Modern IT solutions for transforming patient care

All new Electronic Patient Record GP solutions undergo an extensive assurance process before getting approval. Once approved they appear on the NHS Buying Catalogue.

The NHS England assurance process comprises 3 key areas:

1. Interoperability standards

These ensure the solution integrates safely and securely with all the relevant NHS national services, for example:

• Personal Demographic Service (PDS)
• Electronic Prescription Service (EPS)
• e-Referral Service (eRS)

2. Capability assessment

This ensures the solution provides the core functionality for an EPR GP foundation solution. The capabilities are mandated by the TIF framework and a solution must pass 6 core capabilities.

Further optional, additional capabilities are also available.

3. Overarching standards

These standards apply to the solution and, in some cases, the supplier. The standards, defined by NHS England, cover areas such as:

• training
• hosting
• information governance
• business continuity

There are also 11 overarching standards which a solution must meet such as information governance.

Final assurances and approval are provided by the: 

• NHS England primary care test lab
• NHS England clinical safety group

All TIF solutions undergo extensive clinical assurance assessment by NHS England. 

These must be passed before the solution is approved to go live. 

The process involves 2 main parts.

1. Clinical assessment using a primary care test lab

This uses a test environment integrated with national systems such as PDS and EPS. Suppliers run a series of in depth demonstrations for the NHS England clinical team.

The team is made up of qualified and experienced clinicians. The demonstrations allow the team to see the solution working in a comparable live environment.

They can assess how the solution addresses clinical risks. As part of the process, suppliers are required to provide a detailed clinical hazard log. This provides a basis for an in-depth assessment of the clinical risk profile of the solution.

2. Clinical safety group approval

After successfully completing the clinical assessment sessions, the supplier is responsible for:

• updating their clinical safety case and hazard log with identified:
  • risks
  • hazards
  • mitigation
• presenting the completed log to the clinical safety group

The group will:

• review all risks and hazards which relate to the upcoming go live
• ensure they are content with the severity rating and mitigation

The clinical safety group approve the TIF solution for deployment into the live environment. They do this by issuing a clinical authority to release (CATR).

It is important patient care is not impacted before, during and after switching to a new solution. Data must be migrated accurately and in as complete a state as possible.

The process of moving data from one system to another can often take 7 - 10 days. This leaves practices with large amounts of data that needs to be entered manually after go live.  This means extra disruption and manual effort for the practice. It could potentially also lead to a reduced level of service to patients.

An accelerated process has been piloted on several practice migrations with the aim of reducing migration time and achieving the following:

• minimise practice downtime by:
  • reducing disruption to practice services
  • maintaining a high level of patient care during migrations
• simplify the migration process by:
  • making the transition quicker
  • less labour intensive for GP practices
• gather experience and evidence to contribute to a future, standardised approach by:
  • developing a consistent, supplier agnostic process

This will benefit all stakeholders in the migration from one GP system to another. 

Several new system implementations have now taken place. This includes migrations from Vision to Medicus and EMIS to Medicus. They carried out the data migrations over a weekend. In each case, the GP practice closed to patients on the Friday afternoon. By Monday morning they were able to open with a full set of patient records. This is radically different to the disruption that was previously experienced by staff undertaking migrations. The following benefits were realised:

• reduced downtime
  • the migration was completed within the weekend window
  • the new system was ready for business as usual on Monday
     
• better service to patients
  • the impact to patients was reduced by ensuring appointments were available on Monday
     
• minimal disruption
  • the cutover process reduced the burden on practice staff to a minimum – removing the need for extensive manual catch-up of patient data which would previously have been required
  • this allowed staff to focus on patient care rather than manual workarounds
     
• easier for the practice to get up and running
  • future appointments and smartcard access were prepared in advance
  • this helped staff hit the ground running
     
• better planning
  • clear cut-off timings and communications helped the practice plan more confidently

NHS England will continue to work with all suppliers and practices on the migration process. We will look at where further improvements and efficiencies can be made. These include:

• reducing the administrative burden on practices
• minimising disruption to patient care

NHS England will work towards the implementation of a new, enhanced data migration process. By 2027 NHS England intends that all practice migrations will benefit from an accelerated and much less disruptive process. This work will enable practices to more easily move supplier, helping to ensure GPs and frontline staff benefit from smoother and less disruptive migrations. 

To help with migration we have developed the clinical system migration guide. The guide is for practices, GP IT delivery partners and integrated care boards. It will help with planning, preparing for and completing migrations. The guidance is currently being refreshed to reflect this accelerated migration process.