Mastering Chaos:

Current Situation: General Observations 

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TPP UK Ltd's Lack of Engagement​

• It appears that TPP UK Ltd has disengaged from the process, seemingly limiting their accountability to their government contract alone. This raises concerns as their obligations do not seem to extend to the GP practices and the patients they serve.

 

Inadequate Communication with the NHS and Patients​

• Despite senior figures from the local NHS Integrated Care Board (ICB) reaching out, TPP UK Ltd has yet to provide a satisfactory response. This lack of engagement suggests a deliberate business decision by the company to restrict communication to NHS staff and completely exclude patients.

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Patients' Exclusion from the Process

• Patients have been made to feel invisible throughout this process. Despite being the core dimension of the service, they have been excluded from the decision-making. If patients were instead considered 'customers', the dynamic would be entirely different. From a business perspective, ignoring customers is highly unusual, which begs the question as to why TPP UK Ltd is operating this way. This deliberate decision not to engage with patients has left them completely unsupported during the poorly executed implementation of SystmOne.

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​​How was the transition ‘sold’ to the practice?

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The Decision to Transition

• This appears to have been driven by something of an "everyone's doing it" mentality. Other practices have transitioned, so why shouldn't we? This approach echoes the principle of social proof, a well-documented form of influence explored by Robert Cialdini.

• Were the practice's needs for a new system clearly established before they began engaging with a new supplier? Unnecessary change often arises when there isn't a compelling need for it.

• How was the patient impact of this change assessed? Was the initial response to the question "How will this affect patients?" properly scrutinised and supported by evidence?

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Impact on Patients and Data

• Switching to a new provider effectively makes every patient, including those registered with the practice for decades, appear as a "new" patient. To what extent were decision-makers aware of the negative impact this radical change would have on the visibility and continuity of patient health data?

• Were those involved in the decision-making process aware that all patients who used the NHS App would be forced to reset their login credentials? Even if this was a necessary step, patients should have been informed in advance.

• Why was a new login process, which required photographic proof, made an absolute requirement for everyone? Was consideration given to patients who might be unable or unwilling to provide this, or to those who are suffering from chronic pain or disability and might find it particularly difficult?

• A local hospital reports that they are now unable to see GP patient records because the JUYI cannot now access GP records because  of the tranfer from EMIS to TPP UK SystmOne. JUYI stands for Joining Up Your Information! (At the time of writing I'm left speechless!) How is this issue to be corrected? How will patients be informed?

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Accountability and Performance

• What success criteria were established to evaluate the transition?

• What constitutes a failure, and is TPP UK Ltd taking any interest in this?

• How is TPP's performance measured at a governmental level, and is anyone at that level paying attention to the reality of their poor performance?

• How is performance data being fed back to the contract holders (TPP UK and the UK government)? Can a response be expected in due course?

 

Future Considerations:

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• TPP UK's disregard for their customers (patients) is unacceptable and warrants a full investigation into how such a detrimental approach has become a normalised part of their operations.

• Other healthcare providers considering TPP UK should be warned that the transition process is far from straightforward.

• A formal channel is needed to allow patients and NHS staff to engage with TPP UK at a senior level to address and resolve the issues they are causing.

• New suppliers entering this market must be informed that a business model similar to TPP UK's is not acceptable.

• Ethical standards in these kinds of contract negotiations are essential, and questions remain about the conduct in this instance.

• Suitably qualified NHS staff must be empowered to ask and understand critical technical questions, especially concerning arbitrary coding decisions that can have unintended consequences for patients.

• Given its current flawed state, the implementation of this 'transition' is difficult to justify. It should only proceed once a clear and compelling need has been demonstrated, particularly since the previous system, EMIS, was functioning well for patients. The purported benefits of this change remain unclear.

• This represents a failure by a private company to properly manage sensitive data, which is effectively on loan to them. TPP UK differs from other companies as they are not selling products to customers, but are instead tasked with designing and implementing a digital delivery system. In this model, we, the patients, become the 'product'. Our medical records are a huge part of our life stories; as such, digital suppliers like TPP UK Ltd. have a responsibility to treat them with far greater care.

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Ultimately trust in the NHS is of paramount importance. This precious commodity has been put at risk by this event and sadly now needs much effort to rebuild it.