes the implementation of a
central shared-care record system for 43 practices (out of a
possible total of 57), the benefits that have already been obtained,
and some of the implications for the national programme.
Our other two articles also describe some problems surrounding
the implementation of information systems, but concentrate on
matters of data collection and quality — topics that are of
importance across the whole of the Service, and vital to the success
of the National Strategic Programme. In her article, Helen Munday, a
researcher from south-east London, reports the results of a recent
survey of data-quality developments in 32 primary care organisations.
Encouragingly, they demonstrate a real concern for data quality, but
show a duplication of effort in gaining better accuracy and
completeness. In their article, Dr Michael Soljak and his colleagues
describe the creation of a chronic-disease register, shared between
three PCTs in north-west London. Their considered view is that the
information from the register, which covers some 200 000
patients, has made a significant contribution to improved management
of coronary heart disease and diabetes, which would have been
impossible without it.
If the new, and indeed continually emerging, structure of the NHS
is to work, PCTs have a crucial role as the fundamental building
block upon which the entire operation of the Service depends. That
vital role, in turn, depends upon the speedy growth of the
information systems mooted in Information for health and the
National Strategic Programme. The articles in this issue show
encouraging signs that that growth is entirely possible,
particularly if the structure is allowed to settle down.
Michael Fairey
Reference
1. Earned autonomy and foundation status. HSJ 2003;
113(5846): 14–15.
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