PSNC Briefing provides community pharmacy contractors with information about the Health and Social Care Network (HSCN), which is the replacement for N3, and tips on how to best procure and use your IT connection: Click on the briefing below:

PSNC Briefing 054/17: How to get more out of your connection – an N3 & HSCN update (August 2017)

Connection options

There are 3 main ways to connect:

1. Through pharmacy system suppliers who may arrange a connection, e.g. via an intermediate ‘aggregator’ company they have selected. The aggregator company usually draws connectivity from a HSCN connectivity supplier. Some pharmacy system suppliers have historically provided offerings for ‘all in one packages’ in which a PMR system, hardware, system upgrades and a connection are all provided;
2. Arranging a connection with a commercial network provider; or
3. A direct connection to HSCN.

Security

HSCN is an open network with more flexible ways to connect.

To ensure that the connection is secure for sending and receiving electronic prescription messages, the network connection must be of a type approved by the NHS Digital.

Pharmacy system suppliers offerings

Some pharmacy system suppliers offer ‘all in one packages’ which include system upgrades and connectivity. Contractors should contact system suppliers directly for more information on the packages being offered. Further information can also be found below.

You or more likely your pharmacy system supplier on your behalf will select an intermediate ‘aggregator’ company to assist with the moving of data between your pharmacy and the central NHS Spine. The aggregator company usually draws connectivity from a HSCN connectivity supplier. (Some pharmacy system supplier aggregators currently use BT as their HSCN connectivity company, historically BT  had been the sole supplier of ‘N3’ but the new HSCN model means that others suppliers can also provide this if they are endorsed).

List of aggregators: See section below.

Pharmacy contractors can enter into a contractual agreement with an approved network provider to purchase an indirect connection independent of the pharmacy system.

Companies offering secure managed network solutions to community pharmacy can be found below. Contractors wishing to contract directly with a network provider should check with their system supplier to ensure the connectivity option is compatible with the pharmacy system and appropriate for operating the EPS.

If you are supplying an aggregator solution to the pharmacy market in England, please email info@psnc.org.uk to have your contact details added to this section of the site.

NHS Digital maintains a larger list of potential aggregators.

Although community pharmacies have the option of connecting directly to HSCN/N3 this is not yet likely to be the most effective option for independent contractors or small chains. To connect directly, contractors are required to be sponsored, in most cases by the local NHS England team.

Some of the larger chains have chosen to connect their corporate networks directly to HSCN/N3.

Community pharmacies do not currently have blanket access to the ‘nww’ area of the internet (e.g. some Local Health Care Records systems may use nww).

If you require access to a webpage or system that uses this part of the internet, then your aggregator (and possibly also your pharmacy system supplier as well if they help to indirectly provide your connectivity) will need to whitelist all of the current webpages/areas.

The aggregator may need to seek further authorisation.

You may also contact it@psnc.org.uk who can provide a template webform to assist with this process where this might be relevant.

To start the process you could identify the nww areas which you require access to, and then ask your system supplier to ask the system supplier aggregator to proceed with trying to get these fully whitelisted.

When you are selecting or negotiating for your connection contract, consider discussing each of these with prospective connectivity suppliers:

• Service levels: What are the usual service and performance levels being offered by the connection supplier? What are the resilience levels and arrangements for business continuity in place? Will contract provisions mean connection speeds will improve in-line with the national average over time, or will connection speed performance remain the same throughout the course of the contract?
• Failures/compensation: What happens if something goes wrong? What will the turnaround time be if there is a connection problem or there is damage to a broadband line? How many hours or days will be required to fix the issue if your connectivity supplier has to work with BT Openreach because the underground broadband wires belong to them? Is there a process for claiming compensation if the connection fails and this impacts on the operation of the pharmacy?
• Installation and coordination with EPS: What are the arrangements for setting up your connection? Will the connection setup be co-ordinated with the pharmacy system configurations necessary to enable EPS?
• Extra benefits: Can the connectivity supplier offer any added benefits alongside your main HSCN connection? For example:
  1. security/protective software/processes which protect your data and systems;
  2. internet telephone options to replace or sit alongside the typical landline option;
  3. a line of non-HSCN broadband for online usage not involving sensitive data transmission;
  4. use of mobile devices within the pharmacy connected to HSCN;
  5. back-up 3G/4G or dual connection to protect business continuity if the local internet connection is lost;
  6. wide area network (WAN) – i.e. a shared connection across multiple pharmacy branches; and
  7. future authentication technology to access systems as alternatives to Smartcard, e.g. key fob, two factor or multi-factor authorisation.
• Compatibility with pharmacy system: Will the connection be compatible with your pharmacy system arrangements? (Pharmacy system suppliers will be able to advise you of what is currently possible with their system).
• Contract length: How long will the contract for the connection last? Different suppliers may offer contracts which last for different lengths of time. Can any existing contracts for hardware, support, software and connection be synchronised to end in-line with each other?
• Contract flexibility: How flexible is the contract? For example, can you change the speed of the connection without an additional charge for making a change being incurred?
• Transparency of offering: Is information that relates to all the points above published online for you, or can it be sent to you, and in a format that allows you to compare against alternative offerings?
• Transparency of data handling practices: Is the organisation transparent about how it will protect data. Has it updated its website to explain how it processes data, and that it complies with GDPR expectations.

In 2004, BT was awarded the sole contract to provide and maintain ‘a health network of networks’ which became known as ‘N3’. This N3 network helped pharmacies to connect with NHS resources, e.g. access to EPS and the central NHS ‘Spine’. BT’s legacy N3 has now been re-branded as the HSCN ‘Transition Network’. The HSCN programme is managed by NHS Digital and they now allow other companies to apply to become direct suppliers of HSCN-endorsed connections. This market of NHS-endorsed connectivity, will therefore no longer be a sole-supplier market.

With the development of HSCN, NHS Digital aim to promote a competitive health connection marketplace, i.e. one that improves choice, innovation and value for money. All pharmacy contractors live with EPS Release 2, currently more than 99%, will already be connecting to the HSCN transition network.

Pharmacy access to HSCN, just like the previous N3 connection does not reduce the importance of continuing to ensure that pharmacies have sufficient cyber security protections in place; read more about this in PSNC Briefing 053/17 Data and cyber security protections.

Q. Will my ability to deliver services and use my systems be disrupted by any ongoing transition to the HSCN?

Adverse impact on service provision is not expected as the HSCN develops. If you or your pharmacy system supplier change the connection in the future (for speed, capability or cost improvements), then there may be some planned configuration adjustments, and a new router might be provided for use by the pharmacy. PSNC has highlighted to NHS Digital that planned remote maintenance relating to changing commercial arrangements, should wherever possible, take place at times when pharmacies are unlikely to be intensively using their connection, e.g. in the middle of the night during the middle of a month.

Q. What impact will the HSCN transition have on overall connection costs?

NHS Digital say they anticipate that over time, like-for-like HSCN connectivity should become considerably cheaper. In the global commercial broadband market, the price for like-for-like connections has decreased over time. The UN’s report ‘The State of Broadband 2014’ highlighted that within 20 years, things were done 100x faster at the same price within the domestic broadband market. Pharmacy teams may use free online speed test tools to assess the performance of their connection and weigh up offerings when they are selecting between pharmacy system and connectivity offerings.

Q. Will the move to the HSCN involve new minimum standards for availability/speed?

NHS Digital set out some minimum standards within the HSCN supplier obligations document. For example, HSCN suppliers provide services which offer minimum 99.95% availability. A HSCN services offering table, if publicised, may provide the ‘menu’ of speed options being used. Such standards apply only to those receiving HSCN connectivity directly, e.g. an aggregator using a HSCN supplier, should be receiving the promised level of service. NHS Digital’s commercial team are continuing to explore putting in place a contractual framework with Pharmacy system suppliers which would include requirements for the resilience of connections.

 Q. Are there any options to improve my connection speed?

One option is for contractors to install an extra ‘normal’ broadband line for internet use which does not involve transfer of sensitive patient data. The N3 and HSCN connections have always been intended for sensitive traffic rather than for all internet usage.