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How CCGs can learn to innovate

Sean Riddell asks how clinical commissioning groups can overcome the twin barriers posed by strategy and procurement to work smarter and improve care.

It is widely recognised that innovation is essential for the future of the NHS. Without radical new ways of working, the NHS cannot hope to deliver £20bn of efficiency savings and cope with the demographic time bomb of an ageing population.

Technology is a vital enabler of innovation. In healthcare - as in the rest of life - it means we can do things differently, saving time and money and creating more customer-focused services.

Although it actively encourages innovation, the NHS has often adopted a “by committee” approach, which rarely works. So how can clinical commissioning groups rise to the challenge and make sure they benefit from innovative technology to help them improve patient care and work smarter?

In my view there are two major barriers to innovation: strategy and procurement.

“Strategy” is an overused word in the NHS, especially around technology. While countless procurement decisions are made every day - from medicines to bandages - when it comes to IT there is often a feeling that you must “wait for the strategy” before doing anything.

Of course, it is important that IT fits into the bigger picture for an organisation - but waiting for a strategy that may or may not come leaves users frustrated and, worse, results in missed opportunities for improvement that may be staring you in the face.While the NHS has been guilty in the past of too centralist an approach to IT strategy, it has now moved to a lighter touch approach - encouraging CCGs to interpret its broad “connect all strategy” as they best see fit on the ground. This is good news - and an opportunity for CCGs to deliver change.

Procurement processes are another barrier. Procuring a single software supplier for a 10-year period across a large geography creates minimonopolies that limit market forces and kill innovation.

In my opinion, framework agreements - for example, the successful GP Systems of Choice framework - are a far better option.

Under GPSoC, if a practice does not like the innovations delivered by the supplier, they can typically give three months’ notice and to go to the market for a replacement. This gives market forces some oxygen while still adhering to public procurement rules.

There has never been a better time to innovate through technology. The government has put clinicians in the driving seat with CCGs and empowered them to deliver change. But how do you get started?

  • Start small and spread the word. Innovation does not have to mean radical change across the whole of an organisation - it can be as simple as switching on online appointment booking at a single GP surgery. Once others see the results, the buzz will quickly spread.
  • Look for the quick wins; there may be missed opportunities staring you in the face - for example, areyou exploiting all the benefits of your current IT system? Most users do not. The latest systems offer a host of sophisticated features such as detailed reporting functionality that can track immunisation rates at the touch of a button.
  • Beware the “S” word: do not fall into the trap of waiting for the new strategy before you do anything; huge organisations like the NHS are always writing and rewriting strategy. Have a clear vision of what you want to achieve in your locality and the confidence to pursue it.
  • Ensure interoperability across the healthcare journey. GPs are the navigators of the patient journey; to deliver innovative patient pathways, they need to be able to share real-time information with other clinicians.
  • Challenge your supplier; give them a wish list of what you want from your system and talk to other users to share ideas.

The best suppliers will listen and respond to their customers’ needs with new developments.

Sean Riddell is chief executive of EMIS Group.

Innovation in action

Barts Community Health Services and NHS East London and the City are using a common record architecture to improve care across a range of adult and children’s services. Using software that allows different clinicians to securely share patient data, they have been able to dramatically reduce duplication of data and onward referrals for secondary care, improve immunisation rates and speed up access to urgent care. For example, the community respiratory team has seen a 73 per cent reduction in onward referrals to secondary care. QResearch - a not-for-profit partnership between the University of Nottingham and EMIS - is using real-time, anonymised patient data to improve the health of the nation.

It has developed a series of innovative algorithms that enable clinicians to predict the likelihood of patients developing lifethreatening conditions. Its QRisk2 formula is widely used by GPs to identify people at risk of developing heart disease, which kills more than 110,000 people in England each year.

The GP market has also driven hardware innovations that are helping practices save time and money. A good example is the touch-screen “arrivals” kiosk that allows patients to check in for an appointment without queuing at reception. As well as freeing up reception time, these also give patients useful information such as whether their GP is running on time.

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