Twenty Years of Dedication, Innovation, and Patient Care:
All 83 GP Practices in Bath and North East Somerset, Swindon and Wiltshire Integrated Care Board (BSW ICB) deploy SystmOne.
Bryan Taylor (IT Manager, BSW ICB) provides his reflection on a two-decade journey, deploying SystmOne in every GP practice across the ICB. In his own words, here’s the story of how that transformation unfolded:
On Wednesday 17th September 2025 BSW ICB finally has all 83 GP practices using the same clinical system, which is TPP SystmOne. This has a huge number of benefits. It makes patient care safer as records can be securely shared within the system. ICB reporting is easier as we only have one system to report on. Training, IT support, and software deployment are easier as you only have to learn and create guides and operating procedures for one system.
Below is the story of my 20-year SystmOne journey to get us here.
GP IT was very different back in 2000.
I joined Wiltshire Health Authority in 2000 as the Primary Care IT Manager, working for David Barley, who was a lovely man sadly no longer with us.
Wiltshire had 48 practices and there were seven different clinical systems in use across these 48.
None of the systems talked to each other so patient record sharing was not possible. All were separate installations… held on a large computer called a clinical server within each practice. These servers needed to be replaced every 4 years, which was an expensive and disruptive task. If it failed, the practice would lose their entire clinical system. This did happen quite frequently, with the practice having no access – often running into days.
“Being able to share patient records and work from anywhere was a revelation.”
The funding model
These suppliers would charge per user of the system, so a large practice would cost more than a small practice. Our most popular system at that time, Emis LV, had a particular quirk in that if you wanted to create a letter using Microsoft Word, you needed to buy an additional Emis LV licence for each user to do this, which made it more expensive than its competitors. The typical licence charge per user was £425 a year.
The system suppliers back then made money by also offering hardware and engineering support. They would supply new computers and send their own engineer to install them; all of these services were charged for. Practices would purchase whatever make of computer and printer that their particular system supplier sold; there was no standardisation like we have today. Practices did have an internet connection but it was quite small and slow compared to today.
One of the additional services that Emis sold was Backup Tape Validation. It was important that the servers running the clinical system were properly backed up each night so that in the event of a hard disk failure, the backup tape could be used to restore the data onto a new hard drive. The tape backup drive was purchased from Emis and they supported it. A member of the practice staff had the important job each night of popping in a backup tape labelled with the day of the week. You would have 10 tapes and would keep two weeks’ worth of Monday-to-Friday backups. The practices would also have to purchase a new set of tapes every so often to ensure reliability. The backup process would run a validation check to compare the taped backup data to the original data. Any discrepancy would alert the user that the backup had failed and you would need to try again, perhaps using a new tape. Emis offered the tape validation service at £100 per validation and you had to sign up for 6 or 12 per year. Practices subscribing to the service would post the backup tape to Emis in a prepaid envelope, Emis would then try a restore and inform you if it was successful or not. Most of our Emis practices were paying for this service out of fear of losing their data if they did not use it.
“It was cutting edge because it used cloud computing […] There was no longer a need for an expensive clinical server within the practice.”
Introducing TPP
I attended a national IT event in 2005 where I met colleagues from other areas. Pete Southern was doing my role in Sussex and he told me about this new clinical system called TPP SystmOne. It was cutting edge because it used cloud computing, so all the data was securely backed up professionally by TPP at a number of national data centres. There was no longer a need for an expensive clinical server within the practice. SystmOne was Windows-based and looked very modern.
When I got back, I contacted TPP and asked if they could come and do a demonstration of SystmOne. At the first demo, we had Dr Helen Osborn from Courtyard Surgery. Helen looked after Erlestoke Prison at the time. Her own practice was using Emis LV and she wished to be able to support Erlestoke with the ability to see their data from her own practice. I wanted Helen to see SystmOne because it was cloud-based, meaning you could log in anywhere with an NHS network connection. Previously, if a practice suffered a major catastrophic event such as a fire or flood, the staff would have to work blind in another location. With SystmOne, provided you could get a network connection, you could log into your practice from anywhere.
Also present were Linda Thomas, Practice Manager, and Dr Stephen Lock from Adcroft Surgery (now Trowbridge HC). The attendees were amazed at how modern and good SystmOne was as a clinical system. The system had colour and even medical drawings. It used a new medical coding system called CTV3 which had thousands more codes than Read2, used by Emis and the other suppliers. Gone were the days of having to create local codes. Adcroft signed up along with The Avenue Surgery, and Helen chose SystmOne for Erlestoke Prison and her own surgery. Today all prisons in the UK use SystmOne for their healthcare. I feel Helen’s decision to choose this paved the way for the prison service.
The business case to fund this change was an easy financial decision. TPP charged a fixed licence fee per practice: you paid £3,500 for unlimited users regardless of practice size. So you can easily see that as long as the practice had more than 8 members of staff, or 5 for an Emis practice due to the double licence issue described earlier, you were saving money. You also didn’t need a clinical server or the Emis tape validation service. SystmOne was Microsoft Windows-based so any hardware that worked with Windows would work with SystmOne, meaning you were no longer under the hardware constraints dictated by the clinical system suppliers. What TPP didn’t offer was any engineering contracts, so if a practice was using Emis as their IT support we would need to find an alternative for them.
Our first practice to go live with SystmOne was The Avenue Surgery in Warminster. They went live in December 2006, quickly followed by Adcroft Surgery in April 2007. After this it snowballed: other practices could see that the system really worked, and being able to share patient records and work from anywhere was a revelation. When I visited practices, I would suggest they have a demonstration and speak with the practices already live. For many years we had a constant stream of practice migrations. 2011 was our busiest year, with 20 practices migrating.
Our accountants loved it too. At the time, The Avenue Surgery in Warminster was our largest practice and the annual bill for their iSOFT Synergy clinical system was £20,000 a year, which we reduced to £3,500 overnight by changing to SystmOne.
“Our accountants loved it too […] the annual bill for clinical system(s) was £20,000 a year, which we reduced to £3,500 overnight”
Not everyone was happy. The various clinical systems account managers didn’t like losing business. I later found out that they had joked that TPP stood for “Taylor’s Pet Project.” It actually stands for The Phoenix Partnership.
We managed to get the majority of our practices over. One of the biggest challenges was teaching staff to use a mouse, as Emis LV didn’t need one and most people didn’t have a home computer back then. The other suppliers, particularly Emis, were haemorrhaging practices fast. They tried to fight back with new clinical systems such as Emis GV (a Windows-based version) and Emis PCS, but PCS was really just GV running on a remote server. Because the suppliers tried to engineer their existing systems to run over the cloud, they would never run as efficiently as a system designed from day one to be cloud-based, suffering from poor performance. Emis GV and PCS also had less functionality than their original LV, which didn’t encourage the Emis user base to change.
The biggest fear GPs had was that if they didn’t hold the data onsite in their own surgery, the Government might take it and give it to Tesco or similar to run GP services. Of course, this never happened, but the feeling of losing control and also the fear they would have outages due to internet issues existed. These were dispelled over time as our live sites proved very reliable, with no unplanned downtime.
The advent of GP Systems of Choice (GPSoC) did slow down the migrations. The pricing model for GP systems changed in line with how software was increasingly being marketed. The key change was suppliers were to be paid a fixed price per patient. Today that value is around £1.50 per patient, charged by both TPP and Emis (now called Optum). This took away the financial incentive to change, but you could see why the system suppliers welcomed the change.
With a large number of practices using SystmOne in Wiltshire, it has steered the strategic decisions for community providers to also use SystmOne to allow further joined-up care.
“It brings a wealth of benefits for the patients, the staff, and the community”
The final piece of the puzzle
I was 41 when I started on this journey. At 61, our final GP practice to make the change – Jubilee Fields – has now gone live with SystmOne on Wednesday 17th September 2025. Lewis Johnson and I attended the go-live and it was the easiest one yet, partly down to the fact that the new partners had come from a SystmOne practice in the New Forest but also thanks to the friendly staff led by Tom Peters, the Practice Manager, who were extremely motivated to learn and to make it a success.
It was always my desire to get all our practices onto the same clinical system before I retire, as it brings a wealth of benefits for the patients, the staff, and the community.
This current chapter may have drawn to a close, but with the pending ICB and NHSE changes coming and clustering plans with Dorset ICB (who are all TPP) and Somerset ICB (whose practices are all Emis), maybe this journey can continue – hopefully completing before Lewis retires.
Also a big thank you to all involved in the Jubilee Fields migration who are not in the photo: Barbara and Sheila from the Smartcard team, Jo Cullen and Steve Mapleston for finding the money and the continuous support, Steve Sedlen for engineering support on the day, Bernie Mayall for training, Martin Wakefield for the hardware required, and all the staff at Jubilee Fields who made us all feel most welcome and supplied us with unlimited coffee, tea, and biscuits throughout the day.
Also a big thank you to Kira Robinson, our TPP account manager, for her support over the last few years and finally to Frank for creating SystmOne and having the vision to improve the sharing and recording of health records, making healthcare safer and more efficient for millions of patients.
Bryan’s story is a reminder of what’s possible when vision, dedication, and partnership come together. We’re honoured that SystmOne has played a part in this journey and continues to support safer, more connected care across BSW.