GP2GP Utilisation Framework

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1 Document filename: GP2GP Utilisation Framework Directorate / Programme Cross Government Programmes Project GP2GP Document Reference <insert> Project Manager Status Live Owner Andrew Walsham Version 1.2 Author Richard Carpenter Version issue date 15/09/15 GP2GP Utilisation Framework Copyright 2014 Health and Social Care Information Centre

2 Document Management Revision History Version Date Summary of Changes /10/14 Initial draft by Richard Carpenter /10/14 Amendments following Dave Gunner initial comments /11/14 Further amendments to reflect the dual approach of the document and change of title /12/14 Amendments following Dave Gunner comments /12/14 Further amendments following Utilisation Report session /01/2015 Final Review following Liza Adkins and Andrew Walsham comments /03/2015 Document now live and to be uploaded to the website /04/2015 Updated to include details of out of scope practices /08/2015 Minor changes to reflect Microtest FRA, changes to reporting and deployment figures Reviewers This document must be reviewed by the following people: Reviewer name Title / Responsibility Date Version Dave Gunner Senior Implementation Manager 15/08/ Liza Adkins Project Manager Utilisation 15/08/ Approved by This document must be approved by the following people: Name Signature Title Date Version Andrew Walsham GP2GP Senior Project Manager Benefits and Utilisation 12/03/ Glossary of Terms Term / Abbreviation BMA CCG CSU EHR What it stands for British Medical Association Clinical Commissioning Group Commissioning Support Unit Electronic Health Record Page 2 of 14

3 FRA GMS GP GPSoC JGPITC NMS ODS RCGP SRO Full Roll Out Approval General Medical Services General Practice GP System of Choice Joint GP IT Committee National Monitoring Service Organisational Data Service Royal College of General Practitioners Senior Responsible Officer Document Control: The controlled copy of this document is maintained in the HSCIC corporate network. Any copies of this document held outside of that area, in whatever format (e.g. paper, attachment), are considered to have passed out of control and should be checked for currency and validity. Page 3 of 14

4 Contents 1 Introduction Purpose of Document Background 5 2 Utilisation Approach National Utilisation Baseline Establishing Stakeholders Engagement Formulate a Utilisation Plan Support and Monitoring 9 3 Tools for Utilisation Monthly CCG GP2GP Utilisation Report Utilisation Presentation(s) Trending Tool GP2GP Key Activities Practice Questionnaire Erroneous Transfers Support with Incident Logging Re-Training 13 4 Roles and Responsibilities 13 Page 4 of 14

5 1 Introduction 1.1 Purpose of Document The purpose of this document is twofold. It aims to provide an approach and a plan for the GP2GP Implementation team to ensure that GP2GP is being fully utilised within England in line with the GP2GP business case. Secondly it will provide guidance to the Implementation Team to assist NHS project managers located within Commissioning Support Units (CSUs) / Clinical Commissioning Groups (CCGs) running local utilisation projects. This document addresses how utilisation will be maximised for those practices where GP2GP functionality has been implemented. A separate Implementation Strategy document 1 covers the process of deploying GP2GP functionality across the various GP systems throughout England. Implementation and utilisation are closely related: not only does utilisation have a dependency on the availability of GP2GP functionality, but the lessons learned from analysing utilisation can help to strengthen the implementation process, tackling issues in implementation that might result in lower than expected utilisation. 1.2 Background GP2GP was first introduced in 2006 and at the time of writing this document is deployed in 97% of GP Practices in England. GP2GP functionality is conceptually straightforward; it enables a patient s electronic health record (EHR) to be transferred directly and securely between a patient s old GP practice and their new one. It is popular with GPs and enjoys support from a number of key stakeholders including Royal College of General Practitioners (RCGP), the British Medical Association (BMA), and the Joint GP IT Committee (JGPITC) which comprises of members from the RCGP and BMA. GP Clinical Systems containing GP2GP functionality are: Supplier EMIS TPP INPS Microtest Current systems EMIS Web SystmOne Vision Evolution 1 GP2GP Implementation Strategy Page 5 of 14

6 1.2.1 GP2GP Benefits The GP2GP business case places the benefits into four key categories, as detailed below: Improved Quality and Continuity of Care The patient s new GP will have knowledge of the patient s current medication, drug interactions, current problems and past medical history, resulting in enhanced patient safety and more focused consultations from day one. Patients have improved confidence that continuity of care is being maintained. Improved Safety There will be fewer transcription errors and omissions because the need to key in information from paper records will be massively reduced. Allergies and adverse drug reactions are flagged for review for new patients, resulting in safer prescribing of new drugs after a GP2GP patient record transfer. Clinical Time Savings Electronic health records will be available for the patient s first and subsequent consultations. GP2GP allows the NHS to preserve the usability of rich data accumulated in patient records, such as history of blood results for diabetics, rather than losing it every time a patient moves between practices which mean fewer requests for duplicate lab tests. Administrative Time Savings Administrative support teams will have to spend less time processing incoming patient records due to the richness of the information available electronically Priorities and Resources There was a requirement in the General Medical Services (GMS) GP Contract that stated GP2GP should be utilised to facilitate the transfer of patient records by 31 st March 2015 and as such there was a real emphasis among CCGs and CSUs to deploy GP2GP across their practices. GP2GP is deployed in 97% of GP practices in England and these deployment figures require a shift in focus for the programme. Less resource will be necessary for deployment and the push will be towards running Utilisation projects. The current GP2GP business case dictates that the priority of the Implementation Team should still be focused on deployment. The business case target is that 99% of practices will be live with GP2GP by March At the time of writing this document, GP2GP is live in 97% of practices and the emphasis is to ensure deployment of GP2GP to all remaining TPP and Microtest practices. This will continue to be the priority as there are still a number of areas currently without any TPP deployments. Once all areas are engaged and deploying, the Implementation Team can begin to focus these organisations on Utilisation projects. Page 6 of 14

7 2 Utilisation Approach This section of the document looks at the approach to Utilisation that the GP2GP Implementation Team should take. It will also add further clarification as to the approach that NHS project managers should take when running local utilisation projects. The approach sets out a clear ordered process for the GP2GP Implementation Team when engaging with key stakeholders namely NHS Project Managers the tools available to them, advice to the NHS Project Managers about how to run a utilisation project and any further monitoring and support that the Implementation team will provide. 2.1 National Utilisation Baseline At the start of any benefits or utilisation project it is vital to be able to measure whether the work that you are about to undertake will be fully realised. In order to measure this, it is necessary to take a snapshot of the current GP2GP Utilisation. This will form a baseline that future utilisation can be compared against. It is logical to take the baseline line using the data that is already available through the Monthly GP2GP CCG Utilisation report (See section 3.1 for further information about this report). As part of the Monthly GP2GP CCG Utilisation Report a utilisation level is set for each practice which identifies high, medium and low utilising practices. The data from the November 2014 report has been used as a baseline at both national and CCG level. Total Practices (in England) 8086 Practices "not live" Number of practices 1286 with GP2GP % (all England practices) 16% Total GP2GP live practices (in England) 6800 Number of practices 2051 High Utilisation (white) % of total GP2GP live practices 30% Medium Utilisation Number of practices 3109 (Amber) % of GP2GP live practices 46% Low Utilisation (Red) Number of practices 1530 % of GP2GP live practices 23% True Inactive Number of practices 70 (Blue) 2 % of GP2GP live practices 1% True Passive Number of practices 40 (Purple) 3 % of GP2GP live practices 1% 2 Practices with no joining patients eligible for GP2GP transfer, therefore no requesting or integrating activity for the reporting month. In addition to this the practice has also received no requests for leaving patient's EHRs. 3 Practices with no joining patients eligible for GP2GP transfer, therefore no requesting or integrating activity for the reporting month. However this practice has received requests for leaving patient's EHRs. Page 7 of 14

8 2.2 Establishing Stakeholders The Implementation Team placed significant effort into gathering and updating key stakeholders after the April 2013 NHS restructure. In every CCG/CSU where there is TPP SystmOne GP2GP deployment activity a key contact has been obtained. There are a number of CCGs that do not have any practices with TPP SystmOne and therefore a contact in these organisations has not been obtained/ confirmed. We recognise that just because a CCG/CSU contact is assisting with the deployment of GP2GP it does not mean they are the correct contact when it comes to managing GP2GP in the live estate and therefore utilisation. The individual Implementation Managers should be responsible for establishing the correct utilisation contact details for each CCG or CSU. A sensible starting point would be the contacts that are already in place but other similar programmes within HSCIC might be able to assist. Once gathered, these contacts should be added to a central data source. This is a priority as these contacts will need to be added to the existing distribution list that receives the Monthly CCG GP2GP Utilisation Report. This current distribution list is includes only personnel that have self-registered to receive the report and as such, it can be assumed does not include all of the correct contact 2.3 Engagement Once the Stakeholders have been established the next phase of the Utilisation Approach will be to begin engagement with these stakeholders. Due to resource constraints within the Implementation Team and the primary focus being deployment, it is not possible to begin systematically engaging with all Utilisation Stakeholders. The priority of engagement for individual implementation Managers within their regions will be as follows: 1. Organisations that have already approached the programme regarding utilisation initiatives/projects 2. Organisations that subsequently approach the programme 3. Organisations identified by the GP2GP programme to be under-utilising 4. All other organisations Drawing on experience from deployments, initial engagement will be a face-to-face meeting with the CCG/CSU contact and should take the form of a PowerPoint presentation, ensuring a consistent message is conveyed by each of the implementation managers. The primary purpose of engagement is to explain the utilisation report and its intricacies. It should make the contacts familiar with the report and what is held within it and ensure that they have an understanding of their practices utilisation. The presentation should also contain information to help identify potential barriers to using GP2GP(either technical, smartcard or business process related). It will also detail the different tools that the local contact can use to overcome these issues. 2.4 Formulate a Utilisation Plan At the end of the initial engagement, the NHS Project Manager in conjunction with the GP2GP Implementation Manager will begin to build a utilisation plan for their organisation. Using the information in the report, NHS Project Managers should highlight practices that are not fully utilising GP2GP and put plans in place to improve this. The Implementation Page 8 of 14

9 Manager will be able to assist by suggesting ideas, tools and best practice. It is important at this stage for the NHS Project Managers within CCGs to plan how much time/resource will be needed for these utilisation projects so they can accurately place a cost on the work if it is then outsourced to another organisation, for example a CSU. 2.5 Support and Monitoring Following the initial engagement there is a clear distinction between the responsibilities for the GP2GP Implementation team and the local NHS Project Managers when it comes to support and monitoring of GP2GP utilisation. The GP2GP Implementation team will have the responsibility of initially contacting the NHS Project Managers and presenting the report to them. At this stage the Implementation Manager will also go through all of the tools and techniques available and together will formulate a plan to improve utilisation within the organisation. Subsequent to this, the NHS Project Manager will have ownership and responsibility for the local utilisation project, including any trending, practice engagement, etc., as they have the responsibility for managing GP2GP in the live estate. That said, the Implementation Managers will be on hand to share any experiences and best practice and offer support and guidance as necessary. 3 Tools for Utilisation 3.1 Monthly CCG GP2GP Utilisation Report The Monthly CCG GP2GP Utilisation report 4 is distributed to a list of key stakeholders within CCGs and where designated, CSU staff who manage GP2GP in the live estate. The report is sent between the 10 th and 15 th of the following month. The report lists all practices in England both live and not live with GP2GP and includes full details of each practice's GP2GP requesting, sending and integration activity, this should help identify potential barriers to using GP2GP (either technical, Smartcard or business process related) as well as providing an overall utilisation level for each practice Utilisation Stages GP2GP utilisation can be broken down into three key activities helping NHS Project Managers to understand how to improve utilisation and support their practices appropriately. The three key activities are: 1. Requesting activity - Registering a new patient and requesting an electronic health record (EHR) from their previous practice 2. Sending activity - Sending an EHR for a leaving patient upon receiving a request from the new registering practice 4 The GP2GP Utilisation reports can be found S:\GP2GP\Utilisation\Reports Page 9 of 14

10 3. Integration activity - Integrating a new patient's EHR into the registering practice's clinical system Requesting The Requesting rate is worked out using the following equation: R+ I / J J - From the total number of joiners within this reporting month, this is the number that may be eligible for a GP2GP transfer R - Number of EHR requests sent to the previous practice for newly registered patients (only if the previous practice is live with GP2GP) I - This only applies to TPP practices - as they do not use GP2GP when a patient moves from one TPP practice to another TPP practice. This is known as an internal transfer Sending The sending rate is worked out using the following equation: E / R E - Number of leaving patient's EHRs sent to their new practice. This only includes EHRs sent within 24 hours. The sent record is also known as an extract. R - Number of requests received for a leaving patient's EHR from their new practice. Integrating The integrating rate is worked out using the following equation: FI / E FI - Number of EHRs fully integrated (not filed as an attachment) into the practice clinical system within 3 working days of receiving it. E - Number of EHRs (or extracts) received as a result of sending a GP2GP request when registering a new patient Utilisation Level The utilisation levels have been set to enable the Project Managers to identify high, medium and low utilisation in each practice, this should help them understand how best to allocate resources and prioritise the practices for the appropriate support to ensure the full benefits of GP2GP are realised. The Request Rate percentage and Integration Rate percentage have both been used to calculate the overall Utilisation level. The request rate and the integration rate will receive a level from 1 to 3 based initially* on the following percentages (*these will be reviewed quarterly): Level 3 - above 70% Level 2-65% to 70% Level 1 - Below 65% Page 10 of 14

11 When these levels are combined, each practice will be allocated a Utilisation level in one of the following categories: WHITE - (Level 6) - High utilisation AMBER - (Level 4-5) - Medium utilisation RED - (Level 2-3) - Low Utilisation BLUE Practices with no joining patients eligible for GP2GP transfer, therefore no requesting or integrating activity for the reporting month. In addition to this the practice has also received no requests for leaving patient's EHRs. If practices show blue for consecutive months CCGs/CSUs should do the following checks: Ensure the practice has not closed, merged, is experiencing technical issues or had GP2GP disabled on their clinical system (before re-enabling GP2GP a Training Needs Analysis should be completed to if the practice needs GP2GP training). PURPLE Practices with no joining patients eligible for GP2GP transfer, therefore no requesting or integrating activity for the reporting month. However this practice has received requests for leaving patient's EHRs. GREY Practices not live with GP2GP on the last day of the reporting month. If the practice is eligible for GP2GP deployment but do not have a planned Go Live/training date, the CCGs/CSUs should follow processes to deploy GP2GP at the earliest opportunity Understanding the Utilisation Report In order to make the most out of the data obtained within the Utilisation report, it is imperative that the information is understood and the nuances with the data considered. This is particularly important for the Implementation managers when they engage with NHS Project Managers to explain the report. This will then enable NHS Project Managers to understand how to improve utilisation and support their practices appropriately Utilisation Report Guidance There is a separate tab contained within the Utilisation report that provides high level guidance to recipients of the report, detailing the utilisation levels Utilisation Report Frequently Asked Questions (FAQs) The report also contains a series of FAQs that have been developed to sit alongside the report, with the answers to some basic questions or scenarios that may arise from the data. These FAQs will be updated as report queries arise and it is important that any issues received are fed back to enable this to happen. Page 11 of 14

12 3.2 Utilisation Presentation(s) Successful deployments to date have proven that initial meetings with NHS Project Managers are more beneficial if they are face to face. A Utilisation Presentation will be used to support these meetings and ensure a consistent message is conveyed when running utilisation projects. The presentation will include: Deployment update Future developments Introduction to utilisation Explanation of the utilisation tools Starting a utilisation project This presentation can also be used by NHS Project Managers when they engage with specific practices regarding utilisation. Implementation Managers should ensure that NHS Project Managers understand the key points of the presentation and that they feel comfortable delivering the presentation. If necessary offering support, for example shadowing during the first few practice engagements, as appropriate. 3.3 Trending Tool The Utilisation Trending tool has been developed to assist CCGs/CSUs with trending the monthly GP2GP utilisation data across their practices. It includes the current GP2GP Endpoint as this will help identify when practices migrate from one clinical supplier/system to another as this may have an impact on their GP2GP utilisation following any down time as part of the migration process. This is particularly useful as the Utilisation report contains data for the current month however, it may be useful when targeting practices for improvements to have a fuller picture of utilisation over an extended period of time. 3.4 GP2GP Key Activities GP2GP Key Activities 5 is a document detailing the key activities during a GP2GP transfer and acts as a quick reference guide for GP2GP users to ensure they are using the system correctly and therefore realising the benefits. 3.5 Practice Questionnaire The Practice Questionnaire 6 is a questionnaire that the NHS Project Manager can send to individual practices to help review GP2GP utilisation within a practice. The survey should help identify potential barriers to using GP2GP (either technical, Smartcard or business process related). This Questionnaire should not only be used for under-utilising practices as real benefit can be obtained by surveying practices that heavily utilise GP2GP as they can share processes and best practice. 5 The GP2GP key activities is located 6 The Utilisation Questionnaire is located n Page 12 of 14

13 3.6 Erroneous Transfers Erroneous Transfers 7 is aimed at handling erroneous transfers but also includes information regarding best practice for registering patients in each of the four principal clinical systems. The information within this document may be useful when running a utilisation project. 3.7 Support with Incident Logging One of the major barriers to utilisation - in particular the sending stage of the transfer - is unresolved technical issues. The Implementation Managers have access to the correct incident support models and should be able to advise on and escalate where appropriate. NHS Project Managers should ensure that all technical issues are logged using the correct support model. For more information about Incident Logging and Support Models can be found of the Service Management 8 pages of the GP2GP Website. 3.8 Re-Training As part of the March 2014 GPSoC Contract suppliers are required to deliver re-training to practices that request it, or where a need (low utilisation) is identified by local organisations, suppliers or by the GP2GP project. It is expected suppliers will undertake a Training Needs Analysis to determine the practice s requirements, and this will shape the delivery and format of the refresher training. 4 Roles and Responsibilities Senior Project Manager Utilisation and Benefits, Project Manager Utilisation: have responsibility for the utilisation workstream. This includes working closely with the Project Manager Tech Data & Reporting, and Implementation Managers, and for developing utilisation improvement strategies. The Senior Project Manager Utilisation and Benefits will need to foster good working relationships with suppliers in order to agree and implement the utilisation strategies; Project Manager Tech Data & Reporting: responsible for working with the Senior Project Manager Utilisation and Benefits, Project Manager Utilisation, and Implementation Managers to ensure the data collection and analysis processes are in place to provide the intelligence to support the utilisation work. Implementation Managers, Senior Implementation Managers: monitor and promote utilisation in the areas they cover and encourage awareness of GP2GP key messages and 7 Erroneous Transfer document located: 8 Service Management pages of the GP2GP website: Page 13 of 14

14 benefits. They also have responsibility for working with the Project Manager Utilisation to ensure that any lessons learned from utilisation improvement activities are built into future strategy. They will also have the responsibility to engage with CCG/ CSU Project Managers to provide help and support with local utilisation projects as appropriate. Junior Project Manager Defect Management: has responsibility for managing any technical defects or problems with GP2GP functionality where it has been deployed in live GP systems. Such problems can have a significant impact on utilisation and must be resolved rapidly where possible, or escalated for inclusion into longer term development plans. Clinical Lead, Senior Responsible Owner (SRO): have responsibility for promoting the benefits of the service to a wider audience, including colleagues in general practice, the wider professional community and patients. Their promotional activities will drive uptake and effective utilisation of the service. Communications Executive (nominated Programme Communications Officer): has responsibility for developing communications material to support the promotional activities of the Clinical Lead, SRO and other members of the team. They will be expected to support any communisations activities associated with the utilisation strategies developed by the Utilisation and Benefits Team. CCG/CSU Project Managers: monitor, promote and manage utilisation within their organisation(s) and encourage awareness of GP2GP key messages and benefits. They also have responsibility to formulate a plan for utilisation ensuring that the right practices are being targeted and the tools have been fully understood and utilised. The GP2GP Implementation Managers can support throughout this process as necessary. Page 14 of 14

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