SECURING EXCELLENCE IN

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1 Putt Patients F SECURING EXCELLENCE IN GP IT SERVICES: BUILDING FOUNDATIONS FOR THE FUTURE Operating Model 2nd edition DIRECT COMMISSIONING WORLD CLASS CUSTOMER SERVICE: INFORMATION, TRANSPARENCY AND PARTICIPATION EMERGENCY PREPAREDNESS CLINICAL AND PROFESSIONAL LEADERSHIP SUPPOR DEVELOPIN ASSURING T COMMISSIO SYSTEM PART QUAL W C CU INFOR TRANS PARTI PEOPLE ACCESSING THEIR DATA FUNDING EQUALITY COLLABORATION PARTNERSHIP WORKING High quality care for all, now and in the future

2 NHS England INFORMATION READER BOX Securing Excellence in GP IT Services: Operating Model, 2nd edition ( ) Directorate Medical Nursing Finance Operations Policy Human Resources Commissioning Development Patients and Information Publications Gateway Reference: Document Purpose Document Name Authors Guidance Securing Excellence in GP IT Services: Operating Model, 2nd edition ( ) NHS England Publication Date 3 April 2014 Target Audience Additional Circulation List Description Clinical commissioning groups (CCGs), Primary Care IT service providers, NHS England (Finance, Commissioning Development, and regional and area team directors) and general practice. CCG Clinical Leads, CCG Accountable Officers, Commissioning Support Unit (CSU) Managing Directors and Informatics leads, Health and Social Care Information Centre (HSCIC). This document sets out the operating arrangements for the delivery of GP IT services across England. It outlines clear accountability, responsibility and financing support for general practice in England to receive high quality IT support services. NHS England will retain full accountability for GP IT and delegate the operational and financial management responsibilities to CCGs with the associated funding. NHS England will retain responsibility for certain IT services which will be commissioned through its area teams from qualified IT delivery partners. This document does not address any human resource implications associated with the management of GP IT, nor does it cover IT support for the commissioning functions of CCGs. Cross Reference Superseded Docs (if applicable) Securing Excellence in GP IT Services: Operating Model, December 2012 Securing Excellence in GP IT Services: Operating Model, December 2012 Modernising Information Management and Technology in General Practice support services, version 1.0 Department of Health Investing in General Practice, The New General Medical Services Contract (the Blue Book) Action Required Timing/Deadlines (if applicable) NHS England and CCGs to operationalise this guidance 31 March 2014 or publication of this document

3 Contact Details for further information Tracey Grainger Programme Head of Primary Care IT Quarry House Leeds LS2 7UE Documents Status This is a controlled document. Whilst this document may be printed, the electronic version posted on the NHS England website is the controlled copy. Any printed copies of this document are not controlled. As a controlled document, this document should not be saved onto local or network drives but should always be accessed from the NHS England website. Crown copyright 2014 First published in December 2012 Second edition published in April 2014 Published to NHS England website, in electronic PDF format only. Prepared by Strategic Systems and Technology Patients and Information Directorate NHS England

4 4 Contents Foreword 6 1. Key messages 7 2. Introduction What does this document do? Where do we want to get to? The next-generation GPSoC framework The CCG-Practice agreement Clinically-led change Excellence in GP IT services Accountability and commissioning responsibilities: system overview The services we need to secure excellence in GP IT Core GP IT services (available to all general practices) Add-on GP IT services (discretionary, to align with CCG strategies) Out of scope services Primary Care IT enabling services (retained by NHS England) Commissioning IT services operational management responsibilities How will the new financial arrangements operate? Achieving equity revenue investment principles for and beyond Applying for transition funding Capital provision Capital depreciation Value for money Asset management Insurance Implications of the new GPSoC framework 27

5 5 Contents 7.5 What are the contractual arrangements? High-level contractual arrangements Between NHS England and CCGs Between NHS England and national applications and infrastructure providers Between CCGs and their GP practices (The CCG-Practice agreement) Between CCGs and their GP IT delivery partners By CCGs on behalf of their constituent GP practices Detailed contractual management responsibilities Information governance Clinical safety Primary Care IT enabling services Other responsibilities How do we provide assurance that Securing Excellence in GP IT is working? Local oversight National oversight Where do I receive support? References Glossary Appendices Appendix A - Developing the informed customer function Appendix B Schedule of Core GP IT Services Appendix C Schedule of Add-on GP IT Services Appendix D Schedule of General Business IT Systems Appendix E Schedule of Primary Care IT enabling services Appendix F GP IT transition funding application form 88

6 6 Foreword High quality care for all, now and in the future In December 2012, we first published Securing Excellence in GP IT Services setting out a comprehensive direction for the provision of GP IT services. This second edition builds on those foundations, describing the operating arrangements and leadership required to support the effective delivery of GP IT services. Our approach is based upon partnership working between NHS England and clinical commissioning groups (CCGs) who will be at the forefront of managing the funding of primary care IT. This will give practices the flexibility to meet local needs, within the framework of a core IT offer and national information governance and security standards. In order to meet the challenges of growing demand, changing patient needs and expectations and a dynamic and innovative technology landscape, the NHS needs to think differently about the way it provides services. To underpin this transformation in service design, we must embed world-class IT across the NHS. This is particularly important in general practice, given its millions of interactions with patients every week and its pivotal role in coordinating patient care. In a restrictive financial environment, we must ensure that every pound spent on IT improves patients experience of care and, where possible, brings efficiencies across the health and care system. This operating model sets out how we will achieve high quality primary care digital systems that support the provision of a more efficient, responsive and integrated service for patients whilst empowering them to have greater control over their health and care. NHS England is accountable for the delivery of GP IT services, but in order to support local clinical leaders to lead service redesign we have delegated to CCGs the responsibility for delivering certain key elements of GP IT services. Under these arrangements, CCGs will receive funding to enable them to secure high quality GP IT services. Starting in April 2014, these financial allocations will be based on a fair-share model to promote equity and ensure a consistent core offer in all parts of the country. These arrangements will continue to give general practices a choice of high quality clinical IT systems that are tailored to local requirements, whilst facilitating the flexibility and innovation we recognise the service needs. This is underpinned by an on-going commitment from NHS England to continue to support and encourage the development of a world class information and technology infrastructure across health and care. Beverley Bryant Director of Strategic Systems and Technology

7 7 1. Key messages This document sets out the revised operating model for the provision of a high quality general practice IT (GP IT) support service, building upon Securing Excellence in GP IT Services, published in December It also articulates clear accountability and commissioning responsibilities for NHS England 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 and production of healthcare software; and NHSmail administration for all primary care contractors. This revised operating model contains a number of enhancements: an approach based on equity for GP IT funding across all areas funding delegated directly to clinical commissioning groups (CCGs) to better enable them to commission GP IT services an increased focus on local leadership and collaborative working improved and more comprehensive descriptions of the services in scope a clearer description of roles and responsibilities redesigned assurance processes to support effective governance and accountability. The main implications of these enhancements are: increased funding for most areas whilst protecting existing services in other areas NHS England will be responsible for commissioning information governance support services for all primary care contractors a targeted drive to understand levels of digital maturity and value for money. We understand that it will take time to implement these changes fully. The introduction of equitable financial shares to allow consistent implementation of highquality IT services will be phased over two years. To ensure safe business continuity during the next two years a time-limited transition fund has been set aside for those CCGs that can demonstrate a genuine need for additional funding due to higher committed running costs. NHS England will publish its General Practice IT Strategy later in This will outline the technology standards that will underpin future service provision and for which the infrastructure of GP IT services will be a critical enabler.

8 8 2. Introduction 2.1 What does this document do? This document provides a description of the specific arrangements that NHS England will put in place for GP IT services to: 1. support delivery of high quality care to patients by general practice 2. support innovation in the provision of patient care 3. provide a solid IT platform on which to build future service improvements. This document sets out the following key elements that will be necessary to support the effective delivery of GP IT: the operating arrangements including financial procedures and associated controls governance arrangements, including roles and responsibilities the leadership required to achieve excellence the responsibilities that NHS England will carry out directly in relation to registration authority (RA) (administration of access to clinical and business systems); information governance (IG) support; clinical safety assurance and secure (NHSmail) administration for all primary care contractors. This document also informs GP practices of what to expect in terms of the provision of GP IT services. NHS England is responsible for funding the information technology that is essential to general practice, including the infrastructure within which practice-held patient records are created and accessed. This infrastructure must be capable of supporting national commissioning intentions for general practice services and CCG aspirations to deliver more integrated care. The operating model for GP IT services is designed to support innovation and service redesign, with a particular focus on joining up care across different settings to improve quality and efficiency. 2.2 Where do we want to get to? We want: our digital systems to perform to the highest possible standards to allow the NHS to meet the needs and expectations of patients and carers our digital systems to be available at the lowest possible cost without compromising performance or quality

9 9 2. Introduction By April 2016, we expect to see: 1. strong local leadership to drive the technology strategy associated with continuing service improvement 2. an equitable financing model for the delivery of GP IT and IT support services, based on practice population 3. an excellent universal core digital capability enabled by effective IT support services across the general practice estate 4. the effective procurement, delivery and exploitation of GP IT capability, across the whole of England 5. collaborative partnership working that has the freedom to innovate and redesign services effectively 6. value for money and efficiency, delivered through the combination of all of the above. to create a Primary Care Digital Maturity Index that provides the assurance that quality and value are being maintained and delivered consistently across the NHS. 2.3 The next-generation GPSoC framework GP IT is intrinsically linked with the General Practice Systems of Choice (GPSoC) framework, which is about to undergo some important changes. It is envisaged that the new GPSoC framework will enable general practice to extend its world-leading position in the use of electronic systems and enable delivery of increasingly rich online services for patients, supporting greater involvement of patients in their own care and shared decision-making. It will also do the following, as outlined in the GPSoC memorandum of information 1 : ensure the continuing provision and evolution of general practice clinical IT systems support efficiency gains in general practice by facilitating better use of existing GP IT and by adopting more mobile working tools and patient facing services through new technology develop new IT functionality that responds to the evolving needs of patients, practices, commissioners and the wider NHS. In particular, interoperability to deliver information to the point of care, and provide data to support commissioning and improve care pathway management improve the security of patient data by providing practices with the option to migrate to centrally-hosted services. 1

10 2. Introduction 10 In order to achieve these objectives the scope of the new GPSoC framework has been broadened, through the inclusion of a wider set of services and providers with the aim of: bringing all key general practice system offerings up to a clearly defined standard of functionality encouraging new entrants to the GP systems market to improve competition and innovation improving practice take-up of strategic functionality to meet national objectives for improving patient care establishing a system of open interfaces and standards to support integration between new and existing systems making the development of GP IT more responsive to practice and patient requirements. Where relevant, supporting guidance will be released at to explain the implications of the new GPSoC framework for the provision of GP IT. 2.4 The CCG-Practice agreement The arrangements covering the provision of GPSoC services, as well as GP IT services, will be reflected in contracts between the parties. The agreement between each practice and the CCG which arranges its GP IT and GPSoC services is called the CCG-Practice agreement. These will need to be completed and signed for each practice in response to the change in governance arrangements that occurred in 2013, and will replace those PCT- Practice agreements which currently exist. NHS England will ensure the provision of a standard CCG-Practice agreement template, with associated guidance for CCGs and practices to support the exercise to complete signature of agreements covering every GP practice. The responsibilities for this are discussed in more detail in section and further detail on the CCG-Practice agreement, including the timescales for completion of the signature exercise, will be made available in due course.

11 11 3. Clinically-led change Technology must be built into every level of business change. The transformational change agenda for the NHS in coming years is huge, and will not be realised without the right leadership and the effective use of technology. CCGs will lead the implementation of GP IT services in partnership with their practices and local health and care providers. It is also important that those responsible for GP IT investment understand why they are investing and what they are investing in through an effective informed customer capability. The role of an informed customer is described in more detail in Appendix A. Local strategies and leadership should ensure that general practice uses technology to support integration of care across local health communities and to deliver local commissioning priorities. To achieve these objectives, CCGs will need to have access to high quality strategic, tactical and operational IT and informatics skills and knowledge. In developing local strategies, it will be essential for CCGs to involve the local health community 2, including patients, carers and their representative bodies. CCGs are encouraged to have a Chief Clinical Information Officer (CCIO) or equivalent accountable officer who will provide leadership for the development of local IT strategy for the delivery of GP IT services. 2

12 12 4. Excellence in GP IT services At a high level, we consider excellent GP IT to look like this: high quality core services (a universal service for every general practice, referenced in Appendix B) investment in add-on services (discretionary services provided over and above core to support local commissioning and strategic priorities - examples referenced in Appendix C) utilisation of all national digital systems such as the Summary Care Record, Patient Online and GP2GP service to meet contractual requirements adoption and use of the latest GPSoC clinical IT systems, including a planned move to fully-hosted systems close integration between general practice and other care settings, enabled by technology, to improve information sharing across the overall health economy. CCGs will commission high quality core GP IT services, in addition to a range of addon discretionary services to support local strategic initiatives. The intention will be to improve service delivery across the local community, supporting local commissioning plans. Collaboration with other providers will enable integrated care.

13 13 4. Excellence in GP IT services GP IT Services the Operating Model NHS England CCGs Holds accountability and provides funding for GP IT Services Sets strategy and operating standards Monitors and drives the benefits of investment Commissions certain Primary Care IT enabling services Commission most GP IT Services (delegated by NHS England) Drive integrated care through local IT strategy GP IT Services Core Service Provision GP IT standard support services as set out in Securing Excellence in GP IT Services operating model Add-on Service Provision GP IT provision at CCG discretion to support local strategic initiatives and commissioning strategies to improve service delivery General Practice Business Support Systems Funded by the general practice to support corporate business delivery functions Service Delivery Organisations Deliver GP IT Services (commissioned and held to account by CCGs) CSU Any other provider NHS England will be directly responsible for certain IT services such as registration authority (RA) (administration of access to clinical and business systems); information governance (IG) support; clinical safety assurance and NHSmail administration and support for all primary care contractors. Area teams will commission these services from qualified delivery partners.

14 5. Accountability and commissioning responsibilities: system overview 14 NHS England is accountable for the provision of GP IT services. NHS England also retains responsibility for, and ownership of, all GP IT assets (inclusive of legacy IT transferred from primary care trusts). However, NHS England has delegated to CCGs the responsibility for delivering most GP IT services, as outlined in NHS Commissioning Board directions under the NHS Act 2006 as amended 3. CCGs may deliver these services themselves or choose to commission these services locally (including the management of the associated assets) from appropriate IT provider(s), for example commissioning support units (CSUs) or other IT delivery partners, including private sector partners. NHS England supports CCGs by setting the overall vision through a General Practice IT Strategy, establishing a single set of standards and maintaining overall budgetary oversight. This includes developing the supplier market and commissioning the Health and Social Care Information Centre (HSCIC) to maintain the national IT infrastructure and provide GP practices with a choice of clinical record systems via the GPSoC framework. NHS England will also ensure the appropriate handling of support for legacy Local Service Provider (LSP) systems. CCGs are responsible for developing local health informatics plans to ensure that technology is being used to optimal effect for the benefit of patient care. NHS England leads a number of national programmes such as Summary Care Record, Electronic Prescription Service, GP2GP and Patient Online that promote and support greater use of digital technologies in primary care and underpin local strategies for integrated care. NHS England, working with the national delivery partner, HSCIC, will ensure general practice has up-to-date applications to support the future use of digital transactions and information exchanges. This will allow CCGs to attain trajectories for the development of digital services and achieve better value for money for the NHS. CCGs will plan and manage the replacement of older general practice applications in conjunction with their local IT delivery partners. We encourage CCGs to work in partnership with primary care stakeholders to set priorities and local direction for IT support services. This includes NHS England area teams, general practices, patients and carers, and professional bodies such as Local Medical Committees and Local Pharmaceutical Committees. At national level, we work in partnership with the British Medical 3

15 15 5. Accountability and commissioning responsibillities: system overview Association and the Royal College of General Practitioners regarding, for instance, the provision of best practice guidance for patient access to services and patient records through technology. Whilst primary care services are the responsibility of NHS England, the revenue funding for GP IT was delegated to CCGs on 1 April 2013, and they are now responsible for determining arrangements for the deployment of this funding and for organising delivery of the associated services and infrastructure. NHS England will manage associated capital funding as set out in the Business Case Approval and Assurance process 4 to complement revenue investment delegated to CCGs. NHS England will provide leadership and work in partnership with CCGs as they develop local IT commissioning arrangements and informed customer capabilities. CCGs will be expected to demonstrate by March 2016 that they are fully providing the services set out in section 6, to ensure that a comparable service is offered across the whole of England. CCGs will be accountable to their local governing bodies and will be responsible for reporting the development of informatics plans to ensure that they meet local needs. Through the introduction of a primary care Digital Maturity Index, NHS England will benchmark nationally the adoption of digital clinical technologies across general practice and wider primary care. NHS England through its area teams will continue to monitor progress of the delivery of GP IT through the clinical commissioning and direct commissioning assurance frameworks 5. It is anticipated that CCGs (or their nominated management function) will require expertise to monitor the performance of local GP IT delivery partners and general practices as they use IT services in accordance with local agreements. Where a situation arises within general practice that cannot be resolved, the CCG will pass the issue to NHS England through its area team for contractual action. NHS England retains responsibility for commissioning services to support all primary care contractors to fulfil their statutory responsibilities relating to information governance, including compliance with the Information Governance Toolkit (IGT). NHS England will commission local services to support adherence to IG policies and procedures and provide support for the completion of practice IGT submissions. NHS England retains responsibility for commissioning registration authority (RA) (administration of access to clinical and business systems), clinical safety assurance and NHSmail support and administration for all primary care contractors. Area teams will commission these services from IT delivery partners

16 16 6. The services we need to secure excellence in GP IT There is a responsibility to deliver local IT support services for general practice contractors as set out in local service agreements, plus implementation and support for national strategic and clinical systems. There are also local obligations under the GPSoC and Local Service Provider (LSP) contracts which need to be met in the deployment and support of GP clinical systems. Whereas there is national funding to develop and deliver GPSoC, LSP, national infrastructure and application solutions, there are still significant local costs in deploying and supporting these systems and the infrastructure on which they operate locally. Note that GP Out of Hours IT services should, in general, be commissioned as part of Out of Hours standard contracts using the CCG operating budget for Out of Hours. 6.1 Core GP IT services (available to all general practices) Core GP IT services and support: these are the fundamental services, commissioned by CCGs, which every general practice must have in order to deliver health services effectively to its patients. CCGs may tailor as many aspects of the core services as necessary to suit local needs. This operating model is designed to support full delivery of high quality standards for these services by the end of 2015/16. There are two main principles supporting our definition of core GP IT services:

17 6. The services we need to secure excellence in GP IT 17 i. Getting the basics right A poor IT system creates frustration, whereas a system which is fit for purpose is greatly 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 with issues as they emerge. CCGs will base the quality of IT services on clearly defined service level agreements which in turn have a robust set of key performance indicators (KPIs) that are managed through effective service management processes. ii. Making the most of what we have already We need to ensure that we get the full benefit from the systems we currently use, to realise their full potential. Local organisations will be encouraged and supported to fully optimise their GP clinical systems e.g. through delivery of the GP2GP system and Patient Online: the roadmap. We must achieve full roll out and use of national strategic systems, such as the Summary Care Record, e-referrals, GP2GP and the Electronic Prescription Service to enhance patient care, enable integrated care across all care settings and achieve operational benefits to both the general practice and patients. Below is a high-level summary of core GP IT services. Further detail is provided in Appendix B.

18 18 6. The services we need to secure excellence in GP IT Service Service Desk General Infrastructure Service Local Clinical Server Support Desktop Maintenance and Support Service Disaster Recovery and Business Continuity Support Service Asset Management & Software Licencing Service Supplier Management and Procurement Service On-going Support for GP Clinical Systems Technology Infrastructure Refresh Service Training Service National Strategic System Implementation Service Summary Support desk for all users which provides: - triage - incident management - audits and investigations as required on desktop access - incident and Service Level Agreement (SLA) reporting. Provision, maintenance and technical support of the necessary infrastructure to deliver core services. Provision and technical support of any necessary local clinical servers. A comprehensive desktop support service. Support in order to assure and regularly test disaster recovery (DR) and business continuity (BC) plans. Registration of assets and software licencing and provision of monthly electronic asset reports to NHS England area team. Vendor management, from procurement through to contract and supplier management to support all core activities. Technical support for core general practice clinical systems on behalf of GP practices. Continual active programme of hardware refresh to a consistently high standard. A comprehensive ongoing training service to support core clinical systems. Planning, local implementation support and advice to users to ensure local deployment and exploitation of national strategic systems.

19 6. The services we need to secure excellence in GP IT 19 Service Routine Project and Change Management Service Client Relationship Management Service Summary Project management service including the planning and delivery of routine projects. Resources to include: project/programme management technical support change management. Provision of named senior manager as designated SLA account manager. 6.2 Add-on GP IT services (discretionary, to align with CCG strategies) Add-on GP IT Services: these IT services support local strategic initiatives to improve service delivery and local commissioning priorities. They are provided to complement core GP IT services and must be connected with the CCG s overall strategic plans and service improvement initiatives. It is important to note that these services may be provided to facilitate inter-organisational initiatives, e.g. to link general practice with other care settings. Add-on services may be purchased and funded directly by CCGs or GP practices if necessary. Below is a high-level summary of add-on GP IT services. Further detail is provided in Appendix C.

20 20 6. The services we need to secure excellence in GP IT Service Additional Infrastructure and Hardware Services Additional Service Provision Additional GPSoC Services Informatics Strategy Support and Planning Estates Strategy Service Exploitation and Optimisation of Core Clinical systems Primary Care Data Quality Service Summary Additional infrastructure and hardware services over and above core infrastructure described above. Provision, maintenance and technical support of the necessary infrastructure and hardware to deliver add-on services. Discretionary deployments across communities to support locality-wide strategies. GPSoC services over and above those listed as core. Support for CCG(s) to develop IM&T strategy, innovation, service development and delivery. Support for CCG(s) in the role of leadership of informatics programme across the local health community. Provision of advice and guidance to support the development of general practice estate relevant to the provision of ICT services and systems. Support and advice for users on how to get the best out of core general practice clinical systems. Provision of a service which provides practices with data quality assistance.

21 6. The services we need to secure excellence in GP IT Out of scope services Out of Scope Services (General Practice Business Support Systems): these are the systems which are associated with the running of the practice business and are not directly connected to patient care. General practice business support systems are funded by the practices concerned and therefore are not covered by these arrangements. Below is a high-level summary only. Further detail is provided in Appendix D. Functional Scope General Practice Business Support Systems Description NHS England provides funding to support general practice to deliver services to patients. Practices are expected to fund business systems such as accounting software. GP IT funding must not be spent purchasing or supporting general practice business systems. The necessary approvals will be required for software installed on general practice networks that may have an impact on core IT operations. 6.4 Primary Care IT enabling services (retained by NHS England) NHS England remains directly responsible, through its area teams, for commissioning some IT services for all primary care contractors. These are fundamental IT services which every general practice must receive. Area teams commission these services from qualified IT delivery partners based on a service level agreement.

22 22 6. The services we need to secure excellence in GP IT Primary Care IT enabling services: these IT support services are required for all primary care contractors that have access to and use of national clinical information systems. This includes community pharmacies, appliance contractors, dental practices, primary ophthalmic providers and primary care provided within prisons. Further information relating to these services is included within: Securing Excellence in IT Services Operating Model for Community Pharmacies, Appliance Contractors, Dental Practices and Community Optometry 6 and Securing Excellence in IT Services Operating Model for Offender Healthcare 7. Below is a high-level summary. Further detail is provided in Appendix E. Services Registration Authority (RA) Description A comprehensive registration authority service that delivers the management of role-based access control, issues smartcards and monitors user adherence to security policy for use of smartcards. Area teams to commission a comprehensive RA service as laid out in the RA Service Schedule NHSmail Administration and Support A comprehensive service to cover the administration and support of NHSmail accounts for primary care providers

23 6. The services we need to secure excellence in GP IT 23 Services Clinical Safety Assurance Functions Description A comprehensive clinical safety assurance service, providing the necessary advice and guidance relevant to national requirements for management of clinical risk in the deployment and use of health IT systems within the area team s geographical area. Assure adherence to: Clinical safety and assurance for the deployment and use of health IT systems ISB and Ensuring implementation of clinical safety in the manufacture of health IT systems ISB Information Governance Support Service To provide a full range of information governance services and advice to support practice compliance with the common-law duty of confidence, Data Protection Act 1998, Human Rights Act 1998 and meeting the requirements of the Caldicott Information Governance Review To also ensure that all devices and systems are managed and used in a secure and confidential manner in line with legal and policy requirements

24 24 7. Commissioning IT services operational management responsibilities The operational management of GP IT requires clear definition of accountabilities and responsibilities across commissioners and IT delivery partners. This section makes clear those responsibilities and the associated aspects of the processes involved. In this document the following terms have these meanings: Accountable means the party has an obligation to report, explain and be answerable for resulting consequences of the relevant activity Responsible means the party has the obligation to carry out the relevant activity. 7.1 How will the new financial arrangements operate? Historically, GP IT investment has been highly variable and inequitable across England. NHS England s intent is that all areas of England will have an equitable level of GP IT revenue investment by April 2016, sufficient to achieve high quality GP IT services for all. The legacy transfer of GP IT services means there are differing levels of service provision, with varied costs. It will take time to resolve this; therefore phased transition will be required. Our approach is to implement for the next two years a transition fund for those CCGs which have higher than average GP IT running costs, to ensure the stability of existing services. Key principles: NHS England will continue to provide national funding to support CCGs in the delivery of GP IT services GP IT funding will be allocated on a fair-share basis, to procure core and add-on services, based on general practice registered populations funds allocated to GP IT services will be ring-fenced and must be used only for IT to support primary care services CCGs will be accountable for any financial risks associated with over-spending if CCGs forecast underspending in-year, NHS England may decide to reallocate the funding. Clear standing financial instructions must be established between commissioners and delivery organisations CCGs and their GP IT delivery partners must follow all necessary financial guidance and processes in relation to provision of GP IT services e.g. NHS England s Capital Accounting Guidance 12. Additionally, CCGs must comply with NHS England Standing Financial Instructions (SFIs) when expending/ deploying GP IT funds. 12 Gateway reference : Document available on request from england.capital@nhs.net

25 7. Commissioning IT services operational management responsibilities 25 Key accountabilities and responsibilities: Accountable NHS England is accountable for investment in primary care and GP IT services. The CCG has financial accountability for the local budgetary management of GP IT funding. Responsible The CCG is responsible for the establishment of effective governance and accountability arrangements to ensure effective and appropriate use of delegated funds. The CCG is responsible for ensuring that: local arrangements comply with established public sector procurement rules appropriate quality and value for money are secured through collaborative procurements with other CCGs where possible investment appraisals consider the full cost of any service transition (e.g. where TUPE costs may have an impact). NHS England area teams are responsible for financial oversight and assurance through the clinical commissioning and direct commissioning assurance frameworks and assessment methodology Achieving equity revenue investment principles for and beyond We will distribute revenue funding in three ways: i. Revenue funding to procure core and add-on GP IT services, outlined in section 6 GP IT funds will be distributed directly to CCGs to manage, through Revenue Transfers, from area teams. An allocation will be made to each area team, specifying each CCG s GP IT funding level agreed by finance and the Strategic Systems and Technology Team within NHS England s Patients and Information Directorate, which retains the Senior Responsible Owner role for the operating model. ii. Transition funding In order to maintain financial stability, a transition fund has been set aside to allow sufficient additional GP IT funds to be made available to those areas which can justify higher than normal running costs, above a CCG s delegated budget for GP IT.

26 26 7. Commissioning IT services operational management responsibilities Prior to approval, CCGs will need to submit a plan which clearly sets out their intent to achieve parity within two financial years. This fund will decrease to zero by 1 April iii Funding for Primary Care IT enabling services to commission IT support services that underpin the use of national strategic systems within general practice Some revenue funding will be distributed to NHS England s area teams to commission Primary Care IT enabling services Applying for transition funding This will be administered through a detailed proforma, which includes guidance for completion as set out in Appendix F. Those CCGs which identify a likely significant shortfall in funding should immediately begin preparation of a plan to achieve parity by 1 April Any approved applications will be formally notified once the process has completed for all areas. Transition funding will be transferred from NHS England to CCGs using the same process for the initial delegated revenue budget Capital provision It is intended that capital will be made available to fund necessary hardware and software replacement and investment programmes. NHS England will make capital expenditure available for schemes which are deemed a priority and which meet the necessary criteria. In accordance with the Capital Accounting Guidance issued in December , CCGs must aim to maximise use of capital funding in order to preserve revenue funding for core and add-on services. All capital asset purchases must be made through nationally agreed purchasing frameworks whenever possible; where not possible, NHS England Standing Financial Instructions and procurement rules must be applied. Capital funding will be managed in accordance with the NHS England Business Case Assurance and Approval process 14. Separate supporting guidance, detailing the capital funding application process and associated priorities, will be released following the publication of this operating model Capital depreciation Capital depreciation will be managed through NHS England financial processes and will not be funded from within the delegated revenue budget to CCGs for GP IT. This includes depreciation charges for legacy assets transferred from PCTs to NHS England on 1 April Value for money Investment of NHS England resources must offer good value for money. Value for money in capital expenditure will be ensured through the extensive use of approved purchasing frameworks, which will be further assured through the Digital Maturity Index as described in section Gateway reference : Document available on request from england.capital@nhs.net 14

27 7. Commissioning IT services operational management responsibilities 27 Efficiencies associated with the delivery of core GP IT services will enable increased investment in add-on GP IT services. 7.2 Asset management Assets relating to GP IT belong to NHS England. CCGs are responsible for recording and maintaining these assets on NHS England s asset register(s) in line with NHS England Standing Financial Instructions. CCGs are responsible for ensuring a full and up-to-date audit trail of all assets in their area and the removal and secure disposal of GP IT assets where appropriate. Separate supporting guidance, detailing the asset management process, will be released following publication of this operating model. 7.3 Insurance Practices must at all times ensure that adequate security arrangements are in place in the practice premises in order to protect NHS-owned equipment. 7.4 Implications of the new GPSoC framework Subject to business case approval some costs, which have historically been paid from local Primary Care IT funds, will be paid for centrally by the GPSoC programme. Guidance relating to how the new framework will operate and associated funding arrangements will be available at (Note: this may be shortly after the publication of this document) once the new arrangements are in place. The new GPSoC contracts are expected to take effect from the end of March GP IT assets held on the register do not need to be individually insured under practice policies (i.e. contents policies) as they are covered under an overarching NHS insurance policy. However, practices should be aware that they have a responsibility to inform their insurance companies that IT equipment will be on their premises. Practices are advised to insure practice-owned IT equipment and ensure cover for the consequences of any loss.

28 7. Commissioning IT services operational management responsibilities 28 Detailed Financial Management Responsibilities: Process NHS England, Patients and Information Directorate NHS England area team CCG Revenue funding Determine operating budget for GP IT funding levels. Distribute GP IT revenue funds and financial instructions to CCGs. Accountable for the management of devolved revenue budgets for core and add-on GP IT services. Transition funding Manage and approve the transition funding process. Distribute and transfer GP IT revenue (transition) funds to CCGs in accordance with Strategic Systems and Technology Team guidance. Apply to NHS England for transition funding in accordance with application guidance. Capital funding Determine capital operating budget, oversight and assurance of the capital approvals process to ensure fairness and consistency nationally. Co-ordinate financial planning, oversight and assurance of area capital bids. Apply to NHS England for capital funding as per NHS England capital guidance. Asset management Produce specific guidance and processes relating to GP IT asset management in support of NHS England standing financial instructions. Accountable for the financial processes associated with the management of assets and oversight of the delivery of the asset management process. Responsible for the asset management and secure disposal processes.

29 29 7. Commissioning IT services operational management responsibilities 7.5 What are the contractual arrangements? A number of agreements and contracts will ensure that all levels of the system are linked in terms of their mutual rights and responsibilities. There needs to be clear accountability and agreement of service specifications so that every general practice understands the level of GP IT services to expect. Key accountabilities and responsibilities: Key principles: effective service management arrangements must be in place to oversee achievement 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 and management of GP IT services can only be made by a CCG any delegated responsibility of management arrangements must have clear assurance and accountability Accountable NHS England is accountable for contracts relating to national strategic/clinical systems and infrastructure as per the NHS mandate. NHS England is accountable for ensuring that CCGs comply with the CCG directions relating to the NHS Act 2006 (as amended), as per Securing Excellence in GP IT Services: Operating Model. The CCG is accountable for ensuring a CCG-Practice agreement is in place with each of its constituent practices and monitoring compliance with that agreement, escalating to NHS England area teams where an issue cannot be resolved. Responsible The GP practice is responsible for fulfilling its responsibilities as laid out in the CCG-Practice agreement. The CCG is responsible for fulfilling its responsibilities as laid out in the CCG-Practice agreement. The CCG is responsible for authorising signature against national infrastructure items such as the N3 network, and national frameworks such as GPSoC on behalf of its constituent practices. The CCG is accountable for the agreement and management of contracts and SLAs with GP IT service providers for the provision of GP IT services to its constituent GP practices, as laid out in this document.

30 7. Commissioning IT services operational management responsibilities High-level contractual arrangements Additional Services Contract NHS England Securing Excellence in GP IT Services: Operating Model CCG Contract and SLA GP IT Delivery Partner(s) GP IT Services CCG-Practice Agreement General Practice GPSoC Services GPSoC Supplier(s) Directions to clinical commissioning groups (CCGs) GPSoC Schedule A GPSoC Call Off Agreements Key Legal Direction Contract Service

31 31 7. Commissioning IT services operational management responsibilities NHS England s area teams will confirm conditions of use to each CCG as part of the transfer of GP IT revenue budget: each CCG must deliver this GP IT operating model funds allocated for GP IT investment will be ring-fenced and must be solely used for IT CCGs will be accountable for any financial risks associated with over-spending each CCG must issue a half-year forecast so any underspend can be identified and redistributed (however, the budget will not be lost in subsequent years if not spent in year one) budgetary management in line with NHS England financial instructions instructions for the transition funding process Between NHS England and CCGs NHS England is accountable for the delivery of GP IT services, but responsibility for the commissioning of GP IT services has been delegated to CCGs. This is in line with directions issued to CCGs by NHS England under the NHS Act 2006 (as amended); therefore no contract is needed between NHS England and CCGs in relation to these directions Between NHS England and national applications and infrastructure providers NHS England will ensure that national applications and infrastructure are commissioned for use by local NHS organisations as appropriate, in keeping with the overall NHS technology strategy Between CCGs and their GP practices (The CCG-Practice agreement) CCGs are responsible for the provision of core and add-on GP IT services for their constituent practices in line with this document. The details of the provision of these services, as well as the rights and 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 which not only ensures the practice understands what GP IT services to expect, and the related responsibilities of both parties, but also ensures that the practice s role in supporting the CCG s obligations under GPSoC and other national contracts is bound by a contractual agreement between the two parties. Where a change of GPSoC or LSP clinical system has been agreed the CCG and GP practice shall jointly undertake the selection process and subsequent migration with the relevant supplier Between CCGs and their GP IT delivery partners The provision of any services should be supported by a contract and SLA with each GP IT delivery partner. SLAs are an important component, which will be reflected or replicated in the CCG-Practice agreement, ensuring the practice can understand key components of the service which it is to