The software is used by GPs to manage electronic patient records and appointment scheduling, and is designed to give practices a single, complete view of a patient’s history from consultations through to prescriptions.
The firm behind it, INPS (In Practice Systems Limited), was one of three awarded a £65 million framework contract to supply IT software to GPs across NHS Scotland in 2019.
All three suppliers had 12 months to develop systems, with the earliest go-live expected around June 2020 and a national rollout planned over roughly 30 months.
However, two of the companies ultimately pulled out.
Microtest withdrew from the framework in 2021, and EMIS Health announced in October 2022 that it was unable to meet the timelines.
That left INPS as the remaining supplier. It was then given a direct award, with Vision as the single GP clinical system for Scotland.
However, confidence in the programme was shaken when INPS entered voluntary administration in December 2024.
Practices were reassured that Vision would continue and services would be maintained, but the insolvency arrived at the worst possible time with many GPs preparing for a complex migration to the new IT.
Dr Chris Williams, Vice Chair (Policy) of Royal College of General Practitioners (RCGP) and a GP in Highlands. (Image: Stewart Grant)
Dr Williams said there was no warning for practices: “By the company being placed into administration, the NHS took second place, the priority then was for the administrator to find a buyer.”
He said it took an eight-month process before the business was taken on by OneAdvanced, and that the transition had thrown up “all sorts of unforeseen difficulties”.
Chief among them, problems with the helpline practices rely on to report and resolve faults.
“Practices [have] felt at their most vulnerable in terms of it malfunctioning or glitching, and in some cases really serious performance problems,” he said.
This included a fault that added several seconds to every prescription printed. “If you’ve allocated a clinician to just putting through prescriptions, that clinician becomes entirely bogged down and hugely unproductive compared to a previous business process.”
“What we have encountered as a problem is the dropping of network connections and the system feeling slow,” Dr Williams said. “That’s been experienced differently and unpredictably — for some GP practices it’s been horrible. Many times a day suddenly their screen has gone blank while they’re in front of patients.
“It’s like driving a car and suddenly losing your speedometer. It might come back after a few seconds, but until it does, you’re gazing into the chasm.”
Tayside and Lanarkshire have become the first health board areas to complete the move, with all GP practices there now on Vision. More than half of practices nationally have now migrated, with the remainder still to follow.
Dr Williams warned that continued problems could see practices asking to defer their migration slots altogether, which would create “a real problem in terms of the allocation of resource” for the rest of the programme.
He said the bug-fixing carried its own risks: “With any rapid rollout of a fix, anyone will know that you run the risk of causing unintended problems, or not fully understanding everything that’s happening.”
Last month, Scottish Conservative MSP for Galloway and West Dumfries Finlay Carson lodged a number of written questions on the Vision 3 rollout.
It came after GP practices in his constituency told him the system was “not simply causing inconvenience but is actively affecting the working environment within practices and placing additional pressure on already stretched teams”.
Finlay Carson outlines his views on Scottish agriculture ahead of the Holyrood election (Image: The Scottish Farmer)
In a letter to NHS Dumfries and Galloway, he also directly raised patient safety, asking the board to set out its assessment of the impact on “appointment capacity, consultation times, administrative workload, staff wellbeing, patient safety and the retention of GPs and practice staff”.
The board’s reply admitted that there were “ongoing performance issues”.
In her answers to Mr Carson, Health Secretary Angela Constance confirmed the Scottish Government does not hold records of the number of complaints or incidents relating to Vision 3 broken down by health board, despite acknowledging concerns raised by GP practices, ministerial correspondence and representations from the RCGP.
The minister also ruled out pausing the rollout.
Mr Carson told The Herald: “The parliamentary answers reveal a significant disconnect between the Scottish Government’s confidence in Vision 3 and the concerns being raised by GP practices.
“While ministers continue to describe the programme as meeting operational requirements, the responses acknowledge system issues, additional support needs and concerns from professional bodies.
“The lack of published performance data, complaint statistics and independent impact assessments means it is currently difficult to verify whether Vision 3 is delivering the level of service expected by frontline GP practices.
“For GPs concerned about workload, patient safety and service capacity, the most significant finding is that the rollout will continue and there is currently no alternative nationally procured replacement system available in Scotland.”
(Image: Jane Barlow/PA)
Responding to Dr Williams’ comments, Ms Constance said: “We are engaging closely with Public Service Delivery Scotland who are working with the owners of Vision to fix known issues and we are already seeing improvements. It is hoped the outstanding local issues will be resolved soon.”
Scott Taylor, VP Operations at OneAdvanced told The Herald: “We welcome feedback from our customers, as patient safety and the reliability of our systems are our highest priorities.
“We work closely with NHS Scotland, PSD and GP practices throughout the rollout of Vision to understand and address any issues raised, ensuring they are investigated and resolved as quickly as possible for the benefit of clinicians and their patients.”