table of contents - nhs england · in support of the ambitions outlined within the general practice...

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Table of Contents

Table of Contents ....................................................................................................... 2

1. Foreword ............................................................................................................. 7

2. Key messages ..................................................................................................... 9

3. Introduction........................................................................................................ 11

3.1 What does this document do?..................................................................... 113.2 Where do we want to get to? What does the future hold?........................... 123.3 General Practice Systems of Choice (GPSoC) Framework ........................ 14

3.3.1 Supporting business continuity ............................................................. 143.3.2 Eligibility for centrally funded GPSoC solutions .................................... 143.3.3 Local access to GPSoC Framework ..................................................... 143.3.4 Access to subsidiary systems under Lot 1 of GPSoC........................... 14

3.4 N3/Health and Social Care Network (HSCN) – transition arrangements..... 143.5 The CCG Practice Agreement..................................................................... 15

4. Clinically-led change.......................................................................................... 16

5. Excellence in GP IT services and the services needed to secure excellence in

GP IT – GP IT Operating Model: .............................................................................. 18

5.1 Core and mandated’ GP IT services (available to all general practices) ..... 226.1.1 Getting the basics right ............................................................................. 226.1.2 Making the most of what we have already ................................................ 22

5.2 Enhanced primary care IT services............................................................. 235.3 Transformational primary care IT services .................................................. 245.4 General practice business support systems................................................ 255.5 Primary Care IT Enabling Services (PCES) ................................................ 26

6. Accountability and commissioning responsibilities: system overview ................ 27

7. Commissioning of IT Services: Operational Management Responsibilities ....... 30

7.1 Financial arrangements............................................................................... 307.2 Detailed financial management responsibilities........................................... 337.3 Revenue provision ...................................................................................... 33

7.3.1 GP IT revenue funding.......................................................................... 33

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7.3.2 Transition funding ................................................................................. 337.3.3 Funding for Primary Care IT Enabling Services (PCES)....................... 34

7.4 Capital provision.......................................................................................... 347.4.1 Capital depreciation.............................................................................. 357.4.2 Value for money ................................................................................... 357.4.3 Inventory and asset management ........................................................ 367.4.4 Insurance.............................................................................................. 36

7.5 Implications of GPSoC Framework ............................................................. 367.6 Alternative Funding Sources ....................................................................... 37

7.6.1 Sustainability and Transformation Fund ............................................... 377.6.2 Primary Care Transformation Funds (PCTF)........................................ 377.6.3 Better Care Fund .................................................................................. 37

7.7 What are the Contractual Arrangements?................................................... 397.7.1 Between NHS England and CCGs ....................................................... 417.7.2 Between NHS England and national applications and infrastructureproviders............................................................................................................ 417.7.3 Between CCGs and their GP practices (The CCG Practice Agreement)

427.7.4 Between CCGs and their GP IT delivery partners ................................ 427.7.5 By CCGs on behalf of their constituent GP practices ........................... 42

7.8 Information Governance.............................................................................. 477.9 Data Security............................................................................................... 517.10 Clinical Safety ............................................................................................. 517.11 Primary Care IT Enabling Services ............................................................. 527.12 Other responsibilities................................................................................... 58

8. Improvement, assessment and assurance: CCG Improvement and Assessment

Framework ............................................................................................................... 62

8.1 Support and ways of working ...................................................................... 638.2 Sustainability and Transformation Planning ................................................ 648.3 Digital Primary Care Maturity Assurance Model.......................................... 648.4 Ongoing Development ................................................................................ 668.5 Benefits for stakeholders:................................................................................ 68

9. Where do I receive support?.............................................................................. 69

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10. References ........................................................................................................ 70

11. Glossary ............................................................................................................ 72

12. Appendix A – Developing the Informed Customer Function .............................. 82

13. Appendix B – Schedule of Services Category Definition ................................... 83

14. Appendix C – Schedule of Services GP IT ........................................................ 88

15. Appendix D – Digital Primary Care Maturity Assurance Indicators .................. 125

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NHS England INFORMATION READER BOX

DirectorateMedical Commissioning Operations Patients and InformationNursing Trans. & Corp. Ops. Commissioning StrategyFinance

Publications Gateway Reference: 05266

Document Purpose

Document Name

Author

Publication DateTarget Audience

Additional CirculationList

Description

Cross Reference

Action Required

Timing / Deadlines(if applicable)

Guidance

LeedsLS2 7UE

NHS EnglandTracey GraingerHead of Primary Care ITQuarry House

This document sets out the operating arrangements for the delivery ofGP IT services across England. It outlines clear accountability,responsibility and financing support for general practice in England toreceive high quality IT support services.NHS England will retain full accountability for GP IT and delegate theoperational and financial management responsibilities to CCGs with theassociated funding.

By 00 January 1900

NHS England

11 May 2016Clinical commissioning groups (CCGs), Primary Care IT serviceproviders, NHS England (Finance, Commissioning Development, andregional and area team directors) and general practice.

CCG Clinical Leaders, CCG Accountable Officers, CSU ManagingDirectors, NHS Digital (HSCIC), NHS England Regional Directors,Directors of Finance, Communications Leads

Securing Excellence in GP IT Services: Operating Model, 2nd edition(2014-16)

Securing Excellence in GP IT Services: Operating Model, 2nd edition(2014-16) “Securing Excellence in GP IT Services: Operating Model”,December 2012“Modernising Information Management and Technology in GeneralPractice support services”, version 1.0 Department of Health“Investing in General Practice, The New General Medical ServicesContract” (the Blue Book)

NHS England and CCGs to operationalise this guidance

Securing Excellence in GP IT Services 16/18

Superseded Docs(if applicable)

Contact Details forfurther information

Document [email protected]

This is a controlled document. Whilst this document may be printed, the electronic version posted onthe intranet is the controlled copy. Any printed copies of this document are not controlled. As acontrolled document, this document should not be saved onto local or network drives but shouldalways be accessed from the intranet.

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Equality and Diversity Statement

Promoting equality and addressing health inequalities are at the heart of NHSEngland’s values. Throughout the development of the policies and processes cited inthis document, we have:

Given due regard to the need to eliminate discrimination, harassment andvictimisation and other conduct prohibited by the Equality Act 2010, toadvance equality of opportunity, and to foster good relations between peoplewho share a relevant protected characteristic (as cited under the Equality Act2010) and those who do not share it; and;

Given regard to the need to reduce inequalities between patients in access to,and outcomes from healthcare services and to ensure services are providedin an integrated way where this might reduce health inequalities

This document supports a number of national programmes aimed at improvingpatient care through the introduction of digital technology. For all the national digitalprogrammes equalities and heath inequalities have been considered. For moreinformation, please refer to the documentation provided by each individualprogramme.

Please note attached new guidelines on accessible information standards

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1. ForewordHigh quality care for all, now and in the futureGeneral practice is a fundamental part of the NHS, playing a pivotal role incoordinating patient care and seeing millions of patient interactions every week. Thechallenge of achieving high quality care in the face of growing demand, changingpatient needs and rising expectations can only be met if we harness the power ofinnovative digital technology, as highlighted in the General Practice Forward View1.To operate within known financial constraints, we must ensure that every poundspent on IT improves patient care, reduces bureaucracy for practitioners and drivesefficiencies across the health and care system.The 2016 operating model sets out how we will achieve world class digital primarycare systems that provide flexible, responsive and integrated services for patients,giving them greater control over their health and care. This model describes thefinancial operating arrangements, assurance process and leadership required tosupport the effective delivery of GP IT services.NHS England is accountable for the delivery of GP IT services, delegatingresponsibility for delivering key elements of GP IT services to clinical commissioninggroups (CCGs). These arrangements promote equity and ensure a consistent coreoffer in all parts of the country. They give general practices the flexibility to meetlocal needs within a nationally agreed framework, adhering to national informationgovernance and security standards, and are underpinned by a centrally managedassurance process.In support of the ambitions outlined within the General Practice Forward View(GPFV) and recognising GP IT as fundamental in underpinning delivery of these, therevised operating model includes expanded core and mandated GP ITrequirements – making it clear what general practice should be able to expect fromIT service delivery arrangements, together with driving digital adoption throughmaturity assurance, providing a new maturity assurance framework to assessprogress towards digital adoption – the Digital Primary Care Maturity Assurancemodel.

In response to the developing primary care landscape as outlined in the Five YearForward View (FYFV), enhanced and transformational service categories havebeen introduced that would support seven day and extended hours working and ‘atscale’ models, together with supporting new and innovative healthcare models,where multiple organisations across care settings are working with general practiceto share patient care.

This operating model aims to support the case for change set out by the Five YearForward View, and moves us closer towards the National Information Board’s vision

1 General Practice Forward View

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of an integrated, paper-free health and care economy. The arrangements willcontinue to give general practices a choice of world class clinical IT systems, tailoredto local requirements that meet the changing needs of the service

Beverley BryantDirector of Digital Technology

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2. Key messagesThis document sets out the revised operating model for the provision of a highquality general practice IT (GP IT) support services, building upon ‘SecuringExcellence in GP IT Services’, first published in December 2012 and the subsequent2nd edition2, published in April 2014.It also articulates clear accountability and commissioning responsibilities for NHSEngland to support IT services in relation to registration authority (RA)(administration of access to clinical and business systems); information governance(IG) support services; clinical safety assurance relating to the deployment, use andproduction of healthcare software; and NHSmail administration for all contractorsproviding primary care essential services to a registered list.This revised operating model contains a number of updates:

An updated description of roles and responsibilities;

A re-designed maturity assurance model for measuring GP IT provision,supported by effective governance and accountability, by demonstratingimprovements in digital maturity;

A re-categorised service schedule, including comprehensive servicedescriptions;

A re-structured finance model, with increased funding provision delegated tolocal commissioner level, to support effective commissioning and delivery ofdigital services for general practice, to meet local needs;

A continued focus on local leadership and collaborative working, closelyaligned with Local Digital Roadmaps (LDRs) and associated digital strategiesacross the local health and care economy.

2 Securing Excellence in GP IT Services: Operating Model 2nd Edition 2014-16

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The main aims of these updates are:

To provide increased ‘local’ flexibility and ownership, to enable commissionersto effectively respond to a rapidly changing Primary Care landscape,

To protect and improve ‘core’ GP IT service provision, whilst providingmechanisms to enable local investment in enhanced and transformationalservices, and

To provide a readily accessible tool to understand levels of digital primarycare maturity and demonstrate value for money in GP IT investment.

It is expected that a significant proportion of CCGs will re-procure their GP ITservices through the Lead Provider Framework. CCGs should ensure prospectiveproviders of these services are familiar with the current GP IT Operating Model andthe underpinning drivers affecting its development.

NHS England will retain responsibility for commissioning Primary Care IT EnablingServices for primary care contractors providing primary care essential services to aregistered list.

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3. IntroductionIn the context of this document general practice or GP services are defined as thoseoperating under a General Medical Services (GMS), Personal Medical Services(PMS) or Alternative Provider Medical Services (APMS) contract offering primarycare essential services to a registered patient list.

3.1 What does this document do?

This document provides a description of the specific arrangements that NHSEngland will put in place for GP IT services to:

Inform general practice of what to expect in terms of the provision of GP ITservices;

Provide a framework which ensures digital technology fully supports andenables new models of care, service integration, extended working and newforms of primary care organisations;

Underpin the IT provision required to build on local accountabilities for digitalprimary care and for Local Digital Roadmaps (LDRs) and strategies ensuringthese become embedded within local commissioning responsibilities andplans;

Define the role of NHS England and its arm’s length bodies in supporting thisoperating framework;

Provide assurance that quality and value are being maintained and deliveredconsistently across primary care services within the NHS.

This document sets out the following key elements that will be necessary to supportthe effective delivery of GP IT:

The operating arrangements including financial procedures and associatedcontrols;

Governance arrangements, including roles and responsibilities;

The leadership required to achieve excellence;

The responsibilities that NHS England will carry out directly in relation toPrimary Care Enabling Services which includes: registration authority (RA)(administration of access to clinical and business systems); informationgovernance (IG) support; clinical safety assurance and secure e-mail(NHSmail) administration for primary care contractors providing primary careessential services to a registered list .

NHS England is responsible for funding the digital services, systems and technologythat are essential to general practice, including the infrastructure within whichpractice-held patient records are created and accessed.This infrastructure must be capable of supporting national commissioning intentionsfor general practice services and CCG aspirations to deliver more integrated care.

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The operating model for GP IT services is designed to support innovation andservice transformation, with a particular focus on joining up care across care settingsto improve quality and efficiency.

3.2 Where do we want to get to? What does the future hold?

By April 2016 there should be in place:

Strong local leadership to drive the implementation of Local DigitalRoadmaps supported by local digital strategy moving towardsservices which are paper free at the point of care;

An effective financial model for the delivery of GP IT and associatedsupport services, reducing bureaucracy and providing local flexibilityand responsiveness;

A universal core digital capability evidenced via a Digital PrimaryCare Maturity Assurance model across the general practice estate;

The effective procurement, delivery and exploitation of GP ITcapability, across the whole of England;

Collaborative partnership working that has the freedom to innovateand redesign services effectively;

Value for money and efficiency, delivered through the combination ofall of the above.

NHS England wants digital systems to perform to the highest possible standards toallow the NHS to meet the needs and expectations of patients and carers.

The CCG Assurance Framework 2015/163 recognised CCGs as uniquely placed toachieve safe, digital record keeping and the digital transfer of patient informationacross care settings within their health economies. The CCG Improvement andAssessment Framework for 2016/174, outlined in The Government’s mandate toNHSE for 2016/175, will build on this ambition, by assessing progress towards thePaper Free at the Point of Care, 2020 Vision6 and health and care integration, aspart of sustainability requirements.

A digital primary care maturity assurance model will help to facilitate improvedcommissioning of digital services for general practice. It will underpin the

3 CCG Assurance Framework

4 CCG Improvement and Assessment Framework for 2016/17

5 The Government’s Mandate to NHS England for 2016/17

6 Personalised Health and Care 2020

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transformation taking place in service design by embedding world class IT across theNHS.

An important element of this revised approach is that CCGs, working with theirmember GPs, have greater responsibility and capability to select and prioritisesystems and solutions needed locally.

By March 2018, there should be in place:

A national single Digital Primary Care Operating Model supporting and alignedto primary care commissioning, in order to provide a framework which ensuresdigital technology fully supports and enables new models of care, including newforms of primary care organisations and service integration.

Key objectives of the operating model will be:

To ensure digital primary care services can respond to service andorganisational change and can enable innovation in new models of care;

To define clear responsibilities for the national commissioner and localcommissioners. To build on CCG accountabilities for digital primary careand local digital strategy and roadmaps ensuring these become embeddedwithin local commissioning functions;

To retain the high quality, safety and security of GP digital clinical recordsystems extending these standards across all digital primary care servicesand to patient facing digital services where these are part of a virtualprimary care service.

Commissioner driven digital strategy is expected to support the local delivery ofLocal Digital Roadmaps (LDRs) and Sustainability and Transformation Plans(STPs).

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3.3 General Practice Systems of Choice (GPSoC) Framework

GP IT is intrinsically linked with the general practice Systems of Choice (GPSoC)Framework. Full details on the GPSoC Framework7 are available online. Thefollowing changes are relevant to this updated operating model:

3.3.1 Supporting business continuity

An addendum business case has been approved for the funding of GPSoC for twoyears beyond the contract breakpoint of December 2016.This will ensure continuity of services and enable ongoing development work Forexample interoperability to continue, whilst the future operating framework isdeveloped.

3.3.2 Eligibility for centrally funded GPSoC solutions

general practice Contractors (GMS, PMS and APMS contract holders) continue to beeligible for centrally funded GPSoC principal clinical systems providing (i) they arecontracted to provide Primary Care Essential Services to a registered patient list (ii)they have signed the CCG Practice Agreement.

3.3.3 Local access to GPSoC Framework

Work is underway to allow primary care organisations not eligible for centrally fundedGPSoC (Lot 1) systems to directly procure (call down) GPSoC solutions fromsuppliers through the GPSoC framework contract.

3.3.4 Access to subsidiary systems under Lot 1 of GPSoC

Accredited subsidiary clinical systems are available through Lot 1 of GPSoC. Centralfunds to support these are limited and will be assigned against each CCG. Wherethere are insufficient central funds available to meet local demands, CCGs will beable to place orders through GPSoC to locally purchase these systems.

Further details on GPSoC subsidiary systems and the supporting processes isavailable on the NHS Digital (HSCIC) website8.

3.4 N3/Health and Social Care Network (HSCN) – transitionarrangements

The HSCN programme has been put in place to manage the exit from the existingN3 network arrangements and the move to provision successor network servicescapable of supporting the health and social care system. The outline business case

7 GPSoC Framework8 GPSoC How to Order Services

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for the HSCN programme was approved by the Secretary of State for Health inDecember 2015.

The HSCN programme9 will provide a reliable, efficient and flexible way for healthand care organisations to access and exchange electronic information. By reducingcost and complexity, standardising networks, enabling service sharing and extendingthe parameters of collaborative working, it will save money, enable information to bereliably shared and help staff work together more effectively and efficiently.

Provided by multiple suppliers, the HSCN will act like a single network enablinghealth and social care service providers to deliver, share and consume services fromanywhere on the HSCN and with anyone else on the HSCN regardless of theirlocation or network supplier.

It is vitally important for existing N3 customers to engage with the HSCN programmevia [email protected] to ensure they are able to migrate to HSCN connectivitysuccessfully.

3.5 The CCG Practice Agreement

The CCG Practice Agreement, which replaces the previous PCT PracticeAgreement, outlines the terms governing the provision and receipt of GPSoC andGP IT services.This nationally developed agreement sets out the basis on which a CCG will providethe services to practices, and each practice’s responsibilities in respect of the receiptof these services, as outlined within this document.CCGs are required to sign a CCG Practice Agreement with each GP practice (GMS,PMS or APMS contractors offering Primary Care Essential Services to a registeredpatient list) within their area. Work is required locally to customise the appendices tothe national template agreement, as outlined below. These need to be agreed locallywith GP practices:

Appendix 1 - Summary of services

Appendix 2 - Support and maintenance service levels

Appendix 3 - Escalation procedureA signed agreement between the CCG and each practice is a pre-requisite for theprovision of GPSoC services to GPs. Sign off arrangements for both GPSoC andcurrent Local Service Provider (LSP) systems should have been completed by 31March 2016. An escalation must be raised with NHS England regional teams for anyCCG practice agreements not signed.

9 HSCN Programme

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4. Clinically-led changeThe transformational change agenda for the NHS in coming years will not berealised without the right leadership and the effective use of digital enablers. InNovember 2014 the National Information Board (NIB) agreed a number of strategicpriorities for digital health and care in their Framework for Action – PersonalisedHealth and Care 2020, including ensuring that all health and care professionals willbe ‘paper free at the point of care’, using integrated digital care records by 2020.The NIB identifies it as vital that leaders of health and care organisations championinformation and digital capability as core enablers of effective decision-making,service quality, safety, effectiveness and efficiency, whilst also identifying thebarriers that have previously been created by taking insufficient account of the wayclinicians work in practice.CCGs will lead the implementation of GP IT services in partnership with theirpractices and local health and care providers. Local digital strategies and leadershipshould ensure that general practice uses digital technologies to support theintegration of care across local health communities and to deliver localcommissioning priorities. To achieve these objectives, CCGs will need to haveaccess to high quality, strategic and operational digital skills and knowledge.In support of this, CCGs are encouraged to appoint a Chief Clinical InformationOfficer (CCIO) or equivalent accountable officer who will provide leadership for thedevelopment of local digital strategy. The CCIO will ensure effective provision of GPIT services, an essential element in the delivery of LDRs and the wider SustainabilityTransformation Plans (STPs) that will accelerate implementation of the Five YearForward View (FYFV)10.The NHS Planning Guidance for 2016/17 – 2020/21, Delivering the Forward View11

means local health system STPs will increasingly be planning by ‘place’ for localpopulations. There is therefore an increasing need to locally harness the energies ofclinicians, patients, carers, citizens and local community partners includingindependent and voluntary sectors, and local government through local Health andWellbeing Boards. The CCIO role will be critical in providing clinical leadership in thedevelopment of local digital strategy that will support the integration of health andcare, ensuring that digital strategy is closely aligned with and can enable effectivedelivery of STPs.An understanding of national digital strategy is critical, including insight into how thiscan be developed locally to support the integration and transformation of care.Knowledge and understanding of information governance, consent and data security

10 Five Year Forward View11 Delivering the Forward View: NHS Planning Guidance 2016/17 – 2020/21

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are also key aspects of this role, together with leadership skills. These are essentialin bringing together local heath economies in terms of sharing detailed care records.The CCIO role may vary across organisations. It is usually suitable for a clinicianwith an interest in digital technology, with an understanding of the challenges aroundcapturing clinical information at the point of care and sharing that informationthroughout the care process.CCIOs should champion the development, deployment, use and optimisation ofdigital systems.CCGs may want to consider whether the role could be shared across a local healtheconomy where several CCGs are working together.In response, the CCIO Leaders Network12 has been established to promote anddevelop CCIOs across the NHS. Clinicians have come together from across the UKto help support the sharing of ideas, best practice and career development. TheCCIO Leaders Network is currently hosted by Digital Health.It is also important that commissioners responsible for GP IT investment understandwhy they are investing and what they are investing in through an effective “informedcustomer” capability. The role of an “informed customer” is described in more detailin Appendix A.

12 CCIO Network

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5. Excellence in GP IT services and the services neededto secure excellence in GP IT – GP IT Operating Model:

There is a responsibility to deliver local IT support services for general practicecontractors as set out in local service level agreements, plus implementation andsupport for national strategic and clinical systems. There are also local obligationsunder the GPSoC and legacy Local Service Provider (LSP) contracts which need tobe met in the deployment and support of GP clinical systems.Although there is national funding to develop and deliver GPSoC nationalinfrastructure and application solutions, there are still significant local costs indeploying and supporting these systems and the infrastructure on which theyoperate locally.The 3rd edition of the GP IT Operating Model aims to provide the framework andthe flexibility that will enable commissioners to work locally with and support thedevelopment of emerging primary care delivery models and services, and ensureappropriate ‘at scale’ digital solutions that support the delivery of the NIB frameworkand FYFV ambitions.The associated schedule of services has been reviewed in recognition of thesignificant progress that has been made in the development and provision of digitalservices for general practice. This is reflected in the expanded ‘business as usual’support provision outlined in ‘core and mandated GP IT’.Enhanced and transformational categories have been added in response to thechanging primary care landscape as outlined in the FYFV. Further detail is providedwithin the detailed service schedule outlined in the appendices.CCGs should ensure that locally commissioned services and SLAs reflect theupdated ‘core and mandated’ requirements outlined within the schedule of services.Within the updated operating model and at a high level, we consider “excellentGP IT” to look like this;

High quality core and mandated GP IT services - a universal supportservice for every general practice in England, including implementation andsupport for all national digital systems such as the Summary Care Record,Patient Online and GP2GP services to meet contractual requirements.

Locally Targeted investment in:

o Enhanced primary care IT- focused on improving efficiency andeffectiveness by optimising existing systems and infrastructure.Innovative and effective approaches that will better support changes inthe delivery of primary care services, including seven day andextended hours working and ‘at scale’ models.

o Transformational primary care IT - new or additional systems,services or infrastructure that will enable integration of health and careand delivery of new and innovative healthcare models, where multiple

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organisations across care settings are working with general practice toshare patient care.

CCGs will commission high quality core and mandated GP IT services. Inaddition, as part of Sustainability and Transformation Plans (STPs), CCGs needto consider the steps required to deliver a fully interoperable health and caresystem by 2020 that is paper free at the point of care and better able to meet theneeds of patients and citizens, clinicians and commissioners.Enhanced and transformational primary care IT services, whilst discretionary,are to be commissioned locally by CCGs to complement core and mandated GPIT services. They should align with and support the delivery of CCG strategicobjectives, service improvement initiatives, Local Digital Roadmaps and localSTPs, to help improve the delivery of services across the local care community.

NHS England will be directly responsible for ensuring that all primary care contractorshave arrangements in place for certain IT services such as Registration Authority(RA) (administration of access to clinical and business systems); InformationGovernance (IG) support; Clinical Safety Assurance, and NHSmail administration andsupport.For primary care contractors delivering primary care essential services to a registeredlist under GMS, PMS and APMS contractual arrangements, NHS England, isresponsible for directly commissioning these support services.For other primary care contractors that have access to and use of national clinicalinformation systems NHS England is responsible for assuring that appropriatesupport arrangements are in place, as part of local commissioning arrangements.

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Figure 1: GP IT Services – The Operating Model

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The following sections provide a high level summary of the updated schedule ofservices. A more detailed view is included within the appendices, which providesCCGs with the scope, category and description of what is to be commissioned anddelivered locally. There is also a reference to the associated digital primary carematurity assurance indicator(s) that will help to demonstrate progress towards digitalcapability and maturity.

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5.1 Core and mandated’ GP IT services (available to all generalpractices)

These are technologies, systems and support services required to deliver PrimaryCare Essential Services. These are the fundamental services to be commissionedby CCGs, for GP practices, to enable the effective delivery of health and care.

A detailed service schedule of core service provision at a local level is to beincluded within the appendices of the nationally agreed CCG Practice Agreement,to ensure GPs are aware of local service provision arrangements.

Core and mandated GP IT services will be the first call on GP IT revenue fundingthat will be provided as part of annual CCG baseline allocations.

There are two main principles supporting the definition of core GP IT services:6.1.1 Getting the basics right

A poor IT system creates frustration, whereas a system which is fit for purpose isgreatly valued. Every member of general practice staff must have reliable,responsive and efficient IT systems, associated support services and equipment.GP IT delivery partners will be contracted to deliver a robust and effective service,with the capability to minimise problems from the outset and rapidly deal withissues as they emerge. CCGs will base the quality of IT services on clearlydefined service level agreements which in turn have a robust set of keyperformance indicators (KPIs) that are managed through effective servicemanagement processes.6.1.2 Making the most of what we have already

NHS England needs to ensure it gets the full benefit from the systems currentlyused, to realise their full potential. Local organisations will be encouraged andsupported to fully optimise their GP clinical systems for example through deliveryof the GP2GP system and Patient Online. We must achieve full roll out and use ofnational strategic systems, such as the Summary Care Record, e-Referral system,GP2GP and the Electronic Prescription Service, to enhance patient care, enableintegrated care across all care settings and achieve operational benefits to boththe general practice and patients.

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From 2018, there will be a core requirement for CCGs to commission Wi-Fi servicesin general practice, with access for staff and patients. National funding will be madeavailable to cover the initial hardware, implementation and service costs.

5.2 Enhanced primary care IT services

Technologies, systems and support services which enable and improve efficiencyand effectiveness of general practice.

These are discretionary primary care IT services that are developed and agreedlocally to support local strategic priorities and commissioning strategies to improveservice delivery.

Investments in enhanced primary care IT should support the CCG(s) local digitalstrategy and Roadmap and where possible strategic rather than tactical solutionsshould be developed.

Funding for enhanced primary care IT may come from a variety of sources,including but not limited to GP IT monies/CCG allocations, once core andmandated GP IT services are provisioned, transformation or GP Access Funds,local business case development and/or direct CCG/GP practice funding.

It is important to note that these services may be provided to facilitateconfederated working, in support of general practice efficiency and effectiveness,working ‘at scale’ and extended hours.

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5.3 Transformational primary care IT services

Technologies, systems and support services which enable new models of care,service integration, wider GP functions, Multi-speciality Care Providers (MCPs)and Primary and Community Care Services (PACS) organisational models.

These are discretionary primary care IT services that are developed and agreedlocally to support local strategic initiatives and commissioning strategies toimprove service delivery.

Investments in transformational primary care IT should support the CCG(s) localdigital strategy and Roadmap and where possible strategic rather than tacticalsolutions should be developed.

Funding for Transformational Primary Care IT may come from a variety ofsources, including but not limited to GP IT monies/CCG allocations, once 'Coreand Mandated' GP IT services are provisioned, Transformation or GP AccessFunds, local business case development and/or direct CCG/GP practice funding.

It is important to note that these services may be provided to facilitate broaderservice integration and inter-organisational sustainability and transformationinitiatives.

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5.4 General practice business support systems

These are the systems which are associated with the running of the Practicebusiness and are not directly connected to patient care. general practice BusinessSupport Systems are funded by the Practices concerned and should generally beregarded as out of scope, where they are:

Services already funded elsewhere

Business running costs, for example consumables

Internal business support systems, not part of clinical service delivery forexample. payroll, HR, estate management.

General practice business support systems:

These are systems and services which a practice may utilise for businesspurposes, which are not directly related to patient care.

N.B. The ‘Global Sum' within the General Medical Services (GMS) contract (andPMS/APMS equivalent) makes provision for practice expenses including staffcosts and general running costs of the practice (stationery, telephone, heating andlighting, repairs and maintenance).

With evolving primary care delivery models, local service/support arrangementsmay develop that incorporate aspects of service provision that would traditionallyhave been considered GP business support functions to be directly funded by thePractice under GMS (and PMS/APMS equivalent) contractual arrangements.

Where there is demonstrable benefit of incorporating elements of GP businesssupport services for example telephony/VOIP as part of broader efficiency releaseand improved patient care initiatives, GP contributions are to be considered aspart of local funding provision/business case arrangements.

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5.5 Primary Care IT Enabling Services (PCES)

NHS England remains directly responsible, through its regional DCO teams, forcommissioning some IT services. These are fundamental IT services which everygeneral practice must receive. These services should be commissioned fromappropriately qualified IT delivery partners based on a service level agreement.

Primary Care IT Enabling Services

These are fundamental support services provided to general practice that aredirectly funded and commissioned by NHS England regional DCO teams.

Service provision includes:

Registration Authority support services

Information Governance support services

Clinical Safety Officer support

NHSmail administration support

For other primary care contractors, NHS England regional DCO teams will assurethat arrangements for these IT support services are in place for those contractorswho have access to and use of national clinical information systems, as part oflocal commissioning arrangements. This includes community pharmacies,appliance contractors, dental practices, primary ophthalmic providers and primarycare provided within prisons.

Regional teams may wish to consider devolving commissioning responsibilities forPCES services for general practice, to align with broader primary carecommissioning responsibilities under co-commissioning arrangements, whereappropriate. This should however, be reviewed against ‘at scale’ serviceefficiencies that can be realised by the regional commissioning of PCES for thebroader primary care contractor community.

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6. Accountability and commissioning responsibilities:system overviewNHS England is accountable for the provision of GP IT services. NHS England alsoretains responsibility for, and ownership of, all NHS GP IT capital assets (inclusive oflegacy IT transferred from primary care Trusts). However, NHS England hasdelegated to CCGs the responsibility for delivering most GP IT services, as outlinedin NHS Commissioning Board directions under the NHS Act 2006 as amended13.CCGs may deliver these services themselves or choose to commission theseservices locally (including the management of the associated assets) fromappropriate IT provider(s), for example Commissioning Support Units (CSUs) orother IT delivery partners, including private sector partners.NHS England supports CCGs by establishing national standards and maintainingoverall budgetary oversight. This includes developing the supplier market andcommissioning NHS Digital (HSCIC) to maintain the national IT infrastructure andprovide GP Practices with a choice of GP clinical systems via the GPSoCframework. NHS England will also ensure the appropriate handling of support forlegacy Local Service Provider (LSP) systems.CCGs are responsible for developing local digital strategy and delivery plans, toensure that digital technology is being used to optimal effect for the benefit of patientcare.NHS England leads a number of national programmes such as the Summary CareRecord, Electronic Prescription Service, GP2GP and Patient Online. All promote andsupport the greater use of digital technologies in primary care and underpin localstrategies for integrated care.NHS England, working with the national delivery partner, NHS Digital (HSCIC), willensure general practice has up to date applications to support the future use ofdigital transactions and information exchanges. This will allow CCGs to attaintrajectories for the development of digital services and achieve better value formoney for the NHS. CCGs will plan and manage the replacement of older generalpractice applications in conjunction with their local IT delivery partners.We encourage CCGs to work in partnership with primary care stakeholders to setpriorities and local direction for digital support services. This includes NHS EnglandRegional Teams, general practices, patients and carers, and professional bodiessuch as local medical committees and local pharmaceutical committees. At anational level, we work in partnership with the British Medical Association and theRoyal College of General Practitioners regarding, for instance, the provision of best

13 NHS Commissioning Board Directions to Clinical Commissioning Groups (CCGs)

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practice guidance for patient access to services and patient records through digitaltechnology.Whilst primary care services are the responsibility of NHS England, the revenuefunding for GP IT is delegated to CCGs as part of baseline allocations, and they areresponsible for determining local arrangements for the deployment of this fundingand for organising delivery of the associated services and infrastructure. NHSEngland will continue to manage associated capital funding as set out in theoperational Planning Guidance14. Any queries should be directed to regional financeteams.NHS England will provide leadership and work in partnership with CCGs as theydevelop local GP IT commissioning arrangements and ‘informed customer’capabilities.CCGs will be accountable to their local governing bodies and will be responsible forreporting the development of digital plans for GP IT to ensure that they meet localneeds.The introduction of a ‘Digital Primary Care Maturity Assurance’ model will provide arobust and coherent approach for assurance, that will demonstrate to NHS Englandas national commissioner (and its regional offices) and CCGs as localcommissioners with responsibilities for GP IT services, the effective use of NHSinvestment in GP IT services to deliver high quality GP IT services.NHS England through its regional teams will continue to monitor progress of thedelivery of GP IT through appropriate clinical commissioning assurance frameworks.NHS England has a statutory duty to conduct an annual assessment of every CCG.For 2016/17 a new CCG Improvement and Assessment Framework (IAF) is beingintroduced, which will align with priorities outlined within the NHS Mandate andPlanning Guidance and will replace both the existing CCG Assurance Frameworkand CCG Performance Dashboard. The new Framework is expected to supportimprovement through the introduction of an aggregated Ofsted style assessment ofperformance which allows CCGs to benchmark against other CCGs and informswhether NHS England intervention is needed. The CCG IAF is expected to alignclosely with STPs and include integration and technology metrics.It is anticipated that CCGs (or their nominated management function) will requireexpertise to monitor the performance of local GP IT delivery partners and generalpractices as they use IT services in accordance with local agreements. Where adispute between a general practice and a CCG arises concerning the provision of

14 Delivering the Forward View: NHS Planning Guidance 2016/17 – 2020/21 Annex3 to the Technical Guidance: Financial planning templates guidance forcommissioners

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GP IT, that cannot be resolved locally, either party may escalate the matter throughNHS England regional teams for contractual action.NHS England retains responsibility for commissioning services to support all primarycare GMS, PMS and APMS contractors offering Primary Care Essential Services toa registered patient list to fulfil their statutory responsibilities relating to informationgovernance and to support compliance with the Information Governance Toolkit(IGT). NHS England will commission local services to support adherence to IGpolicies and procedures and provide support for the completion of general practiceIGT submissions.NHS England also retains responsibility for commissioning Registration Authority(RA) (administration of access to clinical and business systems), clinical safetyassurance and NHSmail support and administration for general practice as well asassuring that arrangements are in place for other primary care contractors who haveaccess to and are using national clinical IT systems. Regional DCO teams willdirectly commission these services for general practice, from IT delivery partners.

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7. Commissioning of IT Services: OperationalManagement ResponsibilitiesThe operational management of GP IT requires clear definition of accountabilitiesand responsibilities across commissioners and IT delivery partners. This sectionmakes clear those responsibilities and the associated aspects of the processesinvolved.In this document the following terms have the following meanings:

Accountable means the party has the obligation to report, explain and beanswerable for resulting consequences of the relevant activity

Responsible means the party has the obligation to carry out the relevantactivity.

7.1 Financial arrangements

GP IT funding arrangements have been reviewed as part of the strategic review ofthe GP IT Operating Model, in response to the changing primary care landscape asoutlined in the Five Year Forward View (FYFV) underpinned by Personalised Healthand Care 20206.Historically, GP IT investment has been highly variable and inequitable acrossEngland. NHS England’s intent, outlined in the 2014-16 Operating Model, was for allareas of England to achieve an equitable level of GP IT revenue investment by April2016, sufficient to achieve high quality GP IT services for all.The NHS Mandate 2016/17 outlines the need for an increase in devolved power andcontrol, enabling the development of new models of care, tailored to local needs.The revision of GP IT funding arrangements outlined within the 2016-18 operatingmodel, aims to ensure that CCGs have sufficient funding flexibility to commissioneffective GP IT services that meet local need, support the development of newmodels of care, whilst also ensuring:

Standardised high quality IT services

Alignment of GP IT operating arrangements with the strategic direction ofNHS England’s vision and values for primary care and the broader digitalservices delivery agenda

A platform to support service transformation.

Key principles: NHS England will continue to provide national funding as part of CCG

baseline allocations to support the delivery of GP IT services

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Core and mandated GP IT is the first priority for local investment

Investment in local enhanced and transformational services should becommissioner led, in consultation with general practice and will align closelywith Local Digital Roadmaps and Sustainability and Transformation Plans thatwill underpin the integration and transformation of care locally.

Investment for GP IT should be maintained and enhanced to support localplans to address the sustainability and quality of general practice, as outlinedin the NHS Planning Guidance and reflected in the uplift to GP IT revenuewithin CCG baseline allocations for 2016/17.

CCG are accountable for any financial risks associated with over-spending aspart of their overall resource limit

Clear Standing Financial Instructions (SFI) must be established betweencommissioners and delivery organisations

CCGs and their GP IT delivery partners must follow all necessary financialguidance in relation to provision of GP IT services, including the NHS EnglandStanding Financial Instructions15 and NHS England Financial Guidance16.

15 Standing Financial Instructions

16 NHS England Financial Guidance (Available only on the NHS England Intranet)

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Figure 2: Key financial accountabilities and responsibilities

GP IT Service Area Accountable Responsible

Financialarrangements

NHS England is accountable forinvestment in primary care andGP IT services.

The CCG has financialaccountability for the localbudgetary management of GP ITfunding.

The CCG is responsible for the establishment of localgovernance and accountability arrangements to ensure effectiveand appropriate use of delegated funds.

The CCG is responsible for ensuring that:

o local arrangements comply with established public sectorprocurement rules,

o appropriate quality and value for money are securedthrough collaborative procurements with other CCGswhere possible, and

o investment appraisals consider the full cost andsustainability of any service transition for example whereTransfer of Undertakings (Protection of Employment)(TUPE) costs may have an impact or ongoingmaintenance costs.

NHS England Direct Commissioning Operations teams areresponsible for financial oversight and assurance through theclinical commissioning and direct commissioning assuranceframeworks and assessment methodology.

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7.2 Detailed financial management responsibilities

As in previous years, the first priority for CCGs investment of GP IT monies shouldbe in commissioning the provision of essential core and mandated GP IT services. Inaddition, it is essential that CCGs ensure local investment in enhanced andtransformational primary care IT services is closely aligned with Local DigitalRoadmaps (LDRs) and Sustainability and Transformation Plans, to support theintegration and transformation of health and care.

The Government expects the NHS to make year on year improvements in efficiencyand productivity, to ensure a secure and sustainable financial footing, as outlined inthe Mandate to the NHS. Local commissioners should therefore, ensure effectivelocally commissioned GP IT services that provide both value for money andsustainable services.

7.3 Revenue provision

7.3.1 GP IT revenue funding

Whilst the overall budget for GP IT remains static for 2016/17, the release of GP ITTransition monies has enabled uplift on CCG GP IT revenue allocations from £146million to £173 million. Which in real terms provides an uplift from the 2015/16allocation of £2.56/head of population, to a 2016/17 allocation of average £3.03/headof population.From 2016/17, GP IT revenue monies will be included in CCG baseline allocations,calculated on the CCG ‘fair share’ allocation formula, which is being phased in over aperiod of years, to bring CCGs to a fair share/equity position.The GP IT Operating Model outlines CCG responsibilities in terms of GP IT deliveryarrangements. The first call on GP IT revenue funding, is the provision of core andmandated GP IT services, as outlined in the schedule of services which haveexpanded for 2016/17.GP IT revenue monies will be distributed directly to CCGs to manage locally, throughCCG baseline allocations. CCGs should ensure continued investment in GP IT tomaintain and develop existing infrastructure, whilst ensuring effective deliveryagainst the requirements outlined within the GP IT Operating Model for 2016-18.NHS England retains the Senior Responsible Owner role for the GP IT OperatingModel.

7.3.2 Transition funding

Following the introduction of equitable financial shares within the 2014/16 OperatingModel, a time limited two year transition fund was established, for which CCGs could

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apply to access where they were able to demonstrate a genuine need for additionalfunding, to ensure safe business continuity during this period of transition.This was a time limited funding provision with the intent to achieve parity within twofinancial years, from April 2014. This funding stream is therefore, no longer availablefrom April 2016 onwards. The release of transition monies, has allowed for anincrease in revenue allocation across all CCGs.

7.3.3 Funding for Primary Care IT Enabling Services (PCES)

To commission Primary Care IT Enabling Services, that underpin the use of nationalstrategic systems within primary care as outlined in Appendix C. These includeRegistration Authority support services, NHSmail administration, Clinical SafetyOfficer support and IG support for general practice.Funding provision for PCES has been increased from the previous allocation of£8.64 million to £11 million in 2016/17, with the enhanced funding specificallytargeted at enhancing IG support arrangements.Revenue funding for the continued commissioning of PCES will be distributed toNHS England’s regional DCO teams as part of baseline primary care commissioningallocations.A commissioning specification: ‘Information Governance Support for Primary CareProviders’17 has been developed to inform NHS England’s Regions about the IGsupport that they must commission for primary care providers and deliver an outlinestructure for contracting purposes.

7.4 Capital provision

Within current GP IT funding arrangements, capital funding is available onapplication, to fund necessary hardware and software replacement and investmentprogrammes.In recognition of the increased challenges that the current capital managementarrangements pose as IT operating arrangements continue to develop and evolveand to provide increased flexibility for local commissioners (CCGs), discussions areunderway to enable capital to revenue transfer for future funding arrangements.As this may not have been achievable by 1st April 2016, CCGs and local regionaloffices were asked to consider and include GP IT infrastructure requirements for2016/17 and the Five Year Indicative Requirements as part of the broader capital

17 Commissioning Specification: Information Governance Support for Primary CareProviders

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planning process for 2016/17. This will help to inform the ongoing GP IT financialreview whilst ensuring that local ambitions can be fully realised.As in previous years, NHS England will make capital expenditure available forschemes which are deemed a priority and which meet the necessary criteria.

In accordance with the NHS Planning Guidance and associated TechnicalGuidance, CCGs must outline their capital funding requirements includingcapital for GP IT.

All capital asset purchases must be made through nationally agreedpurchasing frameworks whenever possible; where not possible, NHSEngland Standing Financial Instructions and procurement rules must beapplied.

Capital funding will be managed in accordance with the NHS EnglandBusiness Case Assurance and Approval Process18.

Any capital financial queries should be directed to regional finance teams in the firstinstance.As part of sustainability requirements CCGs need to maintain financial balance to beable to deliver against their objectives, which include GP IT Operating Modelarrangements. This will be assessed as part of sustainability review under theproposed CCG Improvement and Assessment Framework.

7.4.1 Capital depreciation

Capital depreciation for NHS England owned assets, will continue to be managedthrough NHS England financial processes and will not be funded from within thedelegated revenue budget to CCGs for GP IT.N.B. This includes depreciation charges for legacy assets transferred from PCTs toNHS England on 1 April 2013.

7.4.2 Value for money

Investment of NHS England resources must offer good value for money. Value formoney in GP IT expenditure will be ensured through the extensive use of approvedpurchasing frameworks including, but not restricted to, the Lead Provider Framework(LPF) for GP IT service delivery. CCGs should ensure that service specifications forprocurement of GP IT services reference the GP IT Operating Model, including butnot limited to, schedule of services requirements in relation to core and mandatedGP IT. Enhanced and transformational service requirements that will enable

18 NHS England Business Case Approvals Process: Capital Investment, Property,Equipment and ICT

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extended hours/seven day working, primary care at scale, sustainability andtransformation that will accelerate implementation of the Five Year Forward View andsupport delivery of the General Practice Forward View1, should also be consideredas part of procurement activities.

Further assurance will be provided through the Digital Primary Care MaturityAssurance arrangements, described within this document, which will be available toNHS England, regional DCO, CCGs and GPs.

Efficiencies associated with the delivery of core and mandated GP IT services willenable increased investment in enhanced and transformational GP IT services.CCGs are required to follow their SFIs to ensure value for money in their GP ITexpenditure.

7.4.3 Inventory and asset management

CCGs need to ensure they maintain adequate inventories of all GP IT assets (capitaland revenue funded) in order to support the operational management of the assetsand also to inform the NHS England asset register requirements as detailed in theNHS England financial guidance.CCGs are responsible for ensuring a full and up to date audit trail of all GP IT assetsin their area and the removal and secure disposal of GP IT assets whereappropriate, as outlined in the SFIs.

7.4.4 Insurance

All NHS owned GP IT equipment does not need to be individually insured underpractice policies (i.e. contents policies), however the practice should ensure that ithas taken reasonable precautions to ensure that NHS England and supplier ownedequipment is protected from theft and malicious damage. Practices should be awarethat they have a responsibility to inform their insurance companies that IT equipmentwill be on their premises. Practices are advised to insure practice-owned ITequipment and ensure cover for the consequences of any loss.Practices must at all times ensure that adequate security arrangements are in placein the practice premises in order to protect NHS-owned equipment.

7.5 Implications of GPSoC Framework

Subject to eligibility criteria, general practices will have access to an accreditedcomputer system where the contractor may store patient records.Certain deployment and local support costs will not be centrally funded. Details onthe current GPSoC Framework including funding arrangements is available atGP Systems of Choice (GPSoC).

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7.6 Alternative Funding Sources

7.6.1 Sustainability and Transformation Fund

The NHS Spending Review provided additional dedicated funding streams fortransformational change, which will build over the next five years and will support thespread of new care models, primary care access and infrastructure, technology rollout, together with key clinical priorities.As part of the Planning Guidance for 2016/17, CCGs are expected to developSustainability and Transformation Plans (STPs) that will help return the system toaggregate financial balance. STPs are expected to become the single applicationand approval process for being accepted onto programmes with transformationalfunding from 2017/18 onwards.In future years, many of these protected transformation funds, will form part of a newwider Sustainability Transformation Fund (STF), though for 2016/17, as outlined inPlanning Guidance, limited available transformation funding will continue to beavailable through separate processes i.e. the Primary Care Transformation Fund(PCTF).

7.6.2 Primary Care Transformation Funds (PCTF)

Local STPs should consider sustainable general practice and wider primary care,including how to improve primary care infrastructure. CCGs should consider howtransformation funds could be invested in digital technology to enable enhancedevening and weekend access to primary care, support patient activation and self-care and the adoption of new models of care including MCPs or PACs.

Capital for Prime Minister’s Challenge Funds (PMCF), now known as GP AccessFund (GPAF), was funded from Primary Care Transformation Funds (PCTF) capitalin 2015/16. There are not expected to be any capital funding requirements for GPAccess Fund schemes from 2016/17. Where there are capital requirements, bidsshould be submitted for PCTF capital or included within GP IT capital requirements.

7.6.3 Better Care Fund

The NHS Mandate 2016/17 highlighted the Government’s aim that health and socialcare are integrated across the country by 2020, including through the Better CareFund19, which will provide financial support for councils and NHS organisations to

19 Better Care Fund Planning

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jointly plan and deliver local services. This will be supported through the sharing ofelectronic health records, key to enabling integrated care.

Figure 3: Detailed Financial Management Responsibilities

Process NHS England(Patients andInformationDirectorate)

NHS Englandregional DCOteams

CCGs

RevenueFunding

NHS England isresponsible forallocating thebudgets forcommissioning NHSservices.

Responsible forissuing fundingallocations tocommissionersincluding GP IT.

Accountable for themanagement of devolvedrevenue allocations toensure effective delivery of'core' GP IT services,together with localagreement and fundingprioritisation of enhancedand transformational serviceprovision, in response tolocal need.

TransitionFunding

Ceased April 2016 Ceased April 2016 Ceased April 2016

CapitalFunding

Determine capitaloperating budget,oversight andassurance of thecapital approvalsprocess to ensurefairness andconsistencynationally.

Coordinate financialplanning, oversightand assurance ofCCG GP IT capitalbids.

Manage capitalbudgets forcommissioning.

Apply to NHS England forcapital funding as per NHSEngland capital guidancereleased annually.

AssetManagement

Provide specificguidance andprocesses relatingto GP IT assetmanagement in

Accountable for thefinancial processesassociated with themanagement ofcapital assets and

Responsible for the assetmanagement and securedisposal processes.

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Process NHS England(Patients andInformationDirectorate)

NHS Englandregional DCOteams

CCGs

support of NHSEngland StandingFinancialInstructions.

oversight of thedelivery of the assetmanagementprocess.

7.7 What are the Contractual Arrangements?

A number of agreements and contracts ensure that all levels of the system are linkedin terms of their mutual rights and responsibilities. There needs to be clearaccountability and agreement of service specifications so that every general practiceunderstands the level of GP IT services to expect.Key principles:

Effective service management arrangements must be in place to overseeachievement of Service Level Agreement (SLA) performance and delivery;holding GP IT delivery partners to account as is appropriate

There is a clear escalation process reflected in contractual agreements

The authorisation of contractual agreements for the delivery andmanagement of GP IT services can only be made by a CCG

Any delegated responsibility of management arrangements must haveclear assurance and accountability

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Figure 4: Key contractual accountabilities and responsibilities

GP IT ServiceArea

Accountable Responsible

ContractualArrangements

NHS England is accountable forcontracts relating to nationalstrategic/clinical systems andinfrastructure as per the NHSMandate.

NHS England is accountable forensuring that CCGs comply withthe CCG directions relating tothe NHS Act 2006 (asamended), as per “SecuringExcellence in GP IT Services:Operating Model”.

The CCG is accountable forensuring a CCG-Practiceagreement is in place with eachof its constituent practices andmonitoring compliance with thatagreement, escalating to NHSEngland regional DCO teamswhere an issue cannot beresolved.

The CCG is accountable for thecommissioning, agreement andmanagement of contracts andSLAs with GP IT serviceproviders for the provision of GPIT services to its constituent GPpractices, as laid out in thisdocument.

The CCG is responsiblefor fulfilling itsresponsibilities as laid outin the CCG PracticeAgreement.

The CCG is responsiblefor authorising signatureagainst nationalinfrastructure items suchas the N3 network, andnational frameworks suchas GPSoC on behalf of itsconstituent practices.

The general practice isresponsible for fulfilling itsresponsibilities as laid outin the CCG Practiceagreement.

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Figure 5: High level contractual arrangements

7.7.1 Between NHS England and CCGs

NHS England is accountable for the delivery of GP IT services, but responsibility forthe commissioning of GP IT services has been delegated to CCGs. This is in linewith directions issued to CCGs by NHS England under the NHS Act 2006 (asamended); therefore no contract is needed between NHS England and CCGs inrelation to these directions.

7.7.2 Between NHS England and national applications andinfrastructure providers

NHS England will ensure that national applications and infrastructure arecommissioned for use by local NHS organisations as appropriate, in keeping withnational digital strategy.

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7.7.3 Between CCGs and their GP practices (The CCG PracticeAgreement)

CCGs are responsible for the provision of core, enhanced and transformational GPIT services for their constituent practices in line with the requirements outlined withinthis document. The details of the provision of these services, as well as the rightsand responsibilities of both parties must be recorded in a CCG Practice Agreement,which every practice must sign with its CCG. This is an essential document whichnot only ensures the practice understands what GP IT services to expect, and therelated responsibilities of both parties, but also ensures that the practice’s role insupporting the CCG’s obligations under GPSoC and other national contracts isbound by a contractual agreement between the two parties.Where a change of GPSoC or LSP clinical system has been agreed the CCG andGP practice shall jointly undertake the selection process and subsequent migrationwith the relevant supplier.

7.7.4 Between CCGs and their GP IT delivery partners

The provision of any services should be supported by a contract and SLA with eachGP IT delivery partner. SLAs are an important component, which will be reflected orreplicated within the appendices in the CCG Practice Agreement, ensuring thepractice has visibility of the key components of the service which it is to receive.Effective service management arrangements must exist to support this process.

7.7.5 By CCGs on behalf of their constituent GP practices

CCGs must act as signatory for the provision of certain national infrastructure itemsand systems to their constituent practices, for example this applies to the N3 network(N3 Access Agreement) and GPSoC Framework (for example. GPSoC call offaAgreements and Schedule A). It is important to note that this responsibility cannotbe delegated by the CCG, although aspects of its management may be delegated.

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Figure 6: Detailed contractual management responsibilities

Process CCGs NHS Digital(HSCIC)

GP Practice GP IT DeliveryPartner

GPSoCFramework / CoreGP ClinicalSystems

Commissions GP IT deliverypartners to manage the deliveryplan and ensure all GP practicesare supplied with appropriateclinical systems using thesecontracts, including any systemmigration, implementation andoperational support.

The CCG is responsible for signingoff on GPSoC usage on behalf ofits practices and maintaining theTracking Database (TDB)accordingly. Note that thesignature of such agreementscannot be delegated by CCG toanother body, but the day-to-daymaintenance and management ofthe agreements may be delegated.

Signatory to CCG Practice andlocal GPSoC call off agreementsand ongoing maintenance and

Procures andcontractuallymanagesframeworkcontracts forGPSoC and LSPSystems.

Puts in placecontractmanagement andadvicearrangements toinform CCGs oflocal contractarrangements.

Signatory to theCCG PracticeAgreement.

Complies withCCG PracticeAgreement andLSP terms andconditions (whereappropriate).

Commissioned toimplement, providesupport, servicemanagement andmonitor that GPpractices complywith theirresponsibilitiesaround the use ofGPSoC and LSPServices.

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management of these agreements(for GPSoC and Lead ServiceProvider (LSP)).

NationalInfrastructure

The CCG is responsible for signingnational infrastructure agreements(for example. N3 accessagreement) on behalf of itspractices where necessary. Notethat the signature of suchagreements cannot be delegatedby the CCG to another body, butthe day-to-day maintenance andmanagement of the agreementsmay be delegated.

NHS Digital(HSCIC) procuresnationalinfrastructure andputs in placecontractmanagementadvicearrangements andinforms CCGs ofcontracts andthesearrangements.

Compliance withany terms andconditions fornationalinfrastructure thatapplies to endusers.

Compliance withany terms andconditions fornationalinfrastructure thatapplies.

Contracting core,enhanced andtransformationalGP IT services

Commission GP IT deliverypartners to deliver core, enhancedand transformational GP ITservices. Services must beprocured under appropriateService Level Agreements/contracts which are based onnational guidance, where available

Signatories andaccept complianceto CCG PracticeAgreements.

Delivery ofcommissionedservices in line withService LevelAgreement andKey PerformanceIndicators.

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and include detailed servicedefinitions and associated KPIs.

Routine service reviews must beconducted with GP Practices andGP IT delivery partner(s) to assuredelivery outcomes, serviceperformance and plan futureservice development.

Services must be routinelyassessed to ensure continuedvalue for money, for example usingindustry standard benchmarking.

Signatories to CCG PracticeAgreements and ongoingmaintenance and management ofthese agreements.

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National StrategicSystems andServices

Commission a service to managethe delivery plan andimplementation of nationalstrategic systems and services tosupport local strategy inconjunction with GP practices.

NHS Digital(HSCIC) procuressystems (and somesupport services)on behalf of NHSEngland's Patientsand InformationDirectorate andputs in placecontractmanagement,advicearrangements andprovides oversightand advice on thedischarge of thesearrangements.

Adopt andimplement nationalinitiatives andcomply with anyterms andconditions for useof national systemsthat apply to endusers.

Compliance withany terms andconditions fornational systemsthat apply.

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7.8 Information Governance

Information governance (IG) is a personal responsibility for all. IG requirements forgeneral practices include, amongst other requirements, compliance with commonlaw, the Data Protection Act 1998 and Human Rights Act 1998, policy requirementsand conformance to professional obligations. These include meeting thecommitments given by the Department of Health to the Caldicott Review 2013. TheHealth and Social Care (Safety and Quality) Act 2015 calls for the use of a'consistent identifier', that is '(a) likely to facilitate the provision to the individual ofhealth services or adult social care in England, and (b) in the individual’s bestinterests', and sets out the 'Duty to share information' , with similar provisos. TheInformation Governance Alliance has published several documents on both of thesechanges. See Information Governance Publications from NHS Digital (HSCIC).Thelatter is the legal framework arising from the Caldicott Review 2013. Generalpractices have a commitment to complete the NHS GP Information GovernanceToolkit (GP IGT) to level 2.

How these requirements are supported should be set out in local serviceagreements.NHS England through its regional teams will commission high quality localisedadvice regarding IG to support primary care contractors providing primary careessential services a registered list.CCGs and their GP IT service delivery partners also have certain responsibilities, asdescribed below.Key principles:

NHS England will collaborate with the Information Governance Alliance to setnational IG policy

NHS England will ensure the provision of a local IG support service forprimary care contractors providing primary care essential services to aregistered list, including appropriate support for the management of IG andInformation Security incidents.

All parties are accountable for their compliance with all necessary IG laws andstandards.

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Figure 7: Key Information Governance accountabilities and responsibilities

GP IT ServiceArea


InformationGovernance

NHS England isaccountable as aCommissioner toseek assurance thatpatient informationis handledappropriately andlegitimately.

GP practices areaccountable for theircompliance with allnecessary laws andIG standards. Inpart, this can bedemonstratedthrough attaininglevel 2 of the IGtoolkit.

NHS England is responsible as the commissioner of GP services to ensure GP Practiceshandle patient records in an appropriate manner by adhering to standards andspecifications and that GPs investigate and take appropriate action relating to all seriousincidents.

NHS England regional teams are responsible for commissioning a local IG supportservice as outlined in the Commissioning Specification: Information Governance Supportfor Primary Care Providers

CCGs, when commissioning GP IT services, are responsible for ensuring that their GPIT delivery partner is IG Toolkit Level 2 compliant as a minimum and meets the otherobligations below.

GP IT delivery partners are responsible for maintaining compliance with the AnyQualified Provider (AQP) view of the IG Toolkit with Level 2 compliance as a minimum,including conforming to the rules around offshoring.

GP IT delivery partners are responsible for ensuring their systems conform toinformation standards.

GP IT delivery partners are responsible for enabling GPs, CCGs and NHS England tocomply with their statutory obligations for example complying with subject accessrequests and Freedom of Information requests.

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GP IT ServiceArea


GP practices are responsible for completion of the IG Toolkit and attainment of Level 2compliance with support from their IG Support Service.

GP practices are responsible for the production, approval and maintenance of (andadherence to) their IG and IT security policies in terms of their own staff and their use ofIT equipment, software and infrastructure in line with national requirements andguidance but adapted to local circumstances. The systems will need to comply withpolicies set by NHS England for the health service.

GPs are responsible for reporting SIRIs to both the Strategic Executive InformationSystem (STEIS) and via the IG toolkit SIRI reporting tool.

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Figure 8: Detailed IG Responsibilities

Process NHS England IGTeams in Policy andPatients andInformationDirectorates workingtogether

NHS EnglandRegional DCO Teams

CCGs GP Practice

Reporting IG SeriousIncidents RequiringInvestigation (SIRIs)

Will set operationalpolicies and proceduresrelating to SIRIs,develop SIRI reportingrequirements in the IGtoolkit and STEIS andgovernance of SIRIs.

Will support GPinvestigation into SIRIswith advice andguidance from NHSEngland (IG Toolkit).

Reporting any misuse ofclinical systems inbreach of local ornational policy viaSTEIS and the IG team.

Must report any IGbreaches, via STEISand the IG Toolkit.

IG Toolkit Will set requirements tobe included within theIG Toolkit which isdelivered by NHSDigital (HSCIC).

Contribute to IG Toolkitrequirements andmonitor compliance intheir area.

Complete the GP viewof the IG Toolkit andattain, as a minimum,Level 2 compliance.

IG support services Will scope the IGsupport services thatGP practices require.

Commission IG supportservices for generalpractice.

Uses the IG supportservice commissionedfor them appropriatelyand follows its advice.

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7.9 Data Security

A review of standards of data security for patients’ confidential data across the NHSis underway. The National Data Guardian for health and care will contribute to thisreview by developing clear guidelines for the protection of personal data againstwhich every NHS and care organisation will be held to account. Recommendationsare anticipated on how the new guidelines can be assured through CQC inspectionsand NHS England commissioning processes.

7.10 Clinical Safety

Clinical safety is the responsibility of all, but fundamentally the responsibility for thesafe use of health IT systems lies with GP practices. All those involved in thedeployment and use of health IT systems must ensure adherence to the relevantnational information standards, namely SCCI016020 (formerly ISB 0160) Clinical RiskManagement: Its Application in the Deployment and Use of Health IT Systems, andSCCI012921 (formerly ISB 0129) Clinical Risk Management: it’s Application in theManufacture of Health IT Systems.A clinical safety assurance service will be commissioned by NHS England through itsregional DCO teams to assure compliance with national standards.

CCGs and their GP IT service delivery partners also have certain responsibilities, asdescribed below.

Key principles: The safe use of health IT systems is a general responsibility of all involved in

their use

GP practices must ensure compliance with the relevant national standardswith respect to the safe use of health IT systems. Note that it is not intendedfor every practice to employ a dedicated clinical safety officer, but wherenecessary practices should request the services of clinical safety assurancespecialists commissioned by the regional DCO team within that locality

GP IT delivery partners must ensure compliance with the relevant nationalstandards with respect to the safe use of health IT systems

20 SCCI0160 Clinical Risk Management: Its application in the deployment and useof health IT systems

21 SCCCI029 Clinical Risk Management: Its application in the manufacture of healthsoftware

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Suppliers must ensure compliance with the relevant national standards withrespect to the manufacture of health IT systems.

There is an expectation that local Clinical Safety services must includeappropriate support for the management of Clinical Safety incidents(Information system related) within general practice.

Figure 9: Key Clinical Safety accountabilities and responsibilities

7.11 Primary Care IT Enabling Services

NHS England regional DCO teams are responsible for commissioning and managingthe IT support services that support general practice as outlined in the Schedule ofServices within Appendix C and will be funded accordingly from primary care ITfunds.Key principles:

Regional DCO teams will commission the necessary services, which supportcritical business functions, ensuring that coverage is sufficient and of highquality, across their entire geographic area for all primary care contractors

Regional DCO teams will carry out regular review through the regional teamassurance process to ensure continued appropriate levels of service havebeen commissioned. Recognising the importance of technology, NHSEngland is appointing additional Digital Technology resource within regionalDCO teams.

From time to time local projects may require special resource considerations,for example an increased demand for Registration Authority experts duringthe local rollout of national systems. The business as usual level of servicecommissioned by the regional DCO team should be able to cope with acertain demand for this type of activity (as decided by the regional DCO teamduring the commissioning process), but additional resource may be needed insome circumstances. For those programmes commissioned by CCGs, thisresource will need to be factored into local plans with associated fundingprovided from GP IT funds.


Clinical Safety GP practices areaccountable for the safetyof health IT systems inuse by them.

All those involved in thedeployment and use ofhealth IT systems.

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Figure 10: Key PCES accountabilities and responsibilities


Primary Care ITEnabling Services

NHS England isaccountable for theprovision of Primary CareIT Enabling Services asoutlined in the GP ITOperating Model.

NHS England regionalDCO teams areresponsible forcommissioningappropriate Primary CareIT Enabling Services asoutlined in the GP ITOperating Model.

NHS England Patientsand InformationDirectorate through itscentral and regionalsupport, is responsible forensuring that regionalDCO teams have therelevant support to assistwith the commissioning ofPrimary Care IT EnablingServices.

CCGs are responsible foridentifying, whereappropriate, where thereis insufficient resource tomeet local needs in thedelivery of Primary CareIT Enabling Services. Thismust be raised with theappropriate regional DCOteam.

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Figure 11: Detailed responsibilities for Primary Care IT Enabling Services

Process NHS EnglandPatients andInformationDirectorate

NHS Englandregional DCO teams

NHS Digital (HSCIC) GP Practices GP IT DeliveryPartner

RegistrationAuthorities(RA) service

Provides strategicleadership for thelocal operating modeland service levelagreement to ensureNHS England isachieving best valuefor money.

Commissions theservice in line withnational standardsand sets service levelagreements for an RAservice for all primarycare contractorsproviding primarycare essentialservices to aregistered patient list.

Assures thatarrangements are inplace for otherprimary carecontractors who haveaccess to and areusing national clinicalIT systems.

Sets standards forsuppliers, includingthe RA serviceschedule.

Maintains andpublishes RA policyand processguidance.

Maintains andpublishes the NationalRole Based AccessControl Database(NRD).

Adherence to NHSDigital (HSCIC) RApolicies and processguidance.

GP practices approvethe issue, revocationand management ofsmartcards for anyaccess by individualsworking in theirpractice to the clinicalsystem.

Delivery of serviceincludingconfiguration, issuingand management ofsmartcards.

Adherence to NHSDigital (HSCIC) RApolicy.

Maintain local RApolicy and processesaligned to NHS Digital(HSCIC) RA policyand processguidance.

Assurance of GPpractices’ adherenceto RA Policy andprocesses. Ifassurance cannot beobtained, then the

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issue is passed to theNHS England toresolve.

NHSmailadministrationand supportservice

As above Commissions theservice in line withnational standardsand service levelagreements forprimary carecontractors providingprimary care essentialservices to aregistered patient list.

Authorises IT deliverypartner to manage onits behalf.


Sets standards forsuppliers.

Use of NHSmailservice in line with ITsecurity policies.

Delivery of service inaccordance withnational standardsand service levelagreements.

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IG supportservices

The Data Sharing andPrivacy Unit isresponsible fordeveloping IGguidance incollaboration with theInformationGovernance Alliance.

Commissions theservice in line withoperating guidanceand standards forprimary carecontractors providingprimary care essentialservices to aregistered patient list.


Maintains theInformationGovernance Toolkit.

Completion of GPInformationGovernance Toolkitwith NHS IGrequirements.

Delivery of serviceand support forgeneral practice incompliance with IGrequirements andcompletion ofappropriate returns.

Clinical safetyassuranceservice

Sets the standardsand the assuranceprocess for localcommissioners.

Commissions theclinical safety andassurance servicerequired to complywith SCCI0160(formerly ISB 0160)for the deployment

Responsible forensuring clinicalsystem suppliercompliance withSCCI0129 (formerlyISB 0129) for

Responsible forcompliance withSCCI0160 (formerlyISB0160) governingimplementation andsafe use of health IT

Delivery of clinicalsafety assuranceservice. If assurancecannot be obtained,then the issue ispassed to NHSEngland to resolve.

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and use of health ITsystems for primarycare contractorsproviding primarycare essentialservices to aregistered patient list.


manufacturing ofhealth IT systems.

systems for core andadd-on services. Compliance with

SCCI0160 (formerlyISB0160) governingimplementation andsafe use of health ITsystems for core andmandated GP IT,enhanced andtransformationalprimary care ITservices.

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7.12 Other responsibilities

The following table covers various other accountabilities and responsibilities which are not covered elsewhere.

Figure 12: Other responsibilities

Process NHS England CCG GP Practice GP IT DeliveryPartner

Digital Strategy Set national vision andoperational arrangements forthe delivery of GP IT inconsultation with otherdirectorates across NHSEngland.

Appoint a designatedaccountable officer orCCIO to lead and developlocal strategy and provideoversight oftransformation ofinformation andinfrastructure for localhealth community.

Support delivery ofstrategic initiatives toimprove patient servicesas reinforced in the CCGPractice Agreement andsupported by GP ITdelivery partner and NHSDigital (HSCIC) asappropriate.

Work with the CCG tosupport the NHS’ strategicobjectives and policies forinformation managementand technology.

Involve the Local MedicalCommittee in IT matters,as appropriate.

May be commissionedto assist in theproduction and co-ordination of localdigital strategygoverned by the CCG.

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HardwareManagement

Will commission thedevelopment of standardssetting, warranted environmentand recommended hardwarespecifications for strategic andclinical systems.

Determine local strategyfor hardwaremanagement.

Provision of suitableenvironment includingphysical security, air-conditioning and firesuppression, powersupplies, PAT testing,funding localconsumables (forexample. printer ink andpaper).

Coordinate agreedspecifications wherethese are provided tomore than one CCG inorder to securemaximum value formoney.

Local DataBackups

To recommend as part ofhardware specifications forstrategic and clinical systems.

Commission as specifiedin core and mandatory GPIT services.

Taking data backups(where applicable) is theresponsibility of thepractice unless otherwiseagreed.

Provide services ascommissioned.

DisasterRecovery andBusinessContinuity

No direct responsibility. Commission a DisasterRecovery (DR) andBusiness Continuity (BC)support service asspecified in core andmandatory GP ITservices, ensuring thatadequate review of

It is the responsibility ofeach practice to developand maintain disasterrecovery and businesscontinuity plans.

Provide services ascommissioned.

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practice DR and BC planstakes place.

The CCG shall alsoconfirm its agreement togeneral practice DR andBC plans on behalf ofNHS England, amendedas agreed by the parties.

Systems tosupport individualgeneral practicesand which are notfunded nationallyor by the CCG.

No direct responsibility. Authorise practice-basedsoftware and systems tooperate on and interfacewith GP IT infrastructure.

Must seek approval fromCCG to install practice-based software on GP ITnetworks andinfrastructure.

Must commission systemsand services fromsuppliers that comply withsecurity and technicalrequirements of GP ITdelivery partner.

Fund additionalinfrastructure and supportneeded to support thesesystems if not already in

Enable generalpractice corporatesystems to operate inthe managed ITinfrastructure subjectto security andperformancelimitations andcapacity ofinfrastructure.

If required contractwith GP practices toprovide additional ITservices to supportgeneral practicecorporate systems.

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place under core and add-on GP IT services.

Changes topracticepremises/propertymanagement

Any increase in the ITsupported estate will requireagreement between thecommissioners of primary care(NHS England/CCG) and GPIT services (CCG), GP and theIT delivery partner.

The CCG must beinvolved where there areimplications for the localprovision of GP IT,supporting development ofassociated business casefor individual estatesprojects, includingconsideration of resourceand funding requirementsin relation to GP IT.

It is the responsibility ofthe general practice toseek authorisation fromNHS England for fundingto support new,expansion, mergers andany changes to premisesincluding closures.

This should includeconsideration ofassociated GP ITrequirements.

Any IT related changesto premises mustensure the GP ITdelivery partner is fullyinvolved to ensurecompliance withappropriatespecifications.

The CCG must beinvolved where thereare implications for thelocal provision of GPIT.

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8. Improvement, assessment and assurance: CCGImprovement and Assessment Framework

For 2016/17 NHS England has introduced a new CCG Improvement andAssessment Framework22 to replace both the existing CCG assurance frameworkand CCG performance dashboard. This new framework provides a greater focus onassisting improvement alongside NHS England’s statutory assessment function. Italigns with The Five Year Forward View and planning guidance, with the aim ofunlocking change and improvement in a number of key areas. This approach aims toreach beyond CCGs, enabling local health systems and communities to assess theirown progress from ratings published online.

The Framework is intended as a focal point for joint work and support between NHSEngland and CCGs, and was developed with input from NHS ClinicalCommissioners, CCGs, patient groups and charities. It draws together the NHSConstitution, performance and finance metrics and transformational challenges andwill play an important part in the delivery of the Five Year Forward View and issummarised in the diagram below;

Figure 13: Delivering the Five Year Forward View

22 CCG Improvement and Assessment Framework

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8.1 Support and ways of working

A critical factor in the success of the new framework will be the quality of therelationships between the NHS England local teams and CCGs. We are in ittogether, with joint responsibility for helping each other transform and sustain theNHS. The purpose of engendering mutual assistance and taking timely action whereneeded, should be as valuable as the formal act of annual assessment.

A different way of working is also required between NHS England’s local andregional teams and the national expert teams. This will take into account hownational teams might be involved in local conversations and how local teams co-ordinate identified support requirements. As part of this process operational supporttools will be developed to support CCGs and NHS England’s local teams throughoutthe year to identify trends, outliers and enable drill-down into the CCG IAF indicators.The potential use of online tools will be explored to bring greater transparency to theprocess and to provide a common understanding of the data.

A discussion of current and future CCG support requirements will be initiated in theearly part of 2016/17, using existing data and the year-end assessment of 2015/16.This will be refined as reporting on the indicators becomes available

The CCG IAF aligns with the “triple aim” driven by the Five Year Forward View, NHSPlanning Guidance, and the Sustainability and Transformation Plans (STPs), of: (i)improving the health and wellbeing of the whole population; (ii) better quality for allpatients, through care redesign; and (iii) better value for taxpayers in a financiallysustainable system.

The CCG IAF has been designed to supply indicators for adoption in STPs asmarkers of success. Performance against these high level indicators is likely tostimulate CCG interest in gaining additional insight. The indicators, which are notexpected to remain static, are grouped into four domains, including sustainability,under which the following digital indicators are placed:

Figure 14: Digital Indicators

Area: Indicator Name:

Paper-free at the point of care

Local digital roadmap in place

Digital interactions between primary andsecondary care

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8.2 Sustainability and Transformation Planning

It is anticipated that further insight will continue to be drawn from a range ofalternative sources and supplementary indicators, where needed. NHS England’sregions and commissioning operations will increasingly be responsible for supportingand catalysing local system transformation through the Sustainability andTransformation Planning process23.

Local Sustainability and Transformation Plans (STPs) are expected to provide keyinformation on how CCGs will work towards delivering the transformation challengesset out in the Five Year Forward View, including the use of digital systems andtechnology to enable service transformation.

8.3 Digital Primary Care Maturity Assurance Model

The NHS Mandate highlights a number of technology goals for 2020 including:

95 percent of GP patients to be offered e-consultation and other digitalservices

95 percent of tests to be digitally transferred between organisations

Support the delivery of NIB PHC2020, including Local Digital Roadmaps,improvements in digital maturity and achievement of a paper-free at the pointof care NHS.

The Digital Primary Care Maturity Assurance Model will support CCGs to provideassurance against GP IT delivery arrangements as well as review local digitalmaturity within Primary Care IT. This will assure CCGs of their progress towardstransformation in primary care as well as help identify areas requiring futureinvestment and/or improvement to support the delivery of their local digital ambitionsas outlined in Figure 15.The tool provides an overview of a wide range of indicators, provided through theDigital Primary Care Maturity Assurance portal within the Primary Care Web Tool24

and will provide local intelligence across the local primary care estate as well assupporting CCGs in their responsibilities relating to the local digital strategy, localdigital roadmaps and Sustainable Transformational Plans.

23 Delivering the Forward View: NHS Planning Guidance 2016/17 – 2020/21

24 Primary Care Web Tool

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Figure 15: The Digital Primary Care Maturity Assurance Model

Data will be collected via a number of mechanisms in order to inform this view:

GP Data – collected through the annual e-dec data collection

National data collection/reporting – data will be drawn from a range of existingnational data reporting routes, including HSCIC national programmemonitoring, Tracking Database

CCG Data – collected through CCGs on an annual basis

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Figure 16: Assurance Process

The digital maturity indicators are listed in the appendices, and have, whereverpossible, been mapped to appropriate contractual requirements, standards and/orgood practice guidance.The assessment criteria are aligned with the NHS Digital Maturity Index (forsecondary care supporting Paper Free at Point of Access) and therefore couldsupport a community wide digital maturity view over time.Future transformation and innovation funding initiatives would have a digital maturityreference point to support any award assessment criteria.

8.4 Ongoing Development

The metrics within the maturity assurance model will not remain static. The initialfocus within the Digital Primary Care Maturity Assurance model, will be towards coreand mandatory GP IT, with indicators focussed on capability rather than utilisation.This ensures that the necessary core building blocks are in place within generalpractice, on which to develop and sustain transformational change.

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Over time a number of core and mandatory indicators will be retired and replacedwith indicators for enhanced and transformation support and meaningful use.All practices and all CCGs will have access to the data outputs. Simple drill downfrom national level to CCG and to individual practice level is available. Data isaggregated and presented through a number of classifications including nationalprogrammes, five high impact areas and Digital Maturity Index.

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8.5 Benefits for stakeholders:

Figure 17: Benefits for stakeholders

Stakeholder Investment in GP IT,GP clinical systemsand national digitalassets

Mandatory(contractual)obligations forGP IT

Improving primarycare efficiency andeffectiveness (incl.access)

Transformed primarycare

NHS England

(national and regions)

Assurance on use ofcentral and delegatedfunds

Assurance on NHSobligations

Tracking strategicdelivery and managinglevers and incentives

Tracking strategicdelivery and managinglevers and incentives

CCGs Supports localaccountability for use ofGP IT funds

Supports discharge oflocal accountability forGP IT

… and supports CCGresponsibility for GPservice quality

… and support planningand delivery tracking oflocal digital roadmaps

General practice

(individual andfederations)

Visibility andengagement in how GPIT funds are supportinggeneral practices

Assurance andclarification ofexpectations anddelivery

Supports practicedevelopment includingprimary care at scaleand access trends

Supports new caremodel development andengagement in localdigital investments

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9. Where do I receive support?NHS England’s central GP IT team will work with CCGs and regional DCO teams tooperationalise GP IT.NHS England’s regional Digital Technology teams are available to offer support withGP IT. Contact your regional head directly.Associated supporting materials and guidance will be available through the DigitalPrimary Care website.If you have any questions about these arrangements please contact:[email protected]

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10. References1. General Practice Forward View

2. Securing Excellence in GP IT Services’, 2nd Edition, published in April 2014

3. CCG Assurance Framework

4. CCG Improvement and Assessment Framework for 2016/17

5. The Government’s Mandate to NHS England for 2016/17

6. Personalised Health and Care 2020. Using Data and Technology toTransform Outcomes for Patients and Citizens

7. GPSoC Framework

8. GPSoC How to Order Services

9. HSCN Programme

10. Five Year Forward View

11. Delivering the Forward View: NHS Planning Guidance 2016/17 – 2020/21

12. CCIO Network

13. NHS Commissioning Board Directions to Clinical Commissioning Groups(CCGs)

14. Delivering the Forward View: NHS Planning Guidance 2016/17 – 2020/21Annex 3 to the Technical Guidance: Financial planning templates guidance forcommissioners

15. Standing Financial Instructions

16. GP IT Capital Approval Process - Guidance and Expectations – 2015/16(Only available on the NHS England Sharepoint site)

17. Commissioning Specification: Information Governance Support for PrimaryCare Providers

18. NHS England Business Case Approvals Process: Capital Investment,Property, Equipment and ICT

19. Better Care Fund Planning

20. SCCI0160 Clinical Risk Management: Its application in the deployment anduse of health IT systems

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21. SCCCI029 Clinical Risk Management: Its application in the manufacture ofhealth software

22. CCG Improvement and Assessment Framework 2016/17

23. Delivering the Forward View: NHS Planning Guidance 2016/17 – 2020/21

24. Primary Care Web Tool

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11. Glossary

Acronymwhereapplicable

Term Definition

A&E Accident andEmergency

A medical treatment facility specialising in acute careof patients who present without prior appointment

APMS AlternativeProvider MedicalServices

This allows NHS England to contract with ‘any person’under local commissioning arrangements.

DCO Director ofCommissioningOperations

Regional teams deliver commissioningresponsibilities at a local level. The DCO is theirleader and part of the regional Senior ManagementTeam.

BAU Business asusual

Refers to the level of IT products and services whichare required to just maintain practice services at thecurrent status quo.

BC BusinessContinuity

The activity that ensures critical business functionswill continue to operate despite serious incidents ordisasters that might otherwise have interruptedthem.

BCF Better Care Fund A single pooled budget for health and social careservices to work more closely together in local areas,based on a plan agreed between the NHS and localauthorities.

CaldicottStandards

The Caldicott Standards are based on the DataProtection Act 1998 principles and set out in theform of Principles and relate to the use of patientidentifiable data.

CaldicottGuardian

The Caldicott Guardian is responsible for ensuringimplementation of the Caldicott Principles with respectto patient-identifiable information.

CAF CCG AssessmentFramework

The framework focuses on a CCG's performance indelivering improvements for patients, as well as

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Term Definition

assessment of its capability to deliver core andadditional delegated responsibilities. This will bepublished by the end of March 2016.

CCG ClinicalCommissioningGroup

Clinical commissioning groups will cover the whole ofEngland and will be responsible for commissioning themajority of healthcare for their local population. They willwork with partners including NHS England and localauthorities, who have responsibility for commissioningareas such as specialised services, primary care andpublic health, to commission integrated care for patients.

CCG IAF CCGImprovement andAssessmentFramework

NHS England has a statutory duty to conduct an annualassessment of every CCG and is introducing a newImprovement and Assessment Framework for CCGsfrom 2016/17 onwards, to replace both the existing CCGAssurance Framework and separate CCG performancedashboard.

CCIO Chief ClinicalInformationOfficer

The CCIO role may vary across organisations and isnormally suitable for a clinician with an interest in digital,with an understanding of the challenges aroundcapturing clinical information at the point of care andsharing that information during the care process. CCIOsshould champion the development, deployment, useand optimisation of digital systems.

CESG Communications-ElectronicsSecurity Group

CESG is the National Technical Authority for InformationAssurance within the UK providing a trusted, expert,independent, research and intelligence-based serviceon Information Security on behalf of UK government.

COIN Community OfInterest Network

A network which may be of a logical, physical or ahybrid nature which connects a number of LANs andlocal end points together for the purposes data sharing.These networks are often within one or more PrimaryCare Trusts or Strategic Health Authorities. CoINs aresynonymous with Metropolitan Area Networks (MAN)

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Term Definition

CSU CommissioningSupport Unit

Commissioning Support Units provide services andproducts which help clinical commissioners achievebetter outcomes. Commissioning Support Units have theexpertise to support transformational change initiatives,

Cyber Security Refers to protection to systems from vulnerabilities,mitigating risks, and reacting to cyber security threatsand attacks.

DMI Digital MaturityIndex

The aggregation of individual Digital maturity Self-Assessments into a Digital Maturity Index to enable aclear picture of the relative progress of one organisationagainst peers both regionally and nationally.

DPA Data ProtectionAct 1998

The Data Protection Act 1998 (DPA) is the law thatregulates the processing of information relating toindividuals, including the obtaining, holding, use ordisclosure of that information. Personal data is part ofNHS England's records and requires management in thesame way as other types of records created or held. AsNHS England is a public authority, we are subject to theCode of Practice on Records Management issued undersection 46 of the Freedom of Information Act 2000.

DPC MA Digital PrimaryCare MaturityAssurance

A Digital Primary Care Maturity Assurance model isavailable to review digital maturity assurance withinPrimary Care IT. An outputs based view, which isderived from a wide range of indicators, is providedthrough a Digital Primary Care Maturity Assuranceportal available within the Primary Care Web Tool.

DR DisasterRecovery

Disaster Recovery (DR) is the process, policies andprocedures that are related to preparing for recovery orcontinuation of technology infrastructure that are vital toan organisation after a natural or human-induceddisaster. Disaster recovery focuses on the IT ortechnology systems that support business functions, asopposed to business continuity, which involves planning

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Term Definition

for keeping all aspects of a business functioning in themidst of disruptive events.

DTS Data TransferService

DTS is a secure application-to-application messagingservice used throughout the NHS.

EPS ElectronicPrescriptionServices

The Electronic Prescription Service is an NHS servicethat allows a GP to send prescriptions directly to apatient’s chosen pharmacy. This means that patientscan choose to have a paper-free prescription.

FYFV Five YearForward View

The NHS Five Year Forward View was published on 23October 2014 and sets out a new shared vision for thefuture of the NHS based around the new models of care.It has been developed by the partner organisations thatdeliver and oversee health and care services includingCare Quality Commission, Public Health England andNHS Improvement (previously Monitor and NationalTrust Development Authority).

NHS e-RS(C&B)

NHS e-ReferralService (formallyChoose andBook)

NHS e-Referral Service replaced Choose and Book in2015. This service is used to manage all appointmentsreferred to secondary care from primary care.

GMS General MedicalServices

The range of healthcare that is provided by GeneralPractitioners. This is a local contract agreed betweenNHS England and the practice, together with its fundingarrangements. This is a nationally directed contractbetween NHS England and a practice.

GP general practice General practice (GP) General practitioners (GPs) treatall common medical conditions and refer patients tohospitals and other medical services for urgent andspecialist treatment. They focus on the health of thewhole person combining physical, psychological andsocial aspects of care.

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Term Definition

GPES general practiceExtractionService

A centrally managed service that extracts informationfrom general practice IT clinical systems for a widerange of purposes. It also forms part of the new processfor providing payments to GPs and clinicalcommissioning groups (CCGs).

GP IT general practiceInformationTechnology

The digital systems and services accessible to, andused by practices to deliver services to patients.

GPSoC GP Systems ofChoice

GP Systems of Choice is a programme through whichthe NHS funds the provision of GP clinical IT systems inEngland.

GP2GP GP2GP GP2GP is a project that enables the Electronic HealthRecord (EHR) of a patient to be transferred securelyand directly to a new practice when the patient registersat that practice.

Hardware refresh Computer hardware ages over time and needs to bereplaced; this is the term used for the refresh process.

NHS Digital(HSCIC)

Health and SocialCare InformationCentre

The national provider of information, data and ITsystems for commissioners, analysts and clinicians inhealth and social care.

NHS Digital (HSCIC) is an executive non-departmentalpublic body, sponsored by the Department of Health.

HSCN Health and SocialCare Network

The Health and Social Care Network provides a reliable,efficient and flexible way for health and careorganisations to access and exchange electronicinformation.

The programme was established in July 2014 tomanage the exit from the existing N3 contract (whichexpires in March 2017) and to provision successornetwork services capable of supporting the health andsocial care system.

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Term Definition

IG InformationGovernance

The set of multi-disciplinary structures, policies,procedures, processes and controls implemented tomanage information.

Informedcustomer

Informed customer for IT, ensuring that local decision-making about procuring new systems delivers value formoney for patients.

IPtelephony

Internet Protocoltelephony

IP telephony is a general term for the technologies thatuse the Internet Protocol's packet-switched connectionsto exchange voice, fax, and other forms of informationthat traditionally have been carried over the dedicatedcircuit-switched connections of the public switchedtelephone network.

IT DeliveryPartner

IT delivery partners are contracted organisationsprocured by CCGs and/or CSUs to deliver IT servicesfor GP Practices against clearly defined service levelagreements and KPIs.

KPI Key PerformanceIndicator

A set of quantifiable measures used to gauge orcompare performance in terms of meeting their strategicand operational goals

ISB InformationStandards Board(no longer inexistence)

No longer in existence, the Information Standards Boardfor Health and Social Care (ISB) previously approvedinformation standards for implementation in Englishhealth and care. Responsibility for the recommendationfor approval of information standards has nowtransferred to the Standardisation Committee for CareInformation (SCCI).

LDR Local DigitalRoadmap

Local health economies are required to produce LocalDigital Roadmaps detailing the actions they will take todeliver the ambition of being paper-free at the point ofcare by 2020. Local Digital Roadmaps will generatemomentum and drive transformation across local healtheconomies, inform local investment priorities andsupport local benefit realisation strategies.

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Term Definition

LHC Local HealthCommunity

Local Health Communities are New Models of Carewrapped around local people, spanning across all healthand social care services. They are often made up of anumber of service providers from health and social careand third sector organisations to deliver service toresidents in the area.

LPF Lead ProviderFramework

The Lead Provider Framework (LPF) enables ClinicalCommissioning Groups (CCGs), NHS England andother customers to source some or all of theircommissioning support needs, ranging fromtransactional back office support services to morebespoke services that support local and large scaletransformational change projects.

LSP Local ServiceProvider

The LSP contracts deliver critical systems and servicesto the NHS.

MCP MultispecialtyCare Providers

MCPs are made up of different health professionalsincluding GPs, nurses, community health services andhospital specialists. Following a rigorous selectionprocess, a number of Multispecialty Care Providershave been designated as vanguards and will movespecialist care out of hospital and into the community.

MIU Minor InjuriesUnit

Minor Injury Units treat patients whose injuries are notcritical and do not need to go directly to A&E

N3 National Networkfor the NHS (N3)

N3 is the national broadband network for the EnglishNHS, connecting all NHS locations and 1.3 millionemployees across England.

NIB NationalInformation Board

The role of the National Information Board is to put dataand technology safely to work for patients, serviceusers, citizens and the professionals who serve them.The NIB brings together national health and careorganisations from the NHS, public health, clinicalscience, social care and local government, along with

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Term Definition

appointed independent representatives to develop thestrategic priorities for data and technology.

OrderCommunications

Electronic requesting and viewing of pathology andradiology tests and diagnostics.

PACS Primary andAcute CareSystems

Primary and Acute Care Systems join up GP, hospital,community and mental health services to break downbarriers and free up the redesign of care around theneeds of different patient groups.

PCES Primary Care ITEnablingServices

These are fundamental services provided to PrimaryCare contractors providing primary care essentialservices to a registered patient list, which are directlyfunded and commissioned by NHS England RegionalDCO teams. Service provision includes RegistrationAuthority Support Services, IG Support, Services,Clinical Safety Officer Support, NHS Mail AdministrationSupport.

PCTF Primary CareTransformationFund

The Primary Care Transformation (formerlyInfrastructure) Fund is a multi-year £1billion investmentprogramme to help general practice makeimprovements, including in premises and technology

PF@POC Paper Free at thePoint of Care

Paper free at the point of care means that all authorisedcare givers can access a patient’s relevant digitalrecords when and where they need them.

PMS Personal MedicalServices

PMS is a locally agreed alternative to General MedicalService (GMS) for providers of general practice. This isa local contract agreed between NHS England and thepractice, together with its funding arrangements.

PT PenetrationTesting

PT is a planned and ‘friendly’ (non-destructive) attack ona computer system with the intention of identifyingsecurity weaknesses.

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Term Definition

RA RegistrationAuthority

The roles and responsibilities of Registration Authoritiesare defined by NHS policy. In Public Key Infrastructure(PKI) terms there is a single Registration Authority (NHSDigital (HSCIC)). All organisations which run a localRegistration Authority do so, on a delegated authoritybasis from NHS Digital. The RA within the localgovernance structure must ensure that all aspects ofRegistration Authority services and operations areperformed in accordance with the NHS Digital (HSCIC)RA policy. The local Registration Authority ensures thatindividuals providing healthcare services to the NHSdirectly, or indirectly, have access to the Spine enabledapplications and information in accordance with theirrole.

RBAC Role BasedAccess Control

RBAC is the process through which a national set of jobroles, activities and workgroups can be applied to grantusers access to functionality and indirectly to data withinNHS national (Spine) services.

SCCI StandardisationCommittee forCare Information

The Standardisation Committee for Care Informationoversees the development, assurance and approval ofinformation standards, data collections and dataextractions. Membership is drawn from a wide range ofnational bodies and organisations involved in theprovision and management of health and care servicesin England. This ensures a system-wide, joined upapproach to decision making. SCCI meets on a monthlybasis and all its meeting papers are made availableonline.

SCR Summary CareRecord

The Summary Care Record is an electronic record usedto support patient care. The SCR is a copy of keyinformation from a patient’s GP record, such asmedication, allergies and adverse reactions. It providesauthorised healthcare staff with faster, more secureaccess to essential patient information.

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Term Definition

SFI StandingFinancialInstructions

These identify the financial responsibilities that apply toeveryone working for the Authority. The user of StandingFinancial Instructions must take into account relevantprevailing Department of Health and/or Treasuryinstructions. The Director of Finance must approve allfinancial procedures.

SLA Service LevelAgreement

Contract between a service provider and a customer. Itdetails the nature, quality, and scope of the service to beprovided. Also called service level contract.

Spirometry Spirometry is the most common of the pulmonaryfunction tests, a complete evaluation of the respiratorysystem including patient history, physical examinations,chest x-ray examinations, arterial blood gas analysis,and tests of pulmonary function.

STF Sustainability andTransformationFund

The NHS Spending Review provided dedicated fundingstreams for transformational change, which will formpart of a new wider national Sustainability andTransformation Fund. This will support initiativesincluding the spread of new care models, primary careaccess and infrastructure, technology roll-out, andclinical priorities.

STP Sustainability andTransformationPlans

Local health and care blueprints for acceleratingimplementation of the Forward View.

UPS UninterruptiblePower Supply

A power supply with battery backup, that incorporatessafe automatic power-down in the event of power loss

VDI Virtual DesktopInterface /Infrastructure

The practice of hosting a desktop operating systemwithin a virtual machine (VM) to access from a variety ofdevices.

VPN Virtual PrivateNetwork

Data traffic that is "tunnelled" through a less securephysical network (often a wide area network). Data on aVPN is encrypted to ensure end-to-end security.

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12. Appendix A – Developing the Informed CustomerFunctionIt is important that those responsible for general practice IT investment clearlyunderstand why they are investing and what they are investing in. A CCG which haseffective “informed customer” capability will:

Take ownership of the strategic IT direction relevant to primary caredelivery across their locality

Ensure local business strategies and service redesign programmes arealigned with NHS England IT strategies to ensure that GP IT is an effectiveenabler for service improvement which allows CCGs to achieve businessobjectives. This will include aligning stakeholder partners and facilitatingcollaboration where appropriate

Set clear service expectations (through specifications) for strategic partnersby clearly specifying local requirements in the form of a specification andsupporting Service Level Agreements to ensure local delivery partners areclear on service needs

Ensure value for money through the negotiation and contracting of serviceswith effective use of national frameworks and procurement mechanisms inaccordance with NHS England procurement rules

Establish effective governance and accountability arrangements whicheffectively engage strategic partners and hold delivery partners to accountfor their services, which will measured against well-defined and agreed KeyPerformance Indicators (KPIs)

Manage risks effectively and issues in accordance with system-wideprocedures to help ensure the safe and successful delivery of outcomesassociated with IT investment.

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13. Appendix B – Schedule of Services Category Definition

Service Category Definition of Service Category Supporting Notes

Core and MandatoryGP IT services

Technologies, systems and support servicesrequired to deliver Primary Care Essential Services(i.e. registered list based) and (contractually)mandated services and compliance. Alsoenablement of mandated requirements beyondgeneral practice where general practice is anessential component of mandated solution.

These are the fundamental services to becommissioned by CCGs, for GP practices, toenable the effective delivery of health and care. Adetailed service schedule of 'core' service provisionat a local level is to be included within theappendices of the nationally agreed CCG-PracticeAgreement, to ensure GPs are aware of localservice provision arrangements.

Core and mandated GP IT services will be the firstcall on GP IT revenue funding that will be providedas part of annual CCG baseline allocations.

Includes:

GP IT enabling requirements, includingclinical systems, support services/functionsand associated infrastructure needed tosupport the delivery of primary care essentialservices (registered list based) under GMS,PMS and APMS contractual arrangements.

GP IT accountability requirements includingmandated utilisation of and integration withnational systems for example spine, DTS,GP2GP, SCR, Patient Online.

Mandated digital services where GP servicesform an essential component of delivery forexample. e-Discharge.

GP Practices should be able to quickly andeasily to determine which core andmandated services have been commissionedon their behalf.

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Enhanced PrimaryCare IT

Technologies, systems and support services whichenable and improve efficiency and effectiveness ofgeneral practice including primary care at scale.

These are discretionary primary care IT servicesthat are developed and agreed locally to supportlocal strategic initiatives and commissioningstrategies to improve service delivery.

Investments in enhanced primary care IT shouldsupport the CCG(s) local digital strategy and LocalDigital Roadmap and where possible, strategicrather than tactical solutions should be developed.

Funding for enhanced primary care IT may comefrom a variety of sources, including but not limitedto GP IT monies/CCG allocations, once core andmandated GP IT services are provisioned,transformation or GP Access Funds, local businesscase development and/or direct CCG/GP practicefunding.

Broadened from GP IT to primary care IT - totake account of primary care at scale.

Focussed on improving efficiency andeffectiveness:

Optimising existing systems and/orinfrastructure, including interoperabilityopportunities, efficiency release

Innovative and effective approaches that willbetter support changes in delivery of primarycare services

Supporting 7 day week and extended hoursworking

Supporting practice collaborative/at scalemodels for example. Confederated working,GMS Plus/medical home models, as thesedevelop.

N.B. Excludes full shared care modelsacross care settings (Transformation)

TransformationalPrimary Care IT

Technologies, systems and support services whichenable new models of care, service integration,

Primary care IT that involves significantbusiness change/channel shift.

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wider GP functions, MCP and PACS organisationalmodels.

These are discretionary primary care IT servicesthat are developed and agreed locally to supportlocal strategic initiatives and commissioningstrategies to improve service delivery.

Investments in transformational primary care ITshould support the CCG(s) local digital strategyand Local Digital Roadmap and where possible,strategic rather than tactical solutions should bedeveloped.

Funding for transformational primary care IT maycome from a variety of sources, including but notlimited to GP IT monies/CCG allocations, onceCore and Mandated GP IT services areprovisioned, transformation or GP Access Funds,local business case development and/or directCCG/GP practice funding.

New or additional systems, services orinfrastructure, that will enable integration ofhealth and care and delivery of new andinnovative healthcare models, where multipleorganisations across care settings areworking with general practice to sharepatient care, including:

Primary and acute care deliverymodels (PACs)

Multispecialty Care Providers (MCPs) Integrated health and care models

Patient active contribution to their record andelectronic care planning.

Primary Care ITEnabling Services(Commissioned byNHS England)

These are fundamental support services providedto primary care contractors providing primary careessential services to a registered patient list, underGMS, PMS or APMS contractual arrangements thatare directly funded and commissioned by NHSEngland regional teams.

NHS England regional DCO teams areresponsible for commissioning primary careIT enabling services as outlined within thisoperating model.

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Service provision includes:

Registration Authority Support services IG support services Clinical Safety Officer support NHS Mail administration support

General practicebusiness supportsystems

Systems and services which a practice may utilisefor business purposes, which are not directlyrelated to patient care.

N.B. The 'Global Sum' within the General MedicalServices (GMS) contract (and PMS/APMSequivalent) makes provision for practice expensesincluding staff costs and general running costs ofthe practice (stationery, telephone, heating andlighting, repairs and maintenance).

With evolving primary care delivery models, localservice/support arrangements may develop thatincorporate aspects of service provision that wouldtraditionally have been considered GP businesssupport functions to be directly funded by thepractice under GMS (and PMS/APMS equivalent)contractual arrangements.

The majority of GP business supportsystems should be considered out of scopewhere they are:

Services already funded elsewhere Business running costs eg

consumables Internal business support systems,

not part of clinical service delivery egpayroll, HR, estate management.

These services should routinely be assumedto be out of scope, unless local businesscases can demonstrate patient benefit, inwhich case, when considering funding any ofthese services, CCGs should take account ofwhether this service is already funded viaalternative routes eg global sum (GMS, PMSor APMS) contract.

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Where there is demonstrable benefit ofincorporating elements of GP business supportservices eg telephony/Voice Over IP as part ofbroader efficiency release and improved patientcare initiatives, GP contributions are to beconsidered as part of local fundingprovision/business case arrangements.

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14. Appendix C – Schedule of Services GP IT

Service name Servicesummary(scope)

DigitalMaturityAssessmentreference

Servicecategory

Service description (What does the commissioner haveto do? How is this delivered?)

GP IT SupportService Desk

GP IT supportservice desk forall users whichprovides: Triage Incident

management Problem

management Request

management SLA reporting Business

continuity andcriticalincidentmanagement

26, 28 Core andmandated GP ITservices

The local SLA is based upon an agreed supported IT devicevolume.

An ITIL aligned or equivalent, management process for: Incidents Problems Requests

Service specification and performance standardsdocumented and agreed. The following industry standardsare applicable and where relevant, should be incorporatedwhen agreeing the SLA:

ISO 20000 – IT Service Management Standard(previously BS 15000)

ISO 9000 series – Quality Management Systems(previously BS 5750)

Consistent service availability for core GMS contractedhours, as detailed in the GMS contract (08:00 - 18:30,Monday to Friday, excluding Bank Holidays)

Access channels - there must be:

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Servicecategory


A single telephone number for logging calls A single email address for logging calls A web portal for logging and managing calls.

It must be possible to log a call using at least one of thesemethods 24 hours a day, 7 days a week.

The service must have clear and agreed priority incidentcategories, with minimum response and target fix times toensure the safe and effective operation of GP digitalservices.

All calls are prioritised to the agreed standard, inconjunction with the person reporting the incident.

A minimum standard should be agreed forpercentage of incidents resolved on first contact orwithin an agreed timeframe from call logging.

Where 3rd party support is required for incident orproblem management, there is a robust and effectiveresolution plan in place with agreed responsibilities.

IT Support for 7Day andExtended HoursServices

GP IT supportservice,supportinggeneral practicesprovides, when

91 Enhancedprimary care IT

Service provision should be agreed at an appropriate levelwithin the SLA, for safe and effective delivery of these GPservices.

Options for service delivery could include:

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Servicecategory


offered, thefollowingservices: Extended

hours (DES)services topatients

7 day weekservices topatients

An urgent business critical break-fix only service isavailable outside GMS core hours to supportpractices

A restricted service is available outside GMS corehours to support practices

A full service is available outside GMS core hours tosupport practices

The commissioner should ensure, with the support of their ITprovider, that where 3rd party support outside GMS corehours is required for incident or problem management, thereis a robust and effective resolution plan in place.

IT SecurityService

IT securitymanagement andoversight,includingconfigurationsupport, audit,investigation androutinemonitoring,relevant to theinfrastructure andservices provided

29 Core andmandated GP ITservices

Service provision should be agreed at an appropriate leveland capacity within the SLA, to include the following:

Adherence to the appropriate security guidance,including principles of information security and the'Information Security Management: NHS Code ofPractice':

NHS Digital Principles of Information Security

NHS Codes of Practice and Legal Obligations All necessary IT security evidence to support IGT

requirements for general practice

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Servicecategory


through thisschedule.

Audit and investigative services Specialist consultancy

Cyber security: Demonstrate alignment with industry best practice ie

the Cyber Essentials scheme which providesindependent assessment of the security controls inplace. The scheme forms part of the UK's cybersecurity strategy, with suppliers tested on whetherthey can mitigate risks from internet-borne threats onend-user devices including PCs, laptops, tablets andsmartphones, as well as from email, web andapplication servers.

Review local cyber security measures as a minimumannually.

The following industry standards are applicable and whererelevant, should be incorporated when agreeing the SLA:

ISO 270001 for Information Security Management(previously BS 7799)

NHS Information Governance Toolkit (level 2)

All shared infrastructure should have CESG CHECKapproved penetration testing carried out at least once every12 months.

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Servicecategory


Service provision arrangements will need to reflect futureNHS recommendations.

N.B. A review of standards of data security for patients’confidential data across the NHS is underway, withrecommendations anticipated on how the new guidelinescan be assured through CQC inspections and NHS Englandcommissioning processes.

CoreInfrastructureService

Should include: Networking

services,includingHealth andSocial CareNetwork(HSCN)connectivityonce availableand N3connectivityprior to that,as well asnetworksupporting

Core andmandated GP ITservices

Provision, maintenance and technical support of thenecessary infrastructure to deliver core GP IT Services, toinclude:

Network connectivity and access to core GP IT services atpoint of care.

Networking services: Management and support for provision of HSCN

(Health and Social Care Network) connectivity, onceavailable, and N3 connectivity prior to that, includingconnections to main and branch practice sites as pernational entitlement.

Local network services, including equipment, cablingand support.

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Servicecategory


infrastructureeg equipmentand cabling

Filemanagement,data storageand hostingservices

File management, data storage and hosting services forcore services:

Provide access to a secure, resilient off site datastorage facility for all practice data required fordelivery of clinical services, other than that held inexternally hosted applications such as GPSoC clinicalsystems and NHS Mail, to a standard not less that tier3 data centre. Examples include clinical documentseg multi-disciplinary Team discussions/clinical casereviews/referral management reviews, clinicalprotocols etc.

The GP IT delivery partner and any subsidiary service andinfrastructure provided will operate to any prevailing NHSsecurity standards, including Information Governance Toolkitor equivalent industry standard.

Maximum use should be made of best practice to reducecosts and increase efficiency such as server virtualisationand storage area networks.

EnhancedInfrastructure

May include: Networking

services,

31 EnhancedPrimary Care IT

Networking Services:

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Servicecategory


includingadditionalHSCNservices ortop up N3services priorto theintroduction ofHSCNservices andlocalCommunity OfInterestNetwork(COIN)

Networksupportinginfrastructureeg equipmentand cabling

Enhanced oralternativearchitectures

Management and support for provision of additionalHSCN services or top up N3 services prior to theintroduction of HSCN services

Where COINs are a feature of local digital primary careinfrastructure, the use of GP IT allocated funds, to supportthese, needs to consider the following:

Where the COIN is used to support GP IT there is aclear requirement for this in addition to centrallyfunded N3 services or successor HSCN connectivity

Where the COIN is shared between providers, thecosts need to be appropriately proportioned

Where the COIN is used to support GP IT, thenetwork must have sufficient bandwidth, low latencyand low contention ratio to support the necessaryservices

N.B. The cost of COINs which are cross care settingsshould be shared with those care settings.

Local network services, including equipment, cablingand support associated with top up of N3 and localCOIN

Enhanced or alternative architectures including: Virtual Desktop Interface (VDI)

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Servicecategory


Citrix Access Gateway (CAG) Smartcard/Remote Secure Access Token

authentication Single sign on Bring Your Own Device (BYOD)

Estates StrategyService

Provision ofadvice andguidance tosupport thedevelopment ofGP IT estaterelevant to theprovision of ITservices andsystems

Core andMandated GP ITServices

Service provision should be agreed at an appropriate leveland capacity within the SLA, to include the following:

Advice on IT infrastructure requirements andstandards

Identify, as required, suppliers for IT infrastructureand external services (for example. HSCNconnectivity or N3 connectivity prior to theintroduction of HSCN services)

Support development of associated business case forindividual estates projects, including consideration ofresource and funding requirements

Advice and guidance should include consideration oftransformation opportunities, enhanced GP ITservices and local digital strategy

Any increase in the IT supported estate will requireagreement between the commissioners of primary care(NHS England/CCG) and GP IT services (CCG), GP and theIT delivery partner.

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Servicecategory


The resourcing and funding for individual estatedevelopment projects should be incorporated into the overallbusiness case for that development.

Local DeviceMaintenanceand SupportServiceincludingClinical ServerSupport

A comprehensivedesktop devicesupport service,which includesprovision andmaintenance ofthe supporteddesktop estate.

Provision andtechnical supportof any necessarylocal clinicalservers.

14, 15, 58 Core andmandated GP ITservices

The local SLA is based upon an agreed desktop estatevolume.

IT Equipment: The GP IT infrastructure estate supporting core GP IT

includes desktop, server equipment, as appropriate tomeet GPSoC and GP IT Operating Frameworkrequirements

There should be an agreed desktop WarrantedEnvironment Specification (WES) which as aminimum, meets the national WES and the relevantGPSoC clinical system WES

User workstations must be locked down and wellmanaged, with advanced tools, processes andpolicies in place to support diagnosis, repair andupdates. Users must not be able to install unlicensedand unauthorised software or change critical settings.Unsupported (by software supplier) browsers,Operating Systems and business or clinical criticalsoftware must not be used on managed equipment

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Servicecategory


Computers/Workstations: Installation and support of all computers and

peripheral equipment related to core GP IT services Installation and support of all approved standard

software and applications Anti-virus and malware protection, access

management and port control on all active desktopdevices

Encryption to NHS standards on all mobile/portabledevices as outlined in guidance on theimplementation of encryption within NHSorganisations (NHS Digital (HSCIC)):

Guidance on the implementation of encryption within NHSorganisations

Principles of Information Security Defined and documented standardised desktop

image(s), with a formal change control managementsystem

Remote desktop support management available to100% of workstations

Compliance testing and installation of standardsoftware products

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Servicecategory


Compliance testing of software upgrades with NHSnational systems/products

Local servers:

Where local clinical servers are required as part of theGPSoC principal clinical solution, these will be secure,maintained and in line with clinical system vendor(s)Warranted Environment Specification (WES). These will bephysically and technically secured, backed up wherepersistent clinical data is held and have a protected powersupply. Where there are local back up media, this is theresponsibility of the practice. Backup media must be storedin an appropriate environment and tested periodically toensure that data is recoverable. An appropriate storageenvironment for backup media will comprise a fire proofsafe, preferably at an offsite location, but certainlysomewhere other than the server room if the backup mustbe stored in the same building. Backup media from theprevious evening should be removed and placed into safestorage the following morning. The integrity of backup mediafor local GPSoC principal clinical systems must be regularlyvalidated (quarterly) and media should be replaced whenfaulty and not less often then every three years. This cost of

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Servicecategory


backup media for core GPSoC clinical systems is includedwithin this service.

Refresh Programme:

The CCG will have a budgeted plan for core GP ITequipment refresh which includes: desktop PCs, monitors,scanners, smartcard readers, barcode readers, printersincluding dual bin feed printers for consulting rooms wherenecessary.

The CCG will ensure a continual refresh programmewhich identifies and replaces hardware where it hasreached its service life

A local IT refresh and replacement plan will defineequipment standards, availability for practices (whereappropriate by practice type, size, clinical system etc)and target service life by equipment category

The refresh service will include assessment,procurement, rollout, asset tracking and securedisposal (see "Asset Management and SoftwareLicencing Service”)

N.B. The practice is responsible for: Consumables

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Servicecategory


Physical security and environmental requirements (egair-conditioning and fire suppression) and powersupply for GP IT equipment on GP practice premises

Remote accessto the clinicalsystem at thepoint of care

GPs have secureaccess to theclinical systemoutside thepractice tosupport clinicalconsultation.

Provision,maintenance andsupport ofnecessary mobileinfrastructure tosupport clinicalsystem access atthe point of care.

Mobile devicesunder NHSownership ormanaged by theCCG

15, 33 Core andmandated GP ITservices

The local SLA is based upon an agreed mobile estatevolume.

Provision, maintenance and technical support of thenecessary technology and supporting infrastructure todeliver remote access to the GP IT clinical system forconsultation purposes.

The use of mobile computing systems is controlled,monitored and audited to ensure their correct operation andto prevent unauthorised access, supporting IGTrequirements for general practice.

Mobile devices must be locked down and well managed,with advanced tools, processes and policies in place tosupport diagnosis, repair and updates. Users must not beable to install unlicensed or unauthorised software orchange critical settings.

Encryption to NHS standards on all mobile/portabledevices as outlined in guidance on theimplementation of encryption within NHSorganisations (NHS Digital (HSCIC)):

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Servicecategory


commissionedGP IT supportservice.

Principles of Information Security

Guidance on the Implementation of Encryption within NHSOrganisations

Refresh Programme: The CCG will have budgeted plan for mobile GP IT

equipment refresh The CCG will ensure a continual refresh programme

which identifies and replaces mobile hardware whereit has reached its service life

A local IT refresh and replacement plan will definemobile equipment standards, availability for practices(where appropriate by practice type, size, clinicalsystem etc) and target service life by equipmentcategory

The refresh service will include assessment,procurement, rollout, asset tracking and securedisposal (see "Asset Management and SoftwareLicencing Service”)

Remote accessto the clinicalsystems for


The local SLA is based upon an agreed mobile estatevolume.

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Servicecategory


administrativepurposes Provision, maintenance and technical support of the

necessary technology and supporting infrastructure todeliver remote access to the clinical system foradministrative purposes.

The use of mobile computing systems is controlled,monitored and audited to ensure their correct operation andto prevent unauthorised access, supporting IGTrequirements for general practice.

NHS owned or managed devices must be locked down andwell managed, with advanced tools, processes and policiesin place to support diagnosis, repair and updates. Usersmust not be able to install unlicensed or unauthorisedsoftware or change critical settings.

Encryption to NHS standards on all mobile/portabledevices as outlined in guidance on theimplementation of encryption within NHSOrganisations (NHS Digital (HSCIC)):

Guidance on the Implementation of Encryption within NHSOrganisations

Principles of Information Security

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Servicecategory


Refresh Programme: CCG budgeted plan for mobile GP IT equipment

refresh. Availability of these will be defined in theagreed IT refresh plan

The CCG will commission a continual refreshprogramme that will identify and replace hardwarewhere it has reached its service life change date,including assessment, procurement and rollout

DisasterRecovery andBusinessContinuitySupport Service(part 1)

Advice on thedevelopment ofGP businesscontinuity plansand disasterrecoveryarrangements.


Each practice will maintain a disaster recovery (DR) andbusiness continuity (BC) plan. Assurance will be providedthrough the general practice Information GovernanceToolkit.

The CCG will ensure advice/guidance to support thedevelopment of practice DR and BC plans, is available topractices when required.

In the event of a local DR or BC plan being invoked the CCGwill ensure technical support is available as necessary.

DisasterRecovery andBusinessContinuity

CCGcommissionedGP IT serviceprovider will


The CCG requires its GP IT delivery partner, as part ofservice specification/SLA arrangements, to maintain adisaster recovery and business continuity plan.

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Servicecategory


Support Service(part 2)

develop, test andmaintain DR andBC plans,relevant to GP ITservices.

The CCG commissioned service provider for GP IT serviceswill have an annually reviewed, tested business continuityplan and validated IT disaster recovery plan for servicescritical to GP service continuity.

AssetManagementand SoftwareLicencingService

All NHS ownedGP IT equipmentand softwareoperated onsupported GP ITequipment

Asset and licensemanagement

Asset disposal


GP IT equipment (supported and/or NHS owned): Is recorded in an accurate asset register Is subject to an approved IT reuse and disposal policy

and procedure - using authorised contractors - thisshould be compliant with European Communitydirective 2002/96/EC, The Waste Electrical andElectronic Equipment Directive (WEEE Directive).Certificates of destruction of assets are required ondisposal of data processing IT equipment

Software: All software (including operating systems) used on

NHS owned GP IT infrastructure by the practice mustbe approved and recorded on a software licenceregister which must confirm that the software isappropriately and legally licenced for such use.

Ensure that software meets the agreed WESrequirements (to support national and GPSoC clinicalapplications)

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Servicecategory


Ensure there is effective patch and upgrademanagement for operating systems and software inplace

GPSoC systemsupport

GP clinicalsystems andcentrally fundedsubsidiarysystemsaccessed throughthe GPSoCframework.

Support for coregeneral practiceclinical systemson behalf of theGP practices.


Supplier Management and Liaison for GP Systems ofChoice (GPSoC) including:

Local management of service supportcontracts/supplier liaison

Ensure local GPSoC call-off contracts are current andaccurate (i.e. Schedule A)

Manage local payments ensuring that all chargesincurred are current and accurate, includingpayments for additional software to enhance thefunctionality of the clinical system

Inform clinical system suppliers of any changes toexisting contracts, for example. terminations due toGP practices exercising their contractual right tochoice of system

Maintain the Tracking Database (TDB) to ensure theintegrity of GPSoC contracts

Liaising with GPSoC suppliers re: future requirementsand developments

In the event of any unresolved issues, escalate tosuppliers on behalf of GP practices to facilitate asatisfactory resolution

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Servicecategory


To support CCG to meet their requirement to monitorand escalate to NHS England general practice andclinical systems performance in relation to the use ofGP IT services and systems provided under the GPIT operating model

General: Ongoing technical support for GP clinical systems

including technical liaison with GPSoC supplier andclinical application support where not provided by GPsystem supplier


To meet CCG responsibilities to monitor and escalateto NHS England clinical systems performance issuesin relation to the use of GP IT services and/orsystems provided under the GP IT operating modeland/or GPSoC

Migrations and mergers:

Subject to local business case approval, core serviceprovision would include deployment costs such as datamigration, essential infrastructure upgrade requirements,

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Servicecategory


project management, training, technical support, retention oflegacy system and/or data and audit retrieval requirements.

GPSoC (Lot 2) GPSoC Lot 1 and2 related costsnot centrallyfunded

Enhancedprimary care IT

GPSoC Lot 2 services

GPSoC Lot 1 Subsidiary Services where not centrallyfunded.

GPSoC (Lot 3) GPSoC Lot 3costs notcentrally funded

Transformationalprimary care IT

GPSoC Lot 3 services

IT Procurementand SupportService

Facilitating CCGGP IT deliverywith procurementsupport throughto contract andsuppliermanagement andtechnical support,where these arenot sourcedthrough GPSoCframework.


Procurement Service: Provide strategic procurement advice, recommending

collaboration and standard specifications to optimiseefficiency and support costs

Advice and assistance in the development of outputsbased specifications to support GP IT procurementprojects

Procure GP IT using national frameworks asappropriate

CCGs need to ensure that any procurement activity insupport of GP IT, delegated to IT delivery partner(s),does not create conflicts of interest or potentialprocurement challenge

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Servicecategory


General practice clinical systems: Ongoing technical support for general practice clinical

systems including technical liaison with systemsupplier and clinical application support where theseare not provided by system supplier

Management of ongoing system updates asnecessary where these are not provided by systemsupplier


EffectiveCommissioningof GP ITServices

ThecommissionedGP IT services


Where GP IT services are commissioned and contracted,there will be:

Robust and clear service specificationsdemonstrating alignment with this schedule ofservices

Formal SLAs in place Identified and agreed KPIs Regular performance reviews An individual annual practice service review Issue management and escalation arrangements

agreed and clearly documented Formal complaints management procedure

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Servicecategory


A communication plan regarding GP IT for all generalpractices

CCG PracticeAgreement

CCG PracticeAgreement:Terms governingthe provision andreceipt of GPSoCservices and GPIT services


The CCG Practice Agreement is agreed locally, with allassociated documentation included within the appendices.

The CCG Practice Agreement is signed by both the CCGand all individual GP practices, as a core contractualrequirement.

The CCG will ensure that it has the necessary supportavailable to enable compliance with CCG PracticeAgreement, to meet both national and local requirements.

Training andSystemsOptimisation

Training servicesupporting thesafe and effectiveuse of coreclinical systemsand theiroptimisation.


The Practice and CCG responsibilities for training aredescribed within the CCG Practice Agreement

The local SLA should quantify training resources based oneither the number of practice staff or the number of practices(weighted by population where appropriate).

The service should include training for: GPSoC core clinical systems National digital systems eg SCR, EPS2, ERS

And will include training requirements arising from:

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Servicecategory


Staff turnover Refresher training New system functionality

System Optimisation: Support practice optimisation of principle GP clinical

systems and national digital systems, by providingsupport, guidance and advice, including User Groupfacilitation to enable sharing of best practice

Training delivery should reflect: Practice training plans and staff training needs

analysis Environment and estate accommodation and facilities Virtual and online delivery channels Resource availability User satisfaction and customer feedback

N.B. Training for business administration and office systemsis the responsibility of the practice.

NationalStrategicSystem

Promotion,deployment/implementation andsupport of


Advise practices on current and planned nationaldevelopments and solutions.

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Servicecategory


ImplementationService

national digitalsystems,including SCR,EPS2, e-RS,Patient Onlineand GP2GPservices.

Maintain national tracking database with local status ofsystem deployments, changes and updates as requirednationally.

Local deployment programme for national systemsimplementation within general practices, including benefitsrealisation, stakeholder engagement, business changesupport.

Project andChangeManagementService

GP IT servicesinclude formalP3M (Project,Programme andPortfolioManagement)methodologieswhich arerecognised andused in thedeployment ofGP clinicalsystems, localimplementation ofnational solutionsand major


The CCG will ensure skilled project and programmemanagement resources are available, to deliver the plannedprogramme of work, both nationally and locally driven. Thismay be provisioned within current SLA supportarrangements, or could be procured on an ‘as required’basis.

The CCG needs to ensure that there is access to asustainable skilled resource, whilst securing best value formoney.

The service should include: Programme management Project management Technical support Change management

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Servicecategory


primary care ITinfrastructurechanges orupgrades.

Benefit realisation support

Electronicmessaging fordirect patientcommunication

Electronicmessaging (SMSor equivalent) fordirect individualpatient clinicalcommunication.


Provision of electronic messaging functionality ie SMSmessaging, for direct unidirectional individual patientcommunication, to be utilised for clinical and associatedadministrative purposes.

The functionality should only be used for communicatingshort messages to patients, to a locally agreedstandard/format, for example:

Reminders of forthcoming appointments Requests for patients to make an appointment for

example: immunisations, routine reviews, blood test Notifications of ‘missed’ appointments (DNA’s) Notifications of ‘normal’ test results

Reference: GP IT Operating model NHS England letter toCCGs 19/06/15 Gateway Reference 03635

All practices have access to SMS (or equivalent messagingsystem) integrated with the practice principal clinical systemto support communications with patients.

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Servicecategory


Local DigitalStrategy

Strong localleadership todevelop anddeliver localdigital strategy,including GP IT.

86, 12, 151,152, 153, 156

Core andmandated GP ITservices

The CCGs should: Have access to horizon scanning and advice on best

practice and digital innovation Appoint a Chief Clinical Information Officer (CCIO) or

equivalent accountable officer (dedicated or shared)who will provide (clinical) leadership for thedevelopment of local digital strategy including thedevelopment of GP IT services

Develop a commissioning-led digital strategy,supporting innovation, service improvement andtransformation, with GP IT as a key component. Thiswill support the development of Local DigitalRoadmaps

Ensure CCG and GP requirements are represented inany relevant local, regional or national forum

GP Data QualityService

Data qualitytraining, adviceand guidance


Comprehensive data quality advice and guidance service isavailable to all GPs, including training in data quality, clinicalcoding and information management skills.

Development and delivery of a general practice data qualityimprovement plan, where necessary.

The service should include support for:

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Servicecategory


National data audits/extracts/reporting eg NationalDiabetes Audit

General reporting Template development/QA Spreading best practice Data migrations as part of system deployments National system deployments for example. GP2GP,

SCR, CAB/e-RS, EPS Clinical/medical terminology

GP Data QualityAccreditationService

A structured dataqualityaccreditationprogramme isavailable for GPsto ensurecontinuousreview andimprovement


Formal data accreditation support programme that includes:

Data quality baseline/audit review Development and delivery of a GP data quality

improvement plan with practice(s) A formal rolling data accreditation programme for GP

practices that will underpin key work streams tosupport paper free / 2020 vision.

CQRS / GPESSupport

CQRS/GPEStraining, adviceand guidance


Comprehensive CQRS/GPES advice and guidance serviceis available to all GPs, to include review, report managementand remedial action planning, particularly around exceptionreporting, to ensure appropriate data quality within GP sitesto enable effective Quality and Outcomes (QOF) reporting.

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Servicecategory


Wi-Fi forClinicians

Wi-Fi access inGP premises forprimary caredelivery staff


Access to secure Wi-Fi in primary care locations for GPs,clinical primary care and other local clinical provider staff.

Primary Care AtScale

Digitalenablement tosupport primarycare at scale


Practices working collaboratively eg in federations mayrequire clinical systems and IT infrastructure which supportcollaborative working including:

Access to clinical records between practices Shared patient administration, appointment

management and transactions between practices Reporting capabilities across practice federations eg

central reporting Shared infrastructure capabilities eg Active Directory,

file management, intranet etc Digital solutions that support 7 day working E-consultation E-triage

Clinical DecisionSupport

Where notcentrally funded /provisioned


Drug formulary and advice systems Clinical decision support systems

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Servicecategory


DigitalEnablement /PracticeEfficiency /Service Quality

Internal practiceefficiency


Example List - not exhaustive: Patient arrival and kiosk systems, patient touch

screens Display screens (for example. 40 inch TV screens

and or Jayex Boards), projectors, multi-functiondevices, webcams

Blood pressure monitoring, spirometry, 24 ECGhardware and software

Digital cameras Telehealth and monitoring Telemedicine Software for chronic disease management, drug

monitoring, anticoagulation management software,dispensary software, dictation software

Digital order communications and results reporting forlaboratory, imaging and diagnostic tests.

Practice intranet Advanced appointment management Advanced document management Workflow and task management Data entry e-forms

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Servicecategory


AdditionalLocallyCommissionedServices

Additional toGMS primarycare services


Example List - not exhaustive: Local enhanced services and GP specialist interest

schemes Specialist service clinical software/IT infrastructure

SecondaryUsage

Secondary datause


Risk stratification Hospital admissions monitoring Data extraction tools, where not centrally funded Data extract, transfer and analysis (in support of

public health, child health and contracting monitoring)

Patient FacingDigital Services

Where notcentrally funded


Example List - not exhaustive: Patient access portals Patient held records and/or devices Public facing Wi-Fi in GP - (managed and secured

separately from any clinical Wi-Fi services and N3) Data entry e-forms

AdvancedTelephony

Digitalenablement oftransformedprimary care

57 Transformationalprimary care IT

Telephony solutions where they are: Community/inter-practice footprint; and Integrated with other digital services; and Enable transformed primary care

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Servicecategory


Interoperability Interoperabilitysolutions wherenot centrallyfunded


Interoperability solutions supporting: Transactional services eg appointment management Access to shared records Clinical document sharing Notifications and tasks Care coordination including End of Life (EoL)

IntegratedHealth and Care

Integrated healthand care


Record sharing initiatives and support forservice/commissioning re-design

Clinical record portals A&E, MIU, 111, WIC links

general practiceBusinessSupportSystems

Systems andservices which apractice mayutilise forbusinesspurposes, whichare not directlyrelated to patientcare and whichNHS Englandfunds via GMS(and PMS

General practicebusiness supportsystems

With evolving primary care delivery models, localservice/support arrangements may develop that incorporateaspects of service provision that would traditionally havebeen considered GP business support functions to bedirectly funded by the practice under GMS or PMSequivalent, contractual arrangements.

Where there is demonstrable benefit of incorporatingelements of GP business support services egtelephony/VOIP as part of broader efficiency release andimproved patient care initiatives, GP contributions are to be

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Servicecategory


equivalent)contractualarrangements

N.B. The 'GlobalSum' within theGeneral MedicalServices (GMS)contract (andPMS/APMSequivalent)makes provisionfor practiceexpensesincluding staffcosts and generalrunning costs ofthe practice(stationery,telephone,heating andlighting, repairsandmaintenance)

considered as part of local funding provision/business casearrangements.

GP IT money must not be spent purchasing or supportingthe following:

Email systems other than NHSmail Provision of suitable environment including local

physical security and supply of power within practices Funding local consumables (for example. printer ink

and paper) PAT Testing for all IT equipment used on practice

premises (estates management responsibility) Payroll and accounting software licences Production of staff ID cards for new employees and

changes to existing employees (name, role etc.) Practice-hosted provider services, operating outside

Primary Care essential services under GMS, PMS,APMS contracts for example. provision of sexualhealth services

Managing and maintaining systems that only supportthe practice as a business for example. payroll, HRsystems, photocopiers, faxes

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Servicecategory


InformationGovernanceService

To provide a fullrange ofinformationgovernanceservices andadvice to supportGP Practicecompliance withcommon-law dutyof confidence,Data ProtectionAct and Caldicottstandards and toensure alldevices andsystems aremanaged andused in a secureand confidentialway

Primary care ITsupport services(Commissionedby NHS England)

Core IG support services:IG policy support

Support for the production and maintenance of localinformation governance policies and procedures.Provision of advice and support to GP practice onapproval, ratification and adoption of the policies fortheir organisation.N.B. GP practices are responsible for the production,approval and maintenance of (and adherence to) theirIG and IT security policies but support will beprovided.

IG incident managementProvision of advice and/or support to practices on theinvestigation of possible information securitybreaches and incidents.Advising on incident assessment and reporting viathe SIRI reporting tool within the IG Toolkit to NHSEngland (dependent upon severity of incident).Advice on post-incident reviews and actions forcustomer implementation.

IG toolkit compliance supportProvide advice and guidance on how to complete theIGT, including the collection and collation of evidencein support of IG toolkit submissions.

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Servicecategory


N.B. GP practices must submit a toolkit returnannually and responsibility for this lies solely with theGP practice.

IG consultancy and supportProvision of advice, guidance and support on IGrelated issues, including existing operationalprocesses and procedures or new businessinitiatives. Advice and guidance around access andlaws (including access to legal advice). Provision ofguidance on implementing the recommendations ofthe Information Governance Review (“Caldicott2”).

IG TrainingTraining in relation to Information Governance,including the development and provision of trainingmaterials to support IG, as required, and delivery ofad-hoc IG training that is not covered by themandatory online IG training module.N.B. A commissioning specification: ‘InformationGovernance Support for Primary Care Providers’ hasbeen developed to inform NHS England’s regionsabout the information governance support that theymust commission for primary care providers andprovide an outline structure for contracting purposes.

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Servicecategory


Developmental IG support services. As outlined withinthe commissioning specification: ‘InformationGovernance Support for Primary Care Providers’,including:

Wider IG-related compliance support IG Audits Subject Access and Freedom of Information (FOI)

requests Queries from MPs and Parliamentary Questions

Citizen identityProvide support to ensure practices are able todevelop and maintain best practice processes thatcomply with national guidance on citizen identityverification that underpins the delivery of patientfacing services, and assurance requirements asthese are developed.

RegistrationAuthority

A comprehensiveRegistrationAuthority service

Primary care ITsupport services(commissionedby NHS England)

Regional DCO teams to commission a comprehensive RAservice as laid out in the Registration Authorities Operationaland Process Guidelines

Registration Authority service including policing ‘AccessPolicy’ and the delivery and management of role-based or

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Servicecategory


position-based access control and issuing of smartcards.training of RA sponsors.

Support of software to support national systems forexample.) Identity Agent, CMS.

Ensure adherence to access security policy.

Issuing of smartcards (including ID checks / printing etc).

Advise customer RA managers and RA sponsors ofconfiguration of business functions, completion ofdocumentation and use of RA systems (for example. resetPINs).

Involvement in national project roll out such as attendance atproject boards to support project delivery.

NHSmailAdministration

A comprehensiveservice to coverthe administrationof NHSmailaccounts

Primary care ITsupport services(commissionedby NHS England)

Core administrative services (outside national servicesdesks): Providing local organisation administrator support forexample access and support for NHSmail, support formigration from local email services to NHSmail.

Creation, deletion of user and email accounts.

Password resets, account unlocking etc.

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Servicecategory


Clinical SafetyAssurance

A comprehensiveclinical safetyassuranceservice

11 Primary care ITsupport services(commissionedby NHS England)

Clinical assurance and safety: Ensuring that the necessarynational requirements are met for management of clinicalrisk in relation to the deployment and use of health softwarewithin the area team's geographical area.

Assure adherence to: Clinical Risk Management: Its application in the

manufacture of health software SCCI0129 (formerlyISB 129 and DSCN 18/2009)

Clinical Risk Management: Its application in thedeployment and use of health IT systems SCCI0160(formerly ISB 0160 and DSCN 14/2009) (whererequired).

Local clinical safety services for must include appropriatesupport for the management of clinical safety incidents(information system related) within general practice.

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15. Appendix D – Digital Primary Care Maturity Assurance Indicators

DMA Ref Digital Primary Care MaturityAssurance Indicator:

DigitalPrimary CareMaturityAssuranceLevel:

Reference (where appropriate)

1 Consent is appropriately sought beforepersonal information is used in ways thatdo not directly contribute to the delivery ofcare services and objections to thedisclosure of confidential personalinformation are appropriately respected.

Core GP ITand centrallymandatedrequirements

GP ITK

2 The CCG commissioned service providerfor GP IT services will have an annuallyreviewed tested Business Continuity planand validated IT Disaster Recovery planfor services critical to GP servicecontinuity.


GP IT Operating Model

CCG Practice Agreement

3 The practice enriches Summary CareRecords with additional information, forappropriate patients and subject topatient consent.

Enriching SCRs with AdditionalInformation


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5 The practice use only a computer systemupon which the Contractor proposes tokeep patient clinical records which hasbeen accredited by the Secretary of Stateor another person on his behalf inaccordance with general practiceSystems of Choice Level 2.




GMS contract

6 The practice has arrangements in placeto ensure a validated NHS number isused in all NHS clinical correspondence,including referrals, generated by thepractice, except in exceptionalcircumstances where the number cannotbe ascertained.


GMS Contract

NHS number guidance for GP practices V1.1 –June 2011

7 There is a comprehensive ongoingtraining and clinical system optimisationservice to support GP Principal clinicalsystems and national clinical servicesavailable to all practices.




8 All practices complete IGT to at leastlevel 2 in each of the appropriate

Core GP ITand centrally


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requirements each year. (For 2015/16this is 13 indicators).

Mandatedrequirements Department of Health / British Medical

Association good practice guidelines

GP IGTKCCG N3 Access Agreement

GP IT Infrastructure specification guidance

GMS contract 2015/16 review letter

9 All practices have access to SMS (orequivalent messaging system) integratedwith the practice principal clinical systemto support direct communications withpatients. (GP IT Operating model - NHSEngland letter to CCGs 19/06/15Gateway Reference 03635).



NHS England letter to CCGs 19/06/15 GatewayReference 03635

10 All contracts (staff, contractor and thirdparty) contain clauses that clearly identifyinformation governance responsibilities.


GP IGTKGP Infrastructure specification guidance

11 The practices have access to a formalClinical Safety System (SCCI0160


SCCI0160 (formerly ISB 160)

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formerly ISB 160) and qualified clinicalsafety officer.

mandatedrequirements

12 There is a local GP IT strategy andprogramme with roadmap annuallyreviewed and aligned with localcommissioning priorities.



13 The practice uses NHS Mail in thefollowing ways:

Tick all that apply

NHS Mail is the primary emailsystem used by the generalpractice (GP IT Operating Model)

The practice has at least onesecurely managed and dailymonitored NHS Mail account toreceive clinical documentation

None or N/A



Primary Care Contractor IT Operating Model

14 There is an agreed local strategy andapproach for core GP IT infrastructureand software investment to meet theneeds of:



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Maintaining existing IT estaterequired for core GP IT needs

Practice organic/incrementalgrowth

Practice developments eg mergers Significant primary care

developments eg new builds

15 There is a clear agreed local (CCG)budgeted plan for the full funding of allcore GP IT requirements.



16 The practice system is EPS2 enabled andlive (2015/16 GMS Contract Reviewletter).


GMS Contract

2015/16 GMS Contract Review letter

17 The practice is using GP2GP to transferpatient records between practices (GMSContract).


GMS contract

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18 The practice integrates all electronichealth records received via GP2GP within3 working days of receipt.


GPSoC contract

19 The practice has enabled automateduploads to the Summary Care Record(GMS Contract).


GMS Contract

20 GP IT services are commissioned andcontracted with robust and clear servicespecifications.




21 All practices sign the CCG PracticeAgreement.




22 All CCG commissioned GP IT supportservices are supported with KPI reports(at least 4/year) and there are annualservice performance and contract reviewmeetings.



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23 Patients registered at practice can viewtheir test results electronically online.


24 The CCG completes a formal review ofthe IT Services with each Practice at leastonce a year.



26 CCG Commissioned GP IT supportprovides consistent support for core GMScontracted hours (0800 - 1830 Mon - Friexcl Bank holidays) (GMS Contract).


GMS Contract

27 Patients at this practice can view their GPLetters electronically online.


28 The GP IT support service desk hascurrent formal accreditation through arecognised (industry or NHS) scheme ormeets the requirements for GP IT servicedesk in the GP IT Schedule of Services(GP IT Operating model revised 2016).



29 GP IT services available include ITSecurity advice and oversight, including


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configuration support, audit, investigationand routine monitoring.


30 There is a comprehensive data qualityadvice and guidance service is availableto all GPs, including training in dataquality, clinical coding and informationmanagement skills.



31 Where there is a local community networkwholly or part funded through GPIT andused in addition to, or in place of, N3 bygeneral practices AND other locationsand care settings the costs are sharedbetween these organisations.



2 The commissioned GP IT servicesinclude formal P3M (Project, Programmeand Portfolio Management)methodologies which are recognised andused in the deployment of GP Clinicalsystems, local implementation of nationalsolutions and major primary care ITinfrastructure changes or upgrades.



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33 The practice principal clinical system isaccessible outside the practice for thefollowing purposes:

Tick all that apply

Access at all routine locations forGP service point of care delivery(eg out of surgery locations suchas hospitals, nursing homes andcommunity using mobiletechnologies ie point of care)

Access remotely eg home foradministrative and maintenancepurposes

None or N/A


34 The GP IT infrastructure estatesupporting core GP IT (includes desktop,mobile, server and network equipment)has a fully documented plan for refreshand replacement.


GP IT Operating ModelCCG Practice Agreement

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35 All transfers of personal and sensitiveinformation are conducted in a secureand confidential manner.


GP ITK

36 All NHS owned GP IT equipment isrecorded in an accurate asset register.




37 All software (including OperatingSystems) used on NHS owned GP ITinfrastructure by the practice must beapproved and recorded on an softwareasset and licence register which mustconfirm the software is appropriately andlegally licenced for such use.


CCG Practice agreementGP IGTK

38 All NHS owned GP IT equipment issubjected to an approved IT reuse anddisposal policy and procedures - usingauthorised contractors. All disposals arerecorded in the asset managementsystem (36).


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39 All general practices have secure datastorage services available for anyelectronic patient identifiable and clinicaldata other than that stored in theirGPSoC clinical systems and NHS Mail toa standard not less than Tier 3 datacentre.


40 The principal GP clinical system isexternally hosted to NHS DigitalStandards.


41 Monitoring and enforcement processesare in place to ensure NHS nationalapplication Smartcard users comply withthe terms and conditions of use.


GP ITK

43 The practice has a protocol to allowpatients access to their records onrequest in accordance with currentlegislation.


Data Protection Act 1998

GMS schedule 6 Part 9, PMS schedule 5 part 9

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44 The practice has a designated individualresponsible for confidentiality of personaldata held by it.


GMS schedule 6 Part 5, PMS schedule 5 part 5

45 All practice patients are offered access toview online or print the detailed (coded)information from their medical record.


GMS Contract

46 The practice routinely electronicallyorders or receives the followingdiagnostics tests with their main acuteprovider:

Tick all that apply

Place orders for commonlaboratory diagnostic tests

Place orders for common imagingand diagnostic tests

Receive diagnostic reports forcommon imaging and diagnostictests

None or N/A


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48 Local acute trust dischargeletters/summaries are received by thepractice electronically in the followingways:

Tick all that apply

All local acute dischargesummaries/letters are receivedelectronically

All local A&E discharge summariesare received electronically

None or N/A


NHS standard provider contract

Everyone Counts: Planning for Patients 2014/15to 2018/19

50 There is an Information Governancepolicy that addresses the overallrequirements of information governance


GP ITK

52 Patients at this practice can book, view,amend, cancel and print appointmentsonline


GMS Contract

GMS schedule 6, part 5, new paragraph 74C,PMS schedule 5, part 5, paragraph 70D

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53 Responsibility for InformationGovernance has been assigned to anappropriate member, or members, of staff


GP ITK

GMS schedule 6 part 9,PMS schedule 5 part 9

54 All staff members are provided withappropriate training on informationgovernance requirements


GP ITK

55 The use of mobile computing systems iscontrolled, monitored and audited toensure their correct operation and toprevent unauthorised access


GP ITK

56 80% of elective referrals are made usingthe NHS E-referral system


GMS contract 2015/16 review letter

57 Where the practice works within afederation it is able to use its principalclinical system and its IT infrastructure tosupport shared working betweenpractices in the following ways:


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Tick all that apply

Clinical system (records) Appointment booking and

management Integrated telephony systems

across practices Reporting on activity and coded

clinical data Morbidity registers across

aggregated (federation)populations

None or N/A

58 There is a locally agreed WES(Warranted Environment Specification)for GP IT equipment which enablespractices to effectively operateconcurrently applications necessary todelivery both core and enhanced GP IT.


59 Unauthorised access to the premises,equipment, records and other assets isprevented


GP ITK

140





60 There are documented plans andprocedures to support business continuityin the event of power failures, systemfailures, natural disasters and otherdisruptions


GP ITK

61 Wi-Fi access will be available to GPs andprimary care delivery staff in all generalpractice locations.


62 There are documented incidentmanagement and reporting procedures


GP ITK

65 The practice is registered under the DataProtection Act


GMS schedule 6 Part 9,PMS schedule 5 part 9

66 The practice has a procedure forelectronic transmission of patient data inline with national policy including


Data Protection Act 1998

GMS schedule 6 Part 9,PMS schedule 5 part 9

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mechanisms to ensure that computerisedmedical records/data are transferred to anew practice when a patient leaves.


67 There is an information asset register thatincludes all key information, software,hardware and services


GP ITK

68 Use of SNOMED CT in GP principalclinical systems

Transformationin primary care

NIB Framework

72 All local GPs and providers of health andsocial care sharing patient digitalinformation agree to a consistentinformation sharing model (includingcommon consent protocols)


Department of Health / British MedicalAssociation Good Practice Guidelines

73 All locally commissioned providers ofhealth care sharing patient digitalinformation have systems which maintaina full automated audit of read and writeaccess to individual patient records


Data Protection Act Compliance

NHS Care Record Guarantee

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79 A local Electronic Palliative Care Co-ordination System (EPaCCS) supportingthe recording and sharing of people’scare preferences and key details abouttheir care at the end of life which isintegrated with principal primary careclinical systems and meets therequirements of ISB 1580 (End of LifeCare Coordination: Core Content) isavailable.


National End of Life Care StrategyISB 1580 (End of Life Care Coordination: CoreContent)

84 All locally commissioned health and careorganisations (including GPs) can accesstheir principal record systems from alllocal commissioned provider locations.


85 Access to Wi-Fi services is available togeneral practice clinical staff across localcommissioned provider locations.


86 The CCG has appointed a Chief ClinicalInformation Officer (CCIO) or equivalentaccountable officer (dedicated or shared)who will provide (clinical) leadership forthe development of local IT strategy




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including the development of primary careIT services.

88 The practice promotes and offers thefacility for patients (GMS contract2015/16 review letter) and care homesand nursing homes to receiveconsultations electronically, either byemail, video consultation or otherelectronic means.Tick all that apply

Patients Nursing homes Care homes None or N/A

EnhancedPrimary CareIT

90 CCG Commissioned GP IT supportService supports general practice toprovide extended hours (DES) services

Select One:

An urgent business critical break-fix only service is available outsideGMS core hours to support


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practices providing extended hours(DES) services

A restricted service is availableoutside GMS core hours to supportpractices providing extended hours(DES) services

A full service is available outsideGMS core hours to supportpractices providing extended hours(DES) services

91 CCG commissioned GP IT supportservice supports general practice toprovide seven day week services topatients where these are offered.

Select One:

An urgent business critical break-fix only service is available outsideGMS core hours to supportpractices providing seven dayservices


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A restricted service is available tosupport practices providing sevenday services

A full service is available outsideGMS core hours to supportpractices providing seven dayservices

92 All practice patients are offered access toorder, view and print repeat prescriptionsfor drugs, medicines and appliancesonline.


GMS Contract

93 Where there is legitimate access andconsent the practice and other localhealth and social care providers are ableto share electronic patient data by viewaccess to records in the following ways:

Tick all that apply

Other local health providers canaccess practice records

Local social care providers canaccess practice records


NIB Framework

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Practice can access records fromother local health providers

Practice can access records fromlocal social care providers

None or N/A

100 The practice and its registered patientshave access to a shared online systemwhich allows patients to engage with theirGP by:

Tick all that apply

Patients can record their personalhealth data which is accessibleonline by the GP

Patients and GPs can online,collaboratively set goals and careoutcomes and track progressagainst these

None or N/A


101 There is a publicly available and easy tounderstand information leaflet thatinforms patients/service users how their


GP ITK

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information is used, who may haveaccess to that information, and their ownrights to see and obtain copies of theirrecords.


150 Clear standing financial instructions mustbe established between commissionersand delivery organisations. Clearreporting, monitoring and reviewarrangements established to ensure CCGoversight of GP IT funding andexpenditure, with clear escalation pointsagreed.


151 There is clearly defined executiveleadership (CCG) to ensure that digitaltechnology maturity is recognised as akey enabler to achievement of coreobjectives in the effective commissioningand delivery of quality health and careand future service transformation.


152 Formal governance and accountabilityarrangements clearly articulated andembedded, which effectively engagestrategic partners, with terms of reference


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and reporting responsibilities clearlydefined, including the followingforums/structures:

Health and care (cross communitystakeholders)

CCG/primary care strategic level GP IT / operational delivery

including clinical/LMCrepresentation

153 The commissioner (CCG) owns thestrategic digital direction and ensures thatthis is driven by local commissioningobjectives. It recognises and exercises itsresponsibility for innovation andtechnology enabled change, with a clearvision for health and care articulated, withan associated digital strategy in place.


154 Commissioning of clinical services,routinely includes clinical (CCIO)consideration of digitaltechnologies/systems, together withassociated benefits.


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155 Service specifications for commissioningof clinical services, encompass coredigital requirements, including, but notlimited to; data management andreporting, data security, data sharing,systems access, digital technologyrequirements.


156 Formal governance arrangements areestablished which ensure the effectivemapping and provision of digital enablersthat will support delivery of locallyidentified health and care priorities.Business cases (where necessary) areshared with, and agreed with relevantpartners in the local area. Business caseswhere required for Informatics-enabledprogrammes with cross-communityimpact are approved by a relevant cross-community Board.


157 Negotiate and contract for InformationManagement and Technology servicesensuring value for money througheffective use of national framework


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contract (eg Lead Provider Framework -LPF) or other robust procurement inadherence with NHS Englandprocurement rules.

158 The CCG ensures that appropriate IGand information standards/requirementsare clearly specified within any local IM&Tservice specification and associatedservice level agreement (SLA) andcontractual arrangements with IM&Tdelivery partners.Able to evidence level 2 compliance forcommissioned GP IT delivery partners.


159 Information Governance Toolkitcompliance is assured through thestandard contractual routes with widerhealth economy providers.


160 Currently NHS England are responsiblefor commissioning a local IG supportservice as described in Section 5 - GP ITOperating Model. GP Practice IGTcompliance is being monitored locally to


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ensure effective delivery of GP IGTsupport services.

161 The CCG as local commissioner, throughformal local governance arrangements, isresponsible for ensuring benefitrealisation from local investment in digitaltechnology.


162 Benefits are explicitly defined, trackedand captured within individual projects.


163 CCG has secured a service that meets orexceeds the core standards outlined inthe GP IT operating model/frameworkwith clearly define local IM&Trequirements in the form of a detailedservice specification that will ensure localIM&T delivery partners are clear onservice needs.


164 CCGs have appropriate mechanisms inplace to effectively manage risks andissues in accordance with system wide


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procedures to help ensure the safe andsuccessful delivery of outcomesassociated with digital investment.


165 CCGs actively promote take up andutilisation of national strategic systems,such as SCR, e-Referrals, GP2GP,EPS2, Patient Online, to enable moreintegrated care across all care settingsand achieve operational benefits forpatients and clinicians.


166 There is support available to all practicesfor deployment, training, technical issues,tracking database maintenance andsupplier liaison and escalation for GPSoC(lot 1) clinical systems.


167 A formal and structured data qualityaccreditation programme iscommissioned by the CCG and availablefor GP sites to ensure continuous reviewand improvement of data quality withingeneral practice.This will incorporate a baselineassessment, reporting and remedial


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action planning, together with ongoingdata quality advice, guidance and trainingin data quality and informationmanagement techniques and practice.

168 Calculating Quality Reporting Service(CQRS)General Practice Extraction Service(GPES)A proactive support service is in placelocally to support Quality and Outcomes(QOF) data collection and reporting,which includes review, reportmanagement and remedial actionplanning, particularly around exceptionreporting, to ensure appropriate dataquality within GP sites to enable effectiveQOF reporting.


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