I got into healthcare IT in the 90s because my wife was training as a GP. After work, I’d pick the kids up and then drive to the practice. We were often waiting in the car park for her as she had so much admin to finish. It was clear to me that the IT was to blame. I talked to other medics and realised that none of the systems were up to scratch.
I was a software architect for a major bank at the time. I knew I could fix healthcare IT. I had worked on a system at the bank that centralised customer accounts. I wanted to make this possible in healthcare. I quit my job and started writing the cloud architecture for SystmOne. This was in the late 90s – way before the term cloud had even been coined.
Nearly 30 years later, over a quarter of the NHS workforce use SystmOne every single day. It’s used in GP practices, Community Services, Mental Health, Emergency Departments, Hospitals, Prisons, and Social Services… the list goes on. We’re also live in thousands of sites across the world.
The work of General Practice is largely misunderstood. People don’t understand the scale and complexity. TPP do more transactions per day than Visa, MasterCard, and American Express combined. We are far busier than the London Stock Exchange. 70% of all that comes from General Practice.
Tech companies need to be run by technical people. Four of our directors are technical. Our competitors parachute people in from any industry, with any background. As long as you have an MBA or a job-hopping LinkedIn profile, you are in. A year or so later, and a gentle push on the revolving door, they move on with zero accountability.
You have to pay the best to get the best people. Bill Gates talks about the massively disproportionate value of a brilliant coder over an average one. You can tell a lot about a software company by the starting salaries of their coders. Go and look at what TPP pay versus what EMIS pay – it’s a tell-tale metric.
EMIS is a ticking time-bomb. For some time, GPs have been telling me about the appalling service from EMIS. The May bank holiday crash, however, gave me chills. The level of disruption was off the scale. I genuinely thought it might not come back up. The NHS needs to prepare for that eventuality – next time we may not be so lucky. When people tell me EMIS are always going to recover, I remind them of Advanced. They were hacked over a year ago and some services are still not back online.
You can’t put a square peg in a round hole. Any half-decent software engineer can see that EMIS have a fundamental technical problem. Their architecture is wrong. EMIS was OK back in the days of green DOS screens and a practice server in the back-office. They’ve tried to retrofit this architecture into the cloud, to work beyond a single practice. You just can’t do this.
EMIS have a long history of failed promises and product rebrands. GV was supposed to fix the problems in LV. PCS was to fix GV. PCS Enterprise to fix PCS. Web to fix that. Now we have EMIS-X, ‘launched’ in 2018, due in 2026! It’s Groundhog Day. I find it incredible that some people keep falling for it. All of this from the company that caused GPs so much pain with Pinnacle, the Covid vaccination system.
EMIS reminds me of Boeing. There’s a documentary called Downfall on Netflix about the 737 Max crashes. Their engineers had been aware of problems and had raised them. Boeing’s response was to move them to a different city to the sales team. The result was inevitable. Look at EMIS today – they have put their sales team and their engineers in different continents, in different time zones. Their system is getting more and more unreliable.
Being on the stock market compromises companies in mission-critical industries. How could it be any other way? They look for the “Goldilocks” point – to deliver the minimal acceptable service, with maximum pay-out to shareholders. Why would EMIS ever spend a penny more than they need to? It would hurt their profit too much . They have moved so far away from their origins, they seem like a company driven solely by share price.
There’s a sure-fire way to spot smoke-and-mirrors in tech. I saw Suzy Foster, EMIS CEO, saying that EMIS-X was going to solve their problems by introducing “modern technologies”. What does that even mean? It’s a massive red flag. I once heard Ali Parsa, from Babylon Health, say they were using “central brain” technology to power their app. We all know how well that went. Next time you meet a Suzy or an Ali, hold them to account. Ask them to explain exactly what they mean.
Tech giants play the NHS so easily. CIOs and CCIOs don’t have the knowledge to question them. Just watch NHS IT teams say “everything must be browser-based because it’s modern”. Utter nonsense. Firstly, it sounds like a line fed straight from Amazon and Google. It’s an obvious ploy to sell more CPU cycles in the cloud. Secondly, browser technology is over 30 years old. If browsers were the solution, there would be no smartphone apps and just a massive Safari button on your iPhone.
Amazon Web Services was down for hours not long ago. Google and Oracle went down for hours last summer, due only to the hot weather. Yet NHS England strategy is that everything should move in this direction. Is this acceptable for mission-critical GP and hospital services? Of course not. It would breach any SLA in any decent NHS IT contract.
NHS England decisions seem far removed from the needs of frontline services. It’s one of my biggest sources of frustration. We have to fight tooth and nail for General Practice. As an example, we stopped them flooding the GP record with every single home-based LFT result, both positive and negative. We’ve had hundreds of these arguments over the years. The focus needs to be on things GPs want and need. It has to change.
NHS England need to stop technical vanity projects. Development resource is wasted on pointless projects with zero frontline benefit. It’s just job creation. Instead, they should be promoting best practice. Waiting lists are off the charts so they should endorse initiatives like Mid Yorks shared referral pathway or Bradford’s Assist programme. These projects have reduced referrals by over 60% and significantly improved patient outcomes.
I still love my job. I love working with the developers. I love speaking to users across the world, hearing stories of how we have made lives better. I’m going to keep fighting for our frontline services, to make things better for them and for the patients they serve.
To support practices migrating to SystmOne, TPP is offering a referral fee of £10,000 to individuals who recommend SystmOne to a GP practice that subsequently goes live on the system. Click for more information.
Additionally, TPP are also providing a support payment for practices to recover direct costs up to the value of £10,000 per practice as part of the migration. Click for more information.