Introduction

This document sets out the revised Operating Model for the provision of high-quality general practice digital services, building upon ‘Securing Excellence in GP IT Services’, first published in December 2012 and subsequent editions published in 2014, 2016 and 2019.

Purpose – what does this document do?

The Operating Model is a commissioning framework supporting the provision of digital services required for general practices and primary care networks:

  • defining the digital requirements for general practice as clinical and business capabilities and the necessary IT enablers
  • attributing standards (and guidance) to these requirements to ensure quality, safety and compatibility
  • assigning responsibilities for the commissioning, provision and utilisation of these requirements.

This document provides a description of the specific arrangements that NHS England will put in place for GP digital services to:

  • explain how the NHS will fulfil its obligations regarding GP digital services and support under the CCG-Practice Agreement
  • inform general practice of what to expect in the provision of GP digital services, and what is expected of general practices in receiving those services
  • explain how the NHS will ensure key strategic digital programmes and digital mandates across the health and care system are reflected and supported in general practice
  • ensure digital technologies are available to enable service improvement, transformation of care arrangements and patient digital engagement with primary care
  • define the responsibilities of all principal stakeholders in the delivery and utilisation of digital services for general practice
  • set a requirement for regular review to ensure this Operating Model addresses the needs of a changing commissioning and provisioning healthcare environment
  • provide assurance that quality and value are being maintained and delivered consistently across primary care services within the NHS
  • ensure digital enablers are available and used to support the NHS commitment to net zero carbon emissions.

This document sets out the following key elements that will be necessary to support the effective delivery of GP digital services:

  • the operating arrangements including financial procedures and associated controls
  • the governance arrangements, including stakeholder roles and responsibilities
  • the leadership necessary, in commissioning, operational delivery and clinical engagement, to achieve excellence.

Definitions

The following definitions are used in this document:

Additional GP contract digital capabilities: Additional digital systems, technologies and services needed to deliver elements of a GP Contract in addition to providing Essential Services, e.g. an APMS contractor providing walk in services, minor injuries, GP out of hours etc. These are Enhanced Requirements.

Clinical system: The digital application used by the practice to store and manage its electronic patient records provided through GP IT Futures Foundation Solution AND any additional integrated or interfaced applications.

Commercial and procurement hub: The NHS England and NHS Improvement-funded ‘Commercial and Procurement Hub’ supports primary care customers with all aspects of procurement, including buying via the Digital Care Services (DCS) Catalogue and the purchase of solutions and service for the Health Systems Support Framework.

Core and mandated requirements: The requirements for digital systems, technologies and services necessary to deliver Essential Services under the GP Contract or as otherwise nationally mandated. Under the CCG-Practice Agreement these are funded by NHS for GP contractors.

Digital care services catalogue: The Digital Care Services Catalogue Agreement which includes GP IT Futures Framework and the Digital First Online Consultation and Video Consultation Framework Contract (DFOCVC) Framework.

Digital First Online Consultation and Video Consultation Framework Contract (DFOCVC) framework: The Digital First Online Consultation and Video Consultation Framework Contract accessible within the Digital Care Services Catalogue.

Enhanced access: Enhanced Access services offered by PCNs from October 2022.

Enhanced requirements: Requirements for digital systems, technologies and services which may enable service improvement or transformation.

Essential clinical system capabilities: The patient management and clinical capabilities which are Core and Mandated Requirements enabled through accredited software applications and data solutions available through the GP IT Futures Framework.

Essential services: Essential (patient care) services as defined in the GP Contract and Regulations.

Foundation capabilities: The six capabilities defined under GP IT Futures Framework which must be fulfilled to provide a Foundation Solution for general practice.

Foundation solution: A solution (or group of solutions) which maps to the GP IT Futures Framework foundation capability set.

Foundation solution supplier: Any supplier who provides the Foundation Solutions.

GP contract: The contract to supply primary medical services. This includes General Medical Services (GMS) contract, Personal Medical Services (PMS) agreement and Alternative Provider Medical Services (APMS) contract.

GP IT delivery partner: GP IT Delivery Partners are organisations commissioned by integrated care boards (ICBs) to deliver IT services for GP Practices as required under this Operating Model. Where ICBs provide these services directly, they take on the same responsibilities as the commissioned GP IT Delivery Partners.

GP IT enabling requirements: Requirements for services e.g. infrastructure, equipment and support as necessary for practices to operate the solutions provided to meet Core & Mandated and Enhanced Capabilities provided and the National Digital Services.

GP IT futures framework: The GP IT Futures Framework Agreement accessible within the Digital Care Services Catalogue. Provides accredited clinical systems for primary care including Foundation Solutions.

GP IT operating model: This document titled “Securing Excellence in Primary Care (GP) Digital Services” and preceding versions titled “Securing Excellence in GP IT Services”.

High severity incident: An incident defined as severity level 1 or 2 using NHS Digital Severity Level Guidelines. This highlights the NHS Digital approach to severity level guidance. Local interpretation or clarification may be needed.

Managed GP IT device: Any individual IT device which is part of the Managed GP IT Infrastructure.

Managed GP IT infrastructure: Any GP IT equipment, including desktops and mobile equipment, devices, applications or systems regardless of ownership, which is connected to or part of the GP IT infrastructure which the supplier supports and the security of which it controls.

National digital services: NHS centrally commissioned digital services provided to, and used as applicable by all NHS commissioned providers.

NHS Owned IT equipment: IT equipment purchased by the NHS using NHS funds (capital or revenue).

NHS smartcard: Smartcards issued by an approved NHS Registration Authority to provide secure access controls to clinical and personal information by only those that have a valid reason to do so. This definition will apply to NHS approved alternatives or replacements to NHS Smartcards. Note other smartcards, not NHS Smartcards, may be used for other access control purposes.

Operating model: The GP IT Operating Model (see above).

Practice: Any GP Contract holder eligible to receive GP IT services with a signed CCG-Practice Agreement.

Practice business requirements: The requirements for digital systems, infrastructure and organisation activities necessary to run the internal practice business and organisational governance which are the responsibility of the practice to provide.

Practice business support systems: Systems and services which a practice may utilise for business purposes enabling the non-clinical business functions to operate and support the practice as a business organisation. Not directly related to patient care.

Practice managed GP IT equipment: Any GP IT equipment, including desktops, mobile equipment, multi- function copiers etc, regardless of ownership, which is managed by the practice or a contractor appointed by the practice and is not directly connected to the Managed GP IT Infrastructure.

Practice owned GP IT equipment: IT equipment purchased by the practice or individual practice staff members

Practice premises: An address specified in the GP Contract as one at which services are to be provided under the Contract. These locations will be registered with the Organisations Data Service (ODS).

Practice staff: General Practitioners, practice employees and PCN staff as well as health and social care professionals individually commissioned directly by the practice.

Public authorities: NHS organisations (and general practices) which provide public services as defined under relevant legislation including the Freedom Of Information Act 2000 and the Data Protection Act 2018.

The NHS England funded ‘Commercial and Procurement Hub’ is available to support primary care customers with all aspects of procurement, including buying via the Digital Care Services (DCS) Catalogue.

About the operating model

Since the publication of the first GP IT Operating Model in 2012 the document has been welcomed as a definitive reference point for direction on the digital services to be provided to general practices and the responsibilities of the parties involved.

In updating the Operating Model NHS England has with the positive support of general practice and their professional bodies considered the following:

  • the former GP Systems of Choice (GPSoC) framework, the previous GP IT Operating Models and earlier guidance have, with strong clinical engagement and a progressive inclusion of digital services in the GP Contract been successful in realising a highly digitised general practice estate with a large percentage of paper free processes. We must continue to build on this success.
  • the key role of digital technology to underpin general practice resilience and business continuity
  • general practice continues to lead the NHS in the adoption of patient facing digital systems

NHS England recognises a number of significant drivers and trends:

  • the introduction of new models of care and contracts
  • the requirement to protect general practice including cyber security, data security and digital clinical safety
  • the immense pressures on general practice from patient demand, workforce capacity, service transformation, financial constraints and public expectations.
  • the need to support general practice working at scale including PCNs, multi-site practices, and super-partnerships
  • introduction of fresh digital solutions and innovation – including Digital Care Services (DCS) Catalogue
  • delivering on the digital commitments made in the  NHS Long Term plan and the GP Contract (2019)
  • lessons learned from the 2020-21 Covid-19 Response and the 2021 vaccination programme
  • the NHS commitment to net zero emissions
  • the development and evolution of Integrated care Systems (ICS)

The NHS and its supporting care systems and providers continue to change and evolve. This Operating Model is based on the knowledge and understanding at the time of publication and covers the period April 2021 to March 2023.

It mandates a number of digital requirements which must be provided by the NHS to meet its obligations under the CCG-Practice Agreement and to support the GP Contract. ICBs as local commissioners should not view this as defining the limits of local investment in digital services for general practice, but as the minimum set of essential digital services to be provided to practices.

Additional requirements described in this Operating Model as enhanced digital requirements may be the enablers to those service changes which deliver significant benefits. ICBs therefore need to work with local general practices to invest effectively in digital technologies which will enable and underpin service improvement and transformation.

General practices need to utilise and embrace these digital tools making the necessary service changes to realise the benefits they can deliver.

Changes made in this revision include:

  • continued emphasis on ensuring the security and safety of digital services in general practice
  • an enhanced emphasis on improving practice resilience and business continuity through digital enablers
  • the covid-19 pandemic response and vaccination programme lessons learned and their impact on this Operating Model
  • updated funding guidance including new sources of funding and guidance on direct practice funding
  • updated commissioning of GP IT services guidance to assist management of digital first provider organisations operating across multiple ICBs
  • aligning GP IT to support NHS Net Zero Carbon commitments
  • a new appendix listing the applicable framework contracts, including GP IT Futures, which support this Operating Model
  • guidance and a template specification to support practices procuring Advanced Telephony Solutions although GP telephony remains a practice responsibility.
  • Registration Authority and Desktop Infrastructure requirements updated to be ready to support new approved authentication approaches
  • the following become Core and Mandated Requirements:
    • Remote access – revised and updated
    • Online and video consultation
  • the following are no longer Core and Mandated Requirements:
    • clinical servers for local hosting
    • compliance with and reference to EU Falsified Medicines Directive (FMD) have been removed as this was not part of the EU withdrawal agreement

The scope of the Operating Model continues to reflect the ambition stated in the preceding version for a single Digital Primary Care Operating Model aligned to primary care commissioning and providing a framework which ensures digital technology fully supports and enables new models of care.

Organisational scope

The obligation on the NHS to provide GP contractors with accredited electronic patient record systems and the infrastructure and services necessary to support and enable these systems locally remains the underpinning rationale for this Operating Model. This in turn defines the organisational scope for the Operating Model as follows:

Organisations in scope:

Note: see section on sub-contracting of services

Stakeholders:

  • primary stakeholder organisations including ICBs, General Practices, NHS England and NHS Improvement and NHS Digital
  • secondary stakeholder organisations including commissioned GP IT delivery providers, accredited suppliers under DCS Catalogue frameworks and the Health and Social Care Framework (HSSF), GPC England, LMCs and others representing and supporting general practice nationally and locally.

Organisations out of scope:

  • other primary care contractors
  • providers contracted through the NHS Standard Contract
  • direct support to GP Federations and similar collaborative organisational forms, setup as separate organisational entities to provide services to general practice contractors and/or to secure and deliver non-GMS services e.g. through a standard NHS provider contract
  • General Practices contracted under the GP Contract (this includes GMS contracts, PMS agreements and APMS contracts) where a CCG-Practice Agreement is NOT in place.

Note any of the above organisations however may find this Operating Model useful as a reference to service requirements and standards.

Services out of scope:

  • services outside the GP Contract provided by practices for example occupational health services
  • Dispensing practices (approximately 1,000) operating under NHSEI Standard Contract arrangements for pharmaceutical dispensing regulations require software and digital infrastructure to operate the dispensing function. These services are outside the scope for the receipt of GP IT digital services under this Operating Model.

COVID-19 pandemic response lessons learned

Just as the previous Operating Model incorporated lessons learned from the Wannacry global cyber incident in 2017, this Operating Model takes account of the significant, positive and negative, lessons learned from the Covid-19 response and vaccination programme during 2020-21. These are described later in this document.

Key challenges

This revised Operating Model seeks to address the following contemporary challenges for a digitally enabled general practice:

How the Operating Model addresses each of these challenges is described in the key challenges section of this document.

Good practice guidelines

The “Good Practice Guidelines for GP electronic patient records” (last published as version 4 2011) is under revision, with an online resource format expected to replace a single published document. Once published this will supersede the 2011 Version 4 document in this Operating Model.

Guidance contents

Download a PDF copy of ‘Securing Excellence in Primary Care (GP) Digital Services: The Primary Care (GP) Digital Services Operating Model 2021-2023’