Chris Lancelot: Consistency essential from IT to patient care

One of the abiding principles of any good organisation is consistency. The more that staff can depend upon clear rules and consistent rewards the more they will focus on the job in hand. By contrast, opaque rules, inconsistent standards, and unpredictable demands rapidly lead to demoralisation.

IT reimbursement is a classic example of a complex, unwieldy and unfair system. Practices in England are supposed to be reimbursed for 'all core IT expenditure' but this concept is interpreted differently by different PCTs. Some reimburse the not inconsiderable cost of back-up tapes; others are staunchly against doing it. Some consider call-in boards to be 'core': others disagree.

PCTs also respond differently towards software reimbursement, in ways that discriminate between different commercial systems. Some companies, for example EMIS, bundle all software into their main program, while others have a core application which users traditionally surround with third-party bolt-ons - scanning solutions, QOF tools, and so on.

Although these program suites together perform the same function as the EMIS application, some PCTs refuse to pay for them, even though their use is central to the running of the practice and to patient care.

Why should practices in one area of the country be reimbursed, while others aren't? Why should users of some commercial IT systems encounter problems, while others don't? Inconsistent attitudes like this lead to irritation and cynicism among doctors.

This individuality of PCTs has also led to the fragmentation of standards in other areas. Take the QOF: some PCTs insist on a detailed protocol to be followed before a practice can claim that a medicines review has been performed, while others are far more lax. Yet the QOF is a national system.

Consistency may be hard to achieve, but is essential. True consistency means that a patient will be treated exactly the same as anywhere else in the country: the same care quality, treatment paths and availability of diagnostic facilities, medicines and therapies.

But the NHS also needs organisational consistency - consistency of resources, of remuneration and of reimbursement. There should be no postcode lottery in the NHS - not for patient, clinician or manager.

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