Plans by the government and BT to build a national database
holding personal medical records on 50 million people will face a
challenge this week at an annual meeting of GPs.
Doctors at the conference of local medical committees of the
British Medical Association, whose support is vital to the
project's success, will decide whether to oppose proposals to
automatically upload patient records onto a national database
spine.
Some influential GPs oppose the plan and, if they are backed by the
conference, they could undermine ministerial plans for every
patient in England to have a summary electronic medical record on
the national database. Senior health officials will be on the
conference platform to dissuade doctors from opposing the
plan.
Health secretary John Reid has said every patient in England will
eventually be able to access an electronic summary of his or her
medical record under a £620m contract awarded to BT to build the
national database. The plan is a key part of the reform of the NHS,
said Reid.
The spine is at the heart of the National Care Records Service, in
which patient data will be accessible by legitimate users across
the health service; mainly doctors and nurses who will be issued
with a form of ID card which will give them access to the
system.
But many doctors are concerned that the government's plans assume
that GPs will allow sensitive data on their patients to be
transferred to the national database. At this week's conference,
GPs will debate on whether to oppose the plan by insisting that
data from medical records is uploaded to the spine only with the
patient's specific consent.
Under the government's "opt out" plans, there will be an
advertising campaign aimed at making patients aware of the benefits
of the national system.
When the campaign is complete, patients will be assumed to have
consented to their records going onto the spine, unless they
specifically "opt out". Even if patients opt out, their data will
still be on the data spine but in a "pseudonymised" form and not
accessible unless in exceptional circumstances or
emergencies.
But some doctors believe that the confidential relationship between
GPs and patients could be undermined if raw data from medical
records were automatically uploaded to the database.
Because of this concern, motions from grass-roots GPs will be put
to the BMA conference, recommending that medical information should
be transferred from GPs to the national spine only if patients opt
in and give consent for this to happen.
"We were not formally engaged in the specification for the spine,"
said Paul Cundy, a GP and chair of the IT subcommittee of the BMA.
"The current plan is to vacuum up patient data from GPs' systems.
That causes us some concern."
Cundy said he believed doctors should in effect have a switch on
their systems which allows them to send or stop information on
patients going to the spine.
But health officials are concerned that obtaining the patient's
specific consent before their medical information is uploaded will
burden doctors with explaining the benefits of the spine to
patients, reducing the time for consultations. It could also mean
that the spine will not contain records on everyone in England,
despite an announcement by Reid that it will.
The national data spine is one of four main projects that comprise
the national programme for IT in the NHS. The programme is due to
cost more than £6bn - £2.3bn has been allocated so far.
A spokesman for the national programme said, "Consultation on the
issue of confidentiality and research into the requirements for the
management of confidentiality were undertaken with patients,
regulatory bodies, care services and suppliers from 2001 to 2003.
The benefits and risks of a number of consent models were
considered by NPfIT clinical and patient groups, which recommended
the 'opt-out' consent model.
"The national programme has adopted the consent model by means of
'opt-out' with a warning period. It will therefore be assumed that
clinical information can be used unless a patient says otherwise
but individuals will be given a defined period of time in which to
refuse access, in other words 'opt-out'."
BT to pay damages
BT is to pay a six-figure sum in damages to the Department of
Health having missed two of its 56 milestone "deliverables" under a
£530m seven-year contract to deploy an N3 broadband infrastructure
across the NHS.
A BTspokesman said the company did not meet the 16 April deadline
for the delivery of the first phase of N3. Compensation has not yet
been agreed and is likely to be based on the additional costs for
trusts caused by the delay. A spokesman for the national programme
said, "BT is striving to address a small number of shortcomings.
The contracts are proving to be effective."
Analyst firm Ovum Holway said BT has also missed interim targets in
the contract to deliver the national data spine, but it had not
been penalised.