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Manchester CSU on the Paperless Challenge

Manchester CSU on the Paperless Challenge


To help achieve the paperless NHS challenge, one commissioning support unit is enabling the electronic exchange of clinical correspondence

Earlier this year Secretary of State for Health, Jeremy Hunt, challenged the NHS to become paperless by 2018, with the aim of “making it the most modern digital health service in the world.” 

Mr Hunt’s vision for a ‘paperless NHS’ encompasses the joining up of local solutions to drive integration, an innovative approach to technology in healthcare, and the adoption of electronic patient records and electronic referrals.

As a local health economy, Greater Manchester is collectively focusing its energy on addressing this vision, with Greater Manchester Commissioning Support Unit (GMCSU) acting as an important conduit. GMCSU works in partnership with commissioners, secondary care providers, local authorities and other healthcare organisations. We provide support for a wide range of tailored services for specialist clinical support, healthcare commissioning and business support services – including IT. 

The Greater Manchester footprint is vast and diverse with a population of approximately three million, and 12 clinical commissioning groups (CCGs), 10 acute trusts, four community and mental health trusts and a myriad of third sector agencies and charities. 

As a provider of IT services to the 12 CCGs in Greater Manchester, our remit is two-fold. We provide the practical technological systems and solutions that CCGs and GP practices need to operate effectively on a day-to-day basis; and we ensure these are underpinned by robust IT infrastructure, a secure network, and effective data storage and management services. 

We are committed to ensuring that clinicians, healthcare professionals and local authority employees have safe and secure access to the data and information that they need to provide the wide range of services that the people of Greater Manchester expect. 

Our knowledge and experience of NHS IT and the local health economy means we are perfectly placed to support commissioners when it comes to delivering the paperless NHS.

Paperless hospitals

In April 2010 the Department of Health (DH) introduced a new target, requiring NHS hospitals to send patient discharge notes to GPs within 24 hours. Historically, clinical correspondence was posted to practices and could take a number of days to arrive and process, potentially resulting in a delay in GPs receiving patient information. 

In line with the new government requirements, commissioners in Greater Manchester began to consider the use of an electronic system to help overcome these issues. NHS hospitals in Bolton, Stockport and Salford were already using various systems to send clinical correspondence to GP practices, which was working well and realising a number of benefits. 

In 2012, the Greater Manchester health economy invested in the Docman electronic document transfer (EDT) system to connect hospitals with GP practices and began to plan and deliver the project via primary care trusts (PCTs).

The EDT system is an off-the-shelf software solution that integrates with patient administration systems and electronic patient record systems. It allows data to be transferred electronically between organisations - in this case the hospital and the GP practice - securely within the national NHS computer network. The system also integrates with the document management system used by many GP practices, NHS hospitals and community clinics.

The process is relatively simple. Hospitals upload clinical correspondence to the EDT system and the information becomes immediately available to GP practices. Hospitals can upload clinical documents in batches or as and when they need to. 

Practices connect to the system and use their own document collection systems to pull the correspondence down. The information is then instantly transferred onto the practice system for GPs to access. This process happens automatically every two hours; it can also be done manually if practices are expecting urgent information. This ensures that clinical information is guaranteed to be with GPs within the required 24 hours.

Specialist support 

When the NHS landscape changed in April 2013, GMCSU was commissioned to deliver the EDT project on behalf of the local health economy. This has involved us leading on the roll-out of the technical implementation required to connect hospitals and GP practices together, something that we are well placed to do.

We created a specialist team from our IT project management office. Involving highly skilled project management professionals with the knowledge and experience of delivering large scale IT programmes within the NHS has been valuable. The team also has the added value of being able to build on existing relationships with CCGs and hospital providers and detailed knowledge of the local infrastructure across the whole health community. 

The GMCSU IT project team is responsible for:

 - Ensuring that all GP sites – 505 in total – across Greater Manchester can receive clinical correspondence electronically.

 - Installing EDT hubs into each foundation trust so that electronic correspondence can be produced for A&E attendance, in-patient discharge and out-patient discharge.

 - Putting business processes in place so information can be produced and distributed securely.

 - Connecting hospital EDT hubs together so that a patient attending any hospital in Greater Manchester can have their clinical documents relayed directly to their GP, regardless of their geographical location.

By working closely with GP practice managers and CCG clinical leads for IT we are ensuring that each practice has the right software and systems in place to connect to the new EDT system. Our team also provides CCG boards with monthly update reports and arranges IT training for GP practice staff.

A total of 390 out of 503 GP practices are now connected to the EDT system and seven of the 14 trusts are able to send correspondence electronically to GP practices. One million electronic letters have now been sent using the Docman EDT system and we are on track to roll the system out to the remaining GP practices over the next twelve months. 

We are now beginning to link the hospital EDT hubs together and building resilience levels for business continuity and consistency. This involves embedding elements of the EDT hub into operational teams at GMCSU so that our IT service desk can provide technical support to GP practices.

Realising the benefits 

The EDT system is already adding value and realising a number benefits, including increased costs savings, enhanced clinical decision-making and improved patient experience. 

It costs the NHS approximately 65p each time a letter is posted. With an estimated five million letters sent each year, the Greater Manchester health economy is set to make considerable savings. Reducing paper consumption is also helping to address the wider NHS sustainability agenda.

GP practices have reported that they are benefiting from improved workflow and have seen a marked reduction in the time that practice staff spend scanning and uploading information. It not only speeds up delivery and improves productivity but also reduces the risk of losing or duplicating documents.

GPs themselves are benefitting from immediate access to clinical information following a patient’s discharge from hospital. This is improving clinical decision-making - and ultimately patient care - as patients can be seen and treated quicker and more effectively. 

Dr Owain Thomas, GP and Clinical Lead for IM&T at NHS Salford CCG, said: “We have been using electronic document transfers in Salford for a number of years now. This system has provided tangible quality improvements during that time; documents arrive much more quickly (nearly 95% arrive within 24 hours), they are more efficient to handle, both within the practice and in terms of a huge reduction in the amount of paper used. 

“The system itself is significantly safer than paper, as now documents can be tracked from their creation right through to being actioned in a practice - at every point we can trace them and ensure that nothing is missed.

“Put simply, clinicians now have access to appropriate information in a timely manner, with a safe, reliable, efficient system. There is no doubt that over the past few years patient care has benefited from the work done to deliver this system.”

Digital revolution

The paperless hospitals project is just one of a number of innovative health IT programmes underway that GMCSU is supporting commissioners with. 

Last year we secured funding from the Health and Social Care Information Centre to implement the electronic prescription service (EPR) to 57 Greater Manchester. 

We are also providing direct support to a number of existing integrated care initiatives such as the Salford Integrated Record and the Stockport Care Record, to join up care solutions across multiple providers for the benefit of patients.

In the past year a great deal of activity has taken place to migrate the existing networks and systems across the 12 CCGs into an integrated IM&T solution. 

We are upgrading the computer network across Greater Manchester and have invested in 

a brand new data centre, which will allow us to provide future proof, secure and flexible foundations for innovative change. 

The scope and scale of such investments would be impossible for a single CCG or acute trust. This is where we come into its own; we have the ability to negotiate on a collective basis with network and system suppliers, which enables us to bring economies of scale across the region, increasing cost efficiencies for CCGs and ultimately using technology to improve patient care. 


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