GPES appointment business case published

114 Pages·2012·1.36 MB·English

by  H Kausch

General Practice
Extraction Service (GPES)

Appointment Business Case
(published)
Version No: 2.0 - Published Appointment Business Case
Issue Date: March 2012
Authors: GPES Team
General Practice Extraction Service
Appointment Business Case (published)
Table of Contents
EXECUTIVE SUMMARY ....................................................................................................... 6
1. INTRODUCTION ..................................................................................................... 15
1.1 Introduction to the Project ....................................................................................... 15
1.2 Summary Of Document ............................................................................................ 16
1.3 Approvals & Support................................................................................................. 16
2. STRATEGIC CASE ................................................................................................. 18
2.1 Introduction ................................................................................................................ 18
2.2 National Strategic Drivers for GPES........................................................................ 18
2.3 Overview of Organisational Changes ..................................................................... 20
2.4 The Case for Change ................................................................................................ 26
2.5 Service Requirements ............................................................................................... 31
2.6 GPES Funding ........................................................................................................... 40
2.7 GPES Strategic Risks ............................................................................................... 40
2.8 GPES Key Constraints and Dependencies ............................................................. 41
3. ECONOMIC CASE - OPTIONS APPRAISAL .......................................................... 43
3.1 Introduction ................................................................................................................ 43
3.2 Updating the Outline Business Case ...................................................................... 43
3.3 Options analysed in the Outline Business Case .................................................... 44
3.4 Changes Since the Outline Business Case ............................................................ 45
3.5 Appointment Business Case Option Appraisal ..................................................... 46
3.6 Shortlist ...................................................................................................................... 52
3.7 Option Appraisal ........................................................................................................ 53
3.8 Conclusions ............................................................................................................... 60
4. COMMERCIAL CASE ............................................................................................. 61
4.1 Introduction ................................................................................................................ 61
4.2 Changes since the Outline and draft Appointment Business Case ..................... 61
4.3 Overview of Contract Relationships and Implementation .................................... 62
4.4 GPET-Q Services: Process and Outcomes ............................................................ 63
4.5 GPET-E Services: Process and Outcomes ............................................................. 66
4.6 Memorandum of Understanding .............................................................................. 70
4.7 Risk allocation and Risk Transfer ............................................................................ 71
5. FINANCIAL CASE – AFFORDABILITY .................................................................. 74
5.1 Introduction ................................................................................................................ 74
5.2 Changes since the OBC and draft Appointment Business Case ......................... 74
5.3 Summary of Scheme Affordability ........................................................................... 75
5.4 Funding ...................................................................................................................... 77
5.5 Impact on Income and Expenditure Account ......................................................... 79
5.6 Impact on cash Flow ................................................................................................. 80
5.7 Impact on Balance Sheet .......................................................................................... 80
6. MANAGEMENT CASE ............................................................................................ 81
6.1 Introduction ................................................................................................................ 81
6.2 Project Capability and Capacity ............................................................................... 81
6.3 Project Management and Governance .................................................................... 82
6.4 Project Timetable..................................................................................................... 101
6.5 Training .................................................................................................................... 101
6.6 Communications Plan ............................................................................................. 103
6.7 Supporting the Operational Service - Organisation and Cultural Change ........ 103
6.8 Security and Confidentiality ................................................................................... 105
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General Practice Extraction Service
Appointment Business Case (published)
6.9 Benefits Management ............................................................................................. 106
6.10 Stakeholder Management ....................................................................................... 108
6.11 Risk & Contingency Management ......................................................................... 111
6.12 Project Evaluation ................................................................................................... 114

APPENDICES (PROVIDED IN A SEPARATE APPENDICES DOCUMENT)
Appendix A: ICT Moratorium Letter from John Suffolk
Appendix B: Customer Demand Profile
Appendix C: GPES Economic and Financial Model
Appendix D: Optimism Bias (now included within Appendix C)
Appendix E: Risk Workshop Attendee List
Appendix F: Quantified Risk Appraisal (now included within Appendix C)
Appendix G: GPES EPM RAID Log – Project Risk Register
Appendix H: Cost changes/apportionments between OBC and ABC
Appendix I: GET-Q Final Contract
Appendix J: Procurement Documentation (provided with draft ABC)
Appendix K: GET-E Contracts
Appendix L: GPET-E VALUE FOR MONEY APPROACH (amended during redaction)
Appendix M: GPES Project Timetable
Appendix N: GPES Communications Plan
Appendix O: Benefits Management Strategy
Appendix P: Benefits Management Document
Appendix Q: GPES OGC Risk Profile Assessment (RPA)
Appendix R: GPES ABC - PICD and Cabinet Office Approvals
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General Practice Extraction Service
Appointment Business Case (published)
Glossary of Terms
ID Acronym Definition to Abbreviation
1 ABC Appointment Business Case
2 ALB Arm‟s Length Body
3 BAU Business As Usual
4 BMA British Medical Association
5 BT British Telecommunications plc
6 BU Business Unit
7 CAP Common Assurance Process
8 CCG Clinical Commissioning Group
9 CfH NHS Connecting for Health
10 CM Contract Manager
11 COF Commissioning Outcomes Framework
12 CRI Customer Requirement for Information
13 CQC Care Quality Commission (formerly known as the Healthcare Commission)
14 CQRS Calculating Quality Reporting Service (formerly known as GPPCS)
15 DES Direct Enhanced Service
16 DH Department of Health also referred to as “the customer”
17 DHID Department of Health Informatics Directorate
18 DME Data Management Environment (Hosted by The NHS Information Centre)
19 DTS Data Transfer Service
20 ECC Ethics and Confidentiality Committee (see also NIGB)
21 EPM Enterprise Project Management
22 FBC Full Business Case
23 FCBC Full Confirming Business Case
24 FTEs Full Time Equivalent (employees)
25 GMC General Medial Council
26 GMS General Medical Services
27 GP General Practice
28 GPCG General Practice Manager (and Patient) Consultation Groups
29 GPES General Practice Extraction Service
30 GPES-I General Practice Extraction Interoperability (Standard)
31 GPET-E General Practice Extraction Tool - Extraction
32 GPET-Q General Practice Extraction Tool - Query
33 GPPCS General Practice Payments Calculation Service (now known as CQRS)
34 GPSoC General Practice Systems of Choice
35 GPSS General Practice System Suppliers
36 HES Hospital Episode Statistics
37 HQL Health Query Language
38 IAG Independent Advisory Group
39 ICT Information and Communication Technology
40 IFR Interim Formal Response
41 IG Information Governance
42 ISB (NHS) Information Standards Board
43 ITPD Invitation To Participate in Dialogue
44 LES Local Enhanced Service
45 MCU Medical Defence Union
46 MIQUEST Morbidity Information Query and Extract Syntax
47 MoU Memorandum of Understanding
48 NARS NHS Analysis and Reporting Services (replaces HES and Clinical Indicators)
49 NDPB Non-Departmental Public Body
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General Practice Extraction Service
Appointment Business Case (published)
ID Acronym Definition to Abbreviation
50 NHS National Health Service
51 NHS IC The NHS Information Centre for health and social care
52 NICE National Institute for Health and Clinical Excellence
53 NIGB National Information Governance Board for Health and Social Care (see also ECC)
54 NIRS NHS Information Reporting Service
55 NOF NHS Outcomes Framework
56 NPfIT National Programme for Information Technology
57 NPV Net Present Value
58 OCG Office of Government Commerce
59 OJEC Official Journal of the European Community
60 OJEU Official Journal of the European Union
61 OMF Operating Model Framework
62 OBC Outline Business Case
63 PH Public Health
64 PICD Procurement, Investment and Commercial Division (DH)
65 PMCG GPES Practice Manager Consultation Group
66 PMCS Primary Medical Care Services
67 PCT Primary Care Trust
68 PQQ Pre-Qualification Questionnaire
69 PHOF Public Health Outcomes Framework
70 QIPP Quality, Innovation, Productivity & Prevention
71 QMAS Quality Management and Analysis System (Supplied by BT)
72 QOF Quality and Outcomes Framework
73 QS Quality Standard (set by Quality Information Committee, National Quality Board)
74 RCGP Royal College of General Practitioners
75 RfI Request for Information
76 RfO Readiness for Operations
77 SfTP Secure file Transfer Protocol
78 SHA Strategic Health Authority
79 SNOMED-CT Systematized Nomenclature of Medicine Clinical Terms (referred to version 3)
80 SOC Strategic Outline (Business) Case
81 SRO Senior Responsible Owner
82 SUS Secondary Uses Service
83 SQL Simple Query Language
84 TBC To Be Confirmed
85 ToR Terms of Reference
86 TUPE Transfer of Undertakings - Protection of Employment (Regulations)
87 UK United Kingdom
88 UKNSC UK National Screening Committee (also referred to as the English NSC)
89 VfM Value for Money

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General Practice Extraction Service
Appointment Business Case (published)
EXECUTIVE SUMMARY
Introduction
The General Practice Extraction Service (GPES) is a centrally managed primary care data service
that will obtain information from all GP practices in England for approved, Department of Health
(DH) sponsored customers who can demonstrate how the data can be used to benefit patient care
and support the functions of the NHS. The development of GPES is essential to deliver the
information requirements outlined in the 2010 Health White Paper and the Health and Social Care
Bill 2011.
A GPES Outline Business Case (OBC) was developed and received approval from the
Procurement, Investment and Commercial Division (PICD) of the DH in April 2009.
Further reviews were undertaken of all government funded IT capital developments during 2010
and in October 2010 the NHS Information Centre (NHS IC) received confirmation that the GPES
project had been given the approval to proceed following this review. The NHS IC then submitted a
draft Appointment Business Case (ABC) to the PICD which was approved in June 2011.
Funding of approximately £40 million has been earmarked by the DH for the implementation and
operation of the GPES service for the next four years which covers the current Comprehensive
Spending Review period to March 2015. The first year of funding was released following the
approval of the draft ABC. The NHS IC received PICD, Treasury and Cabinet Office approval for
the Final ABC leading to the approval of the Final Confirming Business Case (FCBC), allowing
supplier contracts to be signed and the GPES project to move into the implementation phase.
Please note this redacted version for publication purposes has been edited to remove confidential
information but only where this is thought to be strictly necessary. Where this has been necessary
suitable annotations have been made.

Strategic Case
There have been considerable strategic changes since the OBC was approved in April 2009. The
key changes to the strategic direction of the NHS that will have an impact on the delivery of GPES
are:
The policies and business strategies for the NHS outlined in the Liberating the NHS Health
White Paper and detailed in the Health and Social Care Bill create the statutory
requirement for a centrally managed service to provide primary care data to appropriate
central agencies for legitimate and required purposes.
Changes in the responsibilities and roles of existing NHS organisations including the Care
Quality Commission (CQC), the National institute for Health & Clinical Excellence (NICE)
and the Advisory Committee for Resource Allocation (ACRA) significantly increase their
requirements for primary care data
Development of new NHS organisations including NHS Commissioning Board (NHS CB),
Clinical Commissioning Groups (CCGs) and Public Health England (PHE) to take over the
responsibilities and roles of existing NHS commissioners. These organisations will require
detailed primary care information to enable them to undertake their duties.
The changing role of the NHS IC proposed in the Health & Social Care Bill to become an
Executive Non-Departmental Public Body and have increased responsibility for information
collection and dissemination for the NHS. The NHS IC will not be able to undertake these
statutory functions without GPES
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General Practice Extraction Service
Appointment Business Case (published)
The impact of these changes to the need for GPES is that primary care information will be
essential to support an increasing number of national requirements. These are described below:

Outcomes Frameworks
Under the new strategic arrangements, information will be required to support a number of
outcomes frameworks and the measurements that underpin them. These outcomes frameworks
will include:
NHS Outcomes Framework (newly established from 2010/11). The NHS Outcomes
Framework will include a set of outcome goals that the Secretary of State will use to hold
the NHS Commissioning Board to account;1
Quality and Outcomes Framework (QOF) that is currently used to reward General Practice
for the delivery of quality services based on a series of indicators;
Commissioning Outcomes Framework (COF) which will look to define a series of outcome
indicators based on quality standards produced by NICE and the NHS Outcomes
Framework. These measures will be used to compare and hold to account the performance
of CCGs for their contribution to improvements in the outcomes of patients. It may become
the basis of a scheme designed to reward CCGs that use their resources to achieve high
quality outcomes to patients;
Public Health Outcomes Framework (newly established and being developed).
It is clear that many of the national organisations and functions outlined above will require the
provision of primary care data that is only available from GP clinical systems.
These include:
Requirements with a basis in legislation from CQC and Monitor.
Requirements for producing and monitoring the impact of NICE quality standards.
Requirements for any changes to the funding of practices or the resource allocation formula
for the NHS.
Other Primary Care Data Requirements
In addition to the emerging statutory requirements, information from GP practices could be used to
support a diverse set of local, regional and national level activities, such as clinical information to
support local public health requirements, disease surveillance and the monitoring of population
health such as obesity and smoking.
Case for Change
This section sets out in summary the case for change demonstrating the need to develop GPES.
The limitations of the existing service models are as follows:
There are several methods of data extraction and system suppliers providing data
extraction and analysis services of primary care data throughout the NHS. This increases
the risk of:
- Potential information governance issues;
- Inconsistency of data and data interpretation;
- Inefficiencies where information requests are repeated;
- Confusion for customers as to information sources;

1 The Operating Framework for the NHS in England 2011/12, paragraph 1.11, page 7
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General Practice Extraction Service
Appointment Business Case (published)
- Confusion for General Practitioners about the status of organisations requesting
data from the patient‟s health records;
The national drive for improved, consistent primary care data to support performance and
accountability across the NHS requires improved information process and outputs. The
existing fragmented system will not support this requirement in a sustainable or efficient
way.
Customer requirements for improved extraction, interpretation and presentation of primary
care information in support of decision making and patient care are likely to change as a
result of national strategic drivers and the existing service model does not support these
requirements.
The changing role of the NHS IC requires the organisation to provide central extraction,
analysis and interpretation of primary care data. The NHS IC cannot obtain data efficiently
and securely from all practices in England for the purposes outlined above. The NHS IC is,
therefore, currently unable to carry out the statutory functions outlined in the Health and
Social Care Bill.
The NHS IC will not be able to supply other identified customers with the information they
require.
As set out above the existing systems of primary care data extraction and analysis do not support
the current requirements of the NHS and the national strategic direction of the White Paper and
Health and Social Care Bill and as such there is a significant need for a comprehensive primary
care data extraction service to the NHS.
The NHS IC will have a statutory function to provide national NHS organisations with the primary
care information that they require. It is, therefore, vital that the NHS IC develops this capability and
that investment is provided to enable the organisation to carry out this key function. This will be
delivered through the GPES service.

Service Model
Customers of the service will be able to request an extract of data from GP clinical systems and
the GPES Business Unit will manage this on their behalf. There is an end to end process that will
be followed in order to satisfy requests for data. There are a number of separate stages, some of
which include more than one business process, and where necessary, some stages or processes
may need to be repeated.
The extraction process can be broken down into the steps illustrated below:
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General Practice Extraction Service
Appointment Business Case (published)

The GPES Business Unit will manage the end to end process of requests, extraction and
dissemination of primary care data for customers and will deliver this in whole, part or in
partnership with existing providers. GPES will be delivered using both manual effort and specific
technical support tools. A simplified picture of the technical components is illustrated below.

GPES will be provided by the NHS IC as an end to end service that utilises a range of contracted
and in-house services and components, these are summarised below:
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General Practice Extraction Service
Appointment Business Case (published)
a) NHS IC Customer Relationship Management:
b) NHS IC Post Extraction Analysis and Data Provision to Customer
c) GPET-Q – Query Definition (and maintenance) and Query Execution/Data Extraction
Management:
d) GPES-I – Interoperability Standard
e) GPET-E – Data Extraction
f) Department of Health Informatics Directorate - Access Management and National Reference
Data:
Further details on the people, functions and technology requirements of each of these services and
components can be found in the main document.

Economic Case

The following Critical Success Factors (CSFs) were utilised for the OBC but have been amended
to take account of changes in strategy for the development of options for the ABC:

CSF 1: Strategic Fit
CSF 2: Investment Objectives and Investment Scope
CSF 3: Supplier Feasibility
CSF 4: Potential Affordability
CSF 5: Organisational Achievability

A more detailed description of each CSF and what the options will be evaluated against is provided
in section 3.2.1.

The OBC assessed four options and concluded with a preferred option. As a result of the
significant changes in national policy and requirements since OBC approval, the primary care data
extraction landscape in technology and commercial terms has moved on to the extent that the
investment scope and objectives for GPES required updating. This has resulted in a reduction of
the available options for the GPES project. As a result, whilst retaining the fundamental functional
requirements of the OBC the re-appraisal of options provides a greater level of detail of each sub-
component.
A number of delivery methods were assessed as a long-list for each of the components described
above against the CSF‟s as per the table above and as such the best methods of delivery were
identified to create options to be appraised within the economic case

The two options considered were:

Option 1 – Fully integrated technology used to support the service
Option 2 - Integrated technology used to support the service (except in the area of query
definition and maintenance)

For a detailed description of the key components of each option please refer to section 3.

A detailed economic appraisal of each option was undertaken including risk quantification and the
results are set out in the table below:

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