The role of PRIMIS in the NCRS

North Eastern Derbyshire 2006

PRIMIS facilitators have been playing an important role in helping GP practices in England to prepare for NHS Connecting for Health's National Care Records Service (NCRS), which will create an electronic NHS Care Record for every patient in England.

The NCRS will transform the way health and social care information is managed and will give health and care professionals access to patient information where and when it is needed. It will meet the needs of patients and will give them access to their own private health records.

In North Eastern Derbyshire (*North Eastern Derbyshire PCT has now been amalgamated into Derbyshire County PCT), PRIMIS+ is an integral part of the smooth migration of practices to the new Local Service Provider (LSP) solution, and PRIMIS facilitators have been heavily involved in helping the second and third practices in the country to ‘go-live'. Four practices based within the PCT have at the time of writing (October 2005) migrated their electronic practice records to a new clinical IT system and are connected to a remote LSP server via the core data storage and messaging system known as the Spine. Several other practices within the PCT are progressing towards becoming live.

David Hill**, NHS Primary Care NCRS Project Manager, and Nikki Hinchley***, Primary Care NCRS Data Migration Lead, are the two key people in the PCT's project to migrate practices to the new LSP solution. David is a former PRIMIS+ facilitator and Nikki is an active PRIMIS facilitator, as well as the Data Migration lead for the PCT. Thanks to their knowledge of data migration, coupled with their PRIMIS training and the skills set of the rest of the team, practices migrating to the new solution in North Eastern Derbyshire are well catered for.

Around ten practices at any one time are being guided through this process by the North Eastern Derbyshire team. When one practice goes live, a new practice joins in at the initial stages of the process, so the participating practices are at different stages along the path to going live. At the most crucial stage of the process, the PCT team includes two practice facilitators who support the practices and are fully available pre and post go-live.

The preparation to complete the final data cut from a practice's IT System, prepare the data ready for loading to the new system, and final go-live is complex. This preparation route is what the PCT explains as a 'critical path', and every aspect on this path must be achieved before the practice can go live. On the path there are six streams; an overview stream and five others (connectivity, IT, registration authority, project processes and education, training and development), and all six must run in tandem, with the practice only going-live when all requirements in every stream are met.

The final stage before go-live is the last data cut from the practice's current IT system. A copy of all the clinical database is taken after completion of Thursday evening surgery, and then is couriered to migrating offices in London to be cleansed and checked. Then, the data is sent to LSP offices in Leeds where formatted data is loaded onto the new system. This process takes place between Thursday evening and Sunday afternoon, so that the practice is ready with the new system in place on Monday morning. This does mean, however, that all patient notes, prescriptions and appointments made on the Friday have to be manually inputted into the new system, as the data will miss the cut and will not migrate.

Once live, practices access their clinical records, via the Spine, from a central data warehouse, based at LSP Accenture's remote server off site. This is backed up by a standby server in secondary site. Any updating of patient records, amendments, new patient records etc is now done through the Patient Demographic Service (PDS) component of the NCRS, held on the Spine.

The PCT has aimed for goodwill and flexibility between itself and its practices throughout the whole process, from the initial meeting to the go-live point. For instance, the PCT has been ironing out any data quality issues that might be identified during the preparatory phase, which the PRIMIS facilitator would be ideally placed to help with.

Training has been a critical issue along the path and initial training materials were unsatisfactory and time consuming and needed to be adapted so that a busy practice would benefit from them. A key element in the whole process of migrating to the new solution has been that practices still have to provide their service to patients. All training, installations and meetings etc. must be conducted without disruption to patients or restrict their access to their GP, nurse or other healthcare staff.

In North Eastern Derbyshire, the quality of IT systems varies enormously from practice to practice. Some surgeries have needed almost 100% of their IT equipment replacing, as printers, PCs and other hardware were not compliant with the new system. Other practices have needed very little. The PCT has tried to listen and respond to practices' needs regarding IT hardware, even when those needs have included equipment outside of fundamental requirements – for instance, a laptop for a health visitor to connect to the Spine in the future.

North Eastern Derbyshire PCT had been working with The North Wingfield Medical Centre for some time in many capacities, including PRIMIS. It is a busy practice with four GPs and around 6,500 patients, and has a particularly forward-thinking stance. Having worked closely with David and Nikki in the past to ensure its data was of a high quality, the practice was in a good position to work towards migration to the new solution and connection to the Spine.

Practice Manager, Alan Stray, confirmed: "The practice was in a good situation in terms of data quality and it definitely made the transition easier for us,both for going onto the live system and to becoming paperlight. It didn't mean though, that we were already paperlight; we were very Lloyd George-oriented."

Alan added that as part of migrating to the new solution, the practice had pursued the Paperlight route. By the end of September 2005, the practice had already transferred around 80% of its Lloyd George notes onto the practice system. To facilitate a smooth and speedy transition, an administrator had been employed to transfer all the data into electronic records.

David commented that neither being very data-rich nor becoming paperlight are prerequisites for migrating to the new solution, but that it was a natural progression for practices as they work toward going live onto the new system. Paperlight is a process that can be supported through PRIMIS+ and its training module, "Path to Paperless".

Alan added: "Paperlight was the path to take. What's the point of using such a sophisticated computer system and not being able to pass on the information because it's all on paper? It's proved easier for the GPs too."

Alan Stray had the last comment on the practice's migration: "The PCT was looking for volunteers, and we accepted the challenge. Without a doubt, we're pleased we made that decision. We wouldn't change, nor go back. I think the respect we've got from the PCT has grown in the last six months – both professionally and as individuals."

A data quality facilitator can be the first port of call for any practices, whether they are wanting to improve data quality, looking to go paperlight or to connect to the NCRS in the future. Details of active PRIMIS facilitators within Primary Care Trusts in England can be found in the Find a Facilitator section that can be accessed by clicking here.

* Since this case study was first produced, North Eastern Derbyshire PCT was amalgamated into Derbyshire County PCT, following the 2006 PCT restructuring.

** David now works as a Learning Consultant at PRIMIS

*** Following some time at PRIMIS+ as a Learning Consultant, Nikki is now as Primary Care Informatics Lead at Derbyshire County PCT.