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The General Practitioners Committee of the British Medical Association has expressed concern to the Department of Health about pressures that are being placed on practices to change clinical computer systems. This follows a number of complaints that have been raised with the BMA by the practices concerned. This note is intended to address the issues that need to be considered in such circumstances and to inform PCOs and practices as to the issues involved. In summary practices should, not be forced or coerced, to change their clinical computer system. GP Computer Reimbursement Scheme (Para 58)

Under current red book GMS computer re-imbursement regulations reimbursement is available only for RFA-99 compliant systems and it is implicit that practices should have choice as to which computer system they use. PCOs must not exert financial pressures on practices in favour of any particular system supplier by applying local differential reimbursement criteria.

The National IT Programme and the New GMS contract will lead to the development and deployment of new and improved systems and procurement arrangements. GP choice and involvement in local decision making is explicit in the New GMS contract. It would not be sensible at this stage for PCOs to take decisions on large scale replacement of practice systems in advance of clarity in these areas. However it is recognised that there may be urgent requirements to replace individual practice systems that do not comply with RFA-99 standards in order that local objectives and national targets can be achieved. Any practice system replacement should only go ahead if the new systems are compliant with RFA-99 (v1.1 or v1.2), and on the basis that the same levels of reimbursement are available to all practices regardless of the supplier of the systems concerned..

Until new, integrated, systems are available existing general practice systems will still need to be maintained and upgraded. This vital task should not be ignored. PCOs will be placing their future IT base in jeopardy if they do not continue to support and ensure the usability of current practice systems.

The practice's clinical computer system is a vital tool for modern primary care and the practice must have confidence in the system they use. Changing computer systems puts a considerable burden on the practice and this persists for many months afterwards. Whilst the functionalities of systems vary PCOs should not ask practices to change to new systems that offer less functionality than the systems that are replaced.

There are many important practical and professional considerations that must be taken into account when practices change clinical systems. The GPC is very concerned about data loss or degradation during migration between systems. There is an absolute need to ensure data integrity. GPs have an overriding professional responsibility to protect patient data as well as their being subject to other legal constraints such as the Data Protection Act. Loss of data arising from a system change can be significant. Practices should seek adequate assurances from the relevant supplier that data loss will be kept to the absolute minimum. There should be clear audit trails available to practices. If significant data loss cannot be avoided then the practice should consider whether the move is appropriate. If the practice decides to change system but accepts that data loss will occur, they should consider how they would manage the consequent liability. They should also consider how they would respond to the need to restore one of their old records - for instance providing retrospective evidence. It may require their needing to keep and maintain the original clinical system server so that they can access records as required.

PCOs also have explicit responsibilities to support paperless practices under the amended regulation 36(2) of the National Health Service (General Medical Services) Regulation 1992.