Digital capabilities necessary to enable the practice to fulfil its obligations under the GP Contract are described here. Digital solutions will be provided to meet these requirements which in turn will be supported by a GP IT Enabling Requirements for example infrastructure, equipment, service desk, training. GP IT Enabling Requirements are therefore scoped by those digital solutions (for example Clinical Systems) provided under this Operating Model. All requirements are described in Appendix A.
Where published standards are appropriate and available these are assigned to the requirement and should be met when the service is commissioned.
Responsibilities for fulfilling these requirements (for example commissioning, delivery, assurance, usage) are described in Appendix B.
When commissioning services locally the GP IT Enabling Requirement described may need further development and clarification as part of the local procurement service specification. A GP IT specification commissioning support pack as described in Appendix E is provided to assist clinical commissioning groups (CCGs) in this task
Figure 1: Requirements and capabilities under this Operating Model.
Note: CCG collaboration with practices will include CCGs consulting with Local Medical Committees (LMCs) representing local practices
See Appendix A for detailed requirements.
- Core and mandated requirements
- Enhanced requirements
- Practice business requirements
- Service availability and incident response
- Accreditation, choice and selection of solutions
- De-commissioning of services
The digital solutions and IT enablers required for the delivery of Essential Services under the GP Contract or as otherwise nationally required are Core and Mandated Requirements. Through the CCG-Practice Agreement these are funded by NHS England for GP contractors.
Essential Clinical System Capabilities – patient management and clinical capabilities which can be enabled through software application and data solutions. These solutions must be accredited through the GP IT Futures Framework.
- Foundation solutions – To meet the six Foundation Capabilities practices will choose the best fit Foundation Solution(s) from those available in the catalogue.
- Non-foundation solutions – To meet the other Essential Clinical System Capabilities commissioning CCGs will collaborate with local general practices to choose the best solutions from those available in the catalogue. LMCs should be consulted as appropriate.
- National digital services – digital services commissioned centrally by NHS and provided to, and used by, all NHS commissioned providers as applicable. There is no local choice in these solutions. Local alternatives must not be commissioned.
- GP IT enabling requirements – namely infrastructure, equipment and support services as required by the solutions selected to meet the Essential Clinical System Capabilities and the National Digital Services.
Requirements for digital solutions and IT enablers which are not core and mandated (see above) but which enable service improvement and transformation. Provision of services to meet these requirements through commissioner funding is secondary to meeting Core and Mandated Requirements and is subject to local prioritisation.
- Productive digital capabilities – patient management and clinical capabilities which improve the efficiency and effectiveness of the contracted service and can be enabled through software application and data solutions. Accredited solutions to meet these capabilities will be available through the Digital Care Services (DCS) Catalogue .
- Transformational digital capabilities – patient management and clinical capabilities which enable transformed care, often extending beyond the practice, which can be enabled through software application and data solutions. Accredited solutions to meet these capabilities will be available through the Digital Care Services Catalogue and through Health Systems Support Framework (HSSF).
- Additional GP Contract digital capabilities – Additional digital systems, technologies and services needed to deliver those elements of a GP Contract additional to providing Essential Services, for example an APMS contractor providing walk in services, minor injuries etc.
- GP IT Enabling Requirements – any extension of the core GP IT Enabling Requirements (4.1.4) necessary to support and enable the enhanced capabilities above (4.2.1, 4.2.2, 4.2.3).
In providing services to meet these Enhanced Requirements CCGs should have regard to the following points:
- CCGs have an obligation to ensure requirements already met through NHS funded services or funded through other routes (for example GP global sum, provider baseline tariff) are not also funded as Enhanced Requirements.
- A “capability” where met should be supported by the GP IT Enabling Requirements necessary to access and utilise that capability for example infrastructure, equipment, service desk, specialist support.
- Where a CCG chooses to commission a solution to meet an Enhanced Requirement any standards referenced in this document and applicable to that requirement must be met.
- Enhanced does not infer a capability of lesser importance, only that the relevance and appropriateness will be dependent on the locality context and provision of these services must be secondary to meeting Core and Mandated Requirements.
- Many enhanced digital capabilities will be enablers for service/business change which can realise significant benefits to the NHS, patients and general practice.
The requirements for digital systems, infrastructure and organisation activities necessary to run the internal practice business and organisational governance and are the responsibility of the practice to provide:
- practice business support systems
- practice buildings and estate
- practice operating costs
- practice legal and regulatory responsibilities
- practice websites
- dispensing services
Although responsibility for commissioning and provision of these requirements is out of scope they may be indirectly linked using common infrastructure, standards, assurance, interoperability and security. In such cases practices are required to comply with any relevant technical and security standards.
The infrastructure and general support required to operate these services (namely desktops, printers, network connectivity) can at the discretion of the CCG be funded and provided as “enhanced GP IT Enabling Requirements” where this allows the practice to operate more efficiently and is considered affordable locally.
CCGs are encouraged to consider developing local purchasing frameworks for general practice business support systems and services to facilitate better value for money. Practices can procure from such frameworks to secure better value for money and assurances on cyber security, data security and clinical safety using the standards and guidance referenced in this Operating Model.
CCGs will encourage and provide technical advice to practices to migrate to advanced telephony systems suitable for General Practice which meet the template specification attached to Appendix E. These assist practices manage peak demand, operate telephone and video consultations, improve practice resilience and business continuity and increase workforce flexibility options with remote and home working.
GP digital services must be provided for the hours the general practices are contracted to offer primary care services. Some services however need only be available for restricted “office” hours whilst others may be required for longer hours with appropriately adjusted support levels.
Support for GP digital services needs to:
- match the contracted hours of General Practice services
- reflect business critical digital functions
- support extended access
- respond to high severity cyber incidents (through business continuity and disaster recovery planning).
The following are the minimum service availability requirements:
Standard service hours – Services to be provided between 9am – 5pm, Monday to Friday, excluding Public Holidays. This will include, in addition to the operational support services, those services which do not require an immediate response at any time within the GP contracted hours but which should be available during normal “office” hours.
Operational support hours – Services to be provided for core GP contracted hours, as detailed in the GP Contract (between 8am – 6.30pm, Monday to Friday, excluding Public Holidays). This will cover the provision of services required to respond at any time during the hours required under the GP Contract.
Extended operational support hours – As part of the GP IT enabling services to support PCNs under this model CCGs must commission Extended Operational Support Hours. Support provided during the Extended Operational Support Hours should ensure the continuity of Essential Services. From October 2022 this will support PCN Enhanced Access services. The CCG will consult with PCNs, practices and LMCs to determine the scope of and any applicable restrictions to the “Extended Operational Support Hours” including:
- exceptions (for example public holidays)
- practice premises, practices and operational services supported
- applications supported
High severity incident support hours – All practices must have access with 24 hour 7 day availability to log a High Severity Incident or request using one of the following methods:
- web portal (internet accessible)
GP IT enabling services must provide:
- monitoring of logged High Severity Incidents outside Operational Support Hours
- incident escalation of High Severity Incident to 24 hour 7 day response as necessary whether raised locally or nationally
- a business continuity plan and associated disaster recovery plans which provide the necessary response outside standard operating hours including the mobilisation of resources necessary to manage the incident and meet Recovery Time Objectives (RTO)
- a business continuity response based on a 48 (actual) hour Recovery Time Objectives (RTO) for the practice to provide Essential Services.
See requirements for cyber security, clinical safety assurance, service desk, and information governance.
Systems and infrastructure availability – Critical systems and infrastructure should provide 24 hour 7 day availability with individual contracts defining % availability and support hours. Examples include Clinical Systems (Foundation Solutions), NHS applications, Health and Social Care Network (HSCN), WiFi, Local Networks and GP online and video consultations
Third party support availability – Where a supported service requires third party referral, advice or action for resolution the capability of that service may be limited outside the support hours contractually offered by the third party. In such cases resolution of incidents or problems should be prioritised and based on work around or contingency solutions. In the case of High Severity Incidents and activated business continuity (BC) and disaster recovery (DR) plans third party activities should be integral within these plans.
General practices, which use computerised patient records, are required through the GP Contract to use an accredited clinical system. The accreditation is determined by the inclusion of the required capability in the GP IT Futures Framework. Each practice can determine the most appropriate Foundation Solution from the accredited solution(s) offered in the framework to meet the six Foundation Capabilities described in Appendix A. CCGs and practices will then jointly select the practice’s choice of accredited Foundation Solution, subject to the conditions described in the CCG-practice Agreement.
National Digital Services are commissioned centrally and provided to practices to be used directly or through their clinical system interfaces. There is no local choice or selection of such solutions.
All other capabilities for example online consultation systems or document management systems will be met by solutions determined by the CCG in collaboration with practices and then jointly selected by the CCG and practices. Unlike Foundation Capabilities the use of accredited solutions is not contractually mandated although compliance with standards attributed to the capability should be considered essential. In all cases CCGs should only procure solutions which meet the standards referenced in this Operating Model and whenever possible should use an appropriate national framework contract (see Appendix C). Compliance with CCG Standing Financial Instructions (SFIs) will require demonstration of value for money and product quality and safety. Within any single CCG, practice requirements may vary and therefore in some circumstances procurement of more than one solution may be appropriate. Where GP IT Futures notional CCG funds are used the solutions can only be sourced through the GP IT Futures Framework.
GP IT Enabling Requirements will be commissioned by the CCG to the standards assigned to the requirement commissioned (See Appendix A).
Table 1: Summary of solution selection and mandatory accreditation
|Requirement||Choice of solution||Procurement routes|
|National Digital Services||NHS Digital or NHS England||N/A|
|Core and mandated essential clinical capabilities – GP IT Futures Foundation Capabilities||General Practice chooses its Foundation Solution||Must be accredited and sourced through the GP IT Futures Framework|
|Other core and mandated essential clinical capabilities: not Foundation Capabilities||Commissioning CCG in collaboration with practices||Applicable Framework including DCS Frameworks (see Appendix C)|
|GP IT Enabling Requirements||Commissioning CCG||Applicable Framework or local CCG procurement*|
|Enhanced Capabilities and Requirements||Commissioning CCG in collaboration with practices||Applicable Framework including DCS Frameworks (see Appendix C) or local CCG Procurement*|
|Practice Business Requirements||General Practice||Practice Responsibility|
* “local CCG procurement” will be subject to compliance with standards in this Operating Model and NHS procurement and financial obligations.
The CCG may de-commission a service meeting a core and mandated capability providing:
- the core and mandated capability is still met either through a replacement service or by rationalising service duplication
- the decision does not conflict with the practice’s choice of Foundation Solution
- for non-Foundation Capabilities as part of the determination of the replacement service the practice has been consulted.
The CCG may de-commission a service meeting an enhanced capability providing the risks to and impact on practices and patient services has been identified and affected practices consulted. Where a replacement service for an enhanced digital capability is to be commissioned practice consultation will have taken place as part of the process.
The CCG may de-commission a GP IT enabling service providing:
- any core and mandated enabling requirements are still met either through a replacement service or by rationalising service duplication
- practices are advised of any service delivery changes and Appendix 1 of the CCG Practice Agreement is updated as necessary.
- Executive summary
- The CCG practice agreement
- Requirements and capabilities
- Commissioning, procurement and contract management
- Addressing the challenges
- Transition arrangements and timescales
- Appendix A – Schedule of GP digital requirements and capabilities
- Appendix B – Responsibilities and accountabilities
- Appendix C – Applicable national frameworks
- Appendix D –Digital primary care maturity assurance tool indicators
- Appendix E – Commissioning GP IT enabling services
- Appendix F – Commissioning advanced GP telephony services
- Appendix G – Procurement checklist
- Appendix H – General practice quick reference
- Appendix I – Glossary of terms