The National Programme for IT (NPfIT) system fundamentals, development and implementation process

The fundamental elements of the National Programme for IT (NPfIT) are :-

• The Care Records Service. This handles the spine database of national services.
• Choose & Book. A national electronic referral service which gives patients a choice of place, date and time for their first outpatient appointment.
• The NHS Electronic Prescription Service.
• A new national broadband IT network to upgrade the current infrastructure.
• The Quality Management and Analysis System and a system for GP to GP record transferring.
• NHSmail. A central email directory service due to replace many internal hospital email systems that use the Microsoft mail exchange server.
• The Radiology Information Systems (Ris)
• The N3 broadband network.
• The Picture Archiving and Communication System (PACS).

The Spine database, used by the Care Record Service includes the Personal Demographics Service, which stores demographic information about patients; The Summary Care Record, which is a summary of patient’s clinical information and The Secondary Uses Service which uses information from patient records to provide business reports and statistics for research, planning and public health delivery.

The programme has divided England into five areas and each area, or cluster as they are known, has a Local Service Provider (LSP) responsible for delivering up services at a local level.

Originally there were four regional contractors – BT, Accenture, Fujitsu and CSC, however Accenture and Fujitsu have since withdrawn from the project due to spiralling costs and the current LSP’s are BT Health for London and CSC Alliance for North, Midlands and Eastern and North East and East/East Midlands where it has taken over from Accenture.

In addition to the local service providers the programme has set up a group of National Service Providers who are responsible for common services such as the Choose and Book system and parts of the NHS Care Records Service.

So NPfIT has experienced troubled times throughout its relatively short existence, with the departure of two main suppliers, the creation of NPfIT Local Ownership Programme (NLOP), the scaling down of information held on the Spine and has faced criticism, albeit indirect, from the National Audit Office who said that the government had underestimated the challenges involved in the project, highlighted, it claims, by the “serious delays” in applying new software to individual trusts.

By the end of August 2008 new care records systems were only in use in 133 of the 380 NHS trusts in England and despite an initial deadline for the whole country to be using the system by 2010, less than 20 hospital trusts have currently (March 2010) installed electronic medical records under the project.

Last year the Department of Health’s chief information officer Christine Donnelly warned suppliers of the Care Records Service that she wanted to see significant progress made in its distribution or she would be forced into looking at other approaches.