Last week, we shared a poll on LinkedIn and in our newsletter asking: five years from now, how many GP clinical system (core electronic health record) suppliers do you think there will be?
Views were split; after three days, 51 percent of respondents voted that they do not expect to see any significant change to the market, with three or less suppliers available in 2027. 25 percent expected to see a much wider choice, with seven or more suppliers available, whilst the remaining 24 percent opted for a middle ground, and voted that there would be between four and six suppliers in the market.
To dig deeper into the question, we sent an email out to professionals across the industry. We asked the same question, but this time, respondents had the space to offer their thoughts and any reasonings behind their vote if they would like to share.
Here are some of the views held by our respondents…
All systems must “proactively support interoperability”
Chris Robson, CEO of digital health company Living With, stated that he would expect to see seven or more suppliers in the market by 2027.
He commented that other industries provide a potential model that healthcare might follow. “In most regulated industries where there is a strong legacy of embedded software, a number of players have survived in spite of rapid technological change,” said Chris. “It is likely that healthcare will behave the same way.”
Chris noted that it will take time and money to make change happen, but highlighted that “ultimately it doesn’t matter as long as the NHS mandates that they all proactively support interoperability.”
It depends on EPR convergence
Richard Cullen is the Clinical Chair at Rotherham CCG, Clinical Lead for IT and GP Senior Responsible Officer for Digital Workstream South Yorkshire and Bassetlaw ICS. He commented that he believes the number of suppliers will depend on whether or not the industry sees electronic patient record (EPR) convergence within acute and mental health care.
“If we take primary care in isolation, I would think there will only continue to be two or three GP clinical systems in five years,” Richard said, “however if we get EPR convergence… there may well be practices that opt to adopt the same EPR to provide more seamless care for the patient, and to provide economies in backroom resource.”
As we move more into digital interactions with local populations, Richard said, “we may well see that individual clinicians will more often be entering data into these portals that is then transferred into the EPR, so you wouldn’t necessarily see the core system on a day-to-day basis. This becomes more important as we allow patients to add their own data that might be needed into several health systems, and we use RPA (robot process automation) and AI (artificial intelligence) to utilise that data.”
Richard concluded, “I think there will be two to three standalone primary care EPRs but with four or five EPRs supporting both primary and secondary care being used by individual practices instead of the core systems. They will have communication/data entry systems that sit over those core systems so it will appear that you are using something different.”
“The requirements are hugely complex.”
Carl Woodroffe, Business Development Manager at Cinapsis SmartReferrals, shared his view that the strict requirements for new suppliers to enter the market will create a barrier and prevent more suppliers from joining. He believes that a system overhaul is what is needed most, describing “a new system that’s clinically focused on supporting GPs manage patients and overwhelming demand” as “sorely needed”.
Carl added that the requirements for practices to comply with wider agendas such as record sharing necessitated a change in systems for many, but said that “the intense demands on GP suppliers has left less room for innovation.”
“I see little innovation hitting the market, and the requirements for market entry are hugely complex and demanding,” said Carl. “I’d imagine [that] would put off many potential new suppliers.”
“I think the number could be zero.”
Marcus Baw, GP and software developer, offered “a slightly fantastical, but not totally implausible view”, why he thinks the number of GP core suppliers in five years’ time could be zero.
Marcus focusing on the purported benefits of ‘separating applications from data’, explained why it is “a very difficult task for tightly integrated applications like GP systems, but maybe not impossible for the purely clinical part of the data. NHS England are also procuring a Federated Data Platform. Over the next 5 years, as the use of the this platform increases, and ever larger amounts of identifiable GP data are stored in it, a tipping point may be reached where it makes ‘more sense’ to switch over to using that platform in real-time as the central, single GP data store, and use the GP systems as simply ‘viewers’ or tools to interact with this data.”
Marcus emphasised that this would mean that the core GP system suppliers as we currently know them would become “bolt-on” systems for the main platform. He stressed that this view isn’t widely held or widely accepted, and not one that he himself necessarily agrees with. “What I’m describing here is a fiction – I hope! Not everyone in the healthcare landscape will agree that this is an appropriate or safe direction of travel.” It would mean centralising all identifiable GP data into UK government hands through NHS England. “Civil liberties campaigners would react against this idea, as would many patients and clinicians. The GP system suppliers are also likely to protest loudly.”
However, there could be benefits. Marcus agreed that the strict rules around suppliers causes difficulties and “make it very hard for them to improve while simultaneously maintaining a full service.” With each GP practice in charge of their own data control, “this has led to (literally) millions of data sharing agreements and a level of complexity in GP data flows” that is difficult for GPs to keep track of. Given these challenges, “maybe an ‘inversion’ of where the data is stored would allow better GP user interfaces to emerge… a single unified data store could solve all those issues at a stroke.”
What do suppliers think?
We also heard from three suppliers, to explore their views on the matter.
Craig Oates, Managing Director of Doctrin, said that “the demands on GP clinical system suppliers are changing and the ability to integrate is needed more than ever as integrated care systems (ICSs) come into force.”
Craig believed that NHS Digital’s GP IT Futures programme underlines their commitment to “bring new players into the market [and] open up the GP clinical system landscape. While the current big suppliers aren’t likely to be pushed out as a result, they will potentially become part of an ecosystem where a one-stop solution is replaced by a core platform which integrates with the best parts of other solutions, such as population health management tools.”
He added that the leading systems will need to develop and find ways to better support integration with multiple apps and platforms, with statutory and non-statutory partners. “This will support growing demand from practices, PCNs (primary care networks) and ICSs looking to tailor platforms to meet their local needs.”
In addition, Craig said, “primary care clinical systems are also likely to be boosted by the recently announced Tech Innovation Framework, launched by NHS Digital, which aims to help practices overhaul care by giving them access to a wider range of technology. It’s encouraging to see major steps being taken to support the digitisation of primary care.”
Melissa Morris, CEO and founder at Lantum, commented: “50 percent of respondents have said that there will only be between one and three core clinical system suppliers in five years’ time – this suggests that respondents believe that joined up clinical records will only be achieved through consolidation in the sector, rather than through improved interoperability.” She shared her hopes that this will not turn out to be the case, adding that she hopes to see “the route to streamlined patient data come from better co-operation through multiple vendors, where competitive tension drives faster innovation.”
Meanwhile, CEO of HN Mark England said that he doesn’t think it’s about the numbers, but rather “whether the systems available enable GPs to record the right information as effectively and efficiently as possible, support new models of care, and help primary care networks deliver on their ambition to provide proactive, personalised and integrated care for people closer to home.”
He added that the most important change that needs to happen in the next five years, in his view, is “to ensure this information is shareable and open so that it can then be used to help reduce the burden on GPs. If we can use tools like machine learning to analyse the data, we can move towards a more predictive and preventative model in primary care, using routine healthcare data. This will mitigate future demand on the health system and improve population health. There is too much talk about systems when the focus should be on data and the crucial role it provides in allowing the NHS to be more efficient.”
Many thanks to our respondents for taking the time to share their thoughts.