Medix survey reveals a widespread lack of enthusiasm for national plan among GPs
Family doctor Paul Cundy wants the health service's national programme for IT (NPfIT) to succeed, which is why he views as "thoroughly depressing" the results of the latest Medix survey of doctors.
The results of the survey of 900 doctors were so negative that they inevitably trigger the question: is it too late for the national programme to gain the support of clinicians?
Since February 2003 online polling specialist Medix has carried out four surveys of doctors' views on the NPfIT. All have highlighted problems in engaging clinician support, but the latest poll results are markedly more deprecating than in previous surveys.
A summary of the findings by Medix said, "This survey has detected a significant change from previous surveys. The change is that enthusiasm for the NPfIT has declined sharply and that this is particularly true of GPs."
A year ago 70% of GPs thought the NPfIT was an important priority for the NHS, and 56% were enthusiastic about it. Those figures are now down to 41% and 21% respectively.
Support among non-GPs is stronger - nearly 70% think it is an important priority, and about 50% are enthusiastic. But the buy-in of GPs is critical to the success of the scheme. If they do not participate en masse, the national systems that will cost billions of pounds could prove to be poor value for money or even, in part, pointless.
The support of GPs is needed for Choose and Book, a scheme which aims to allow patients to book online appointments with consultants at a convenient hospital and time.
GPs' support is also important to the success of the National Care Records Service, which will comprise a national database of summarised health records. If GPs boycott the care records service - and many already have - the database may have so many holes that it is not viewed by clinicians as fit to use in earnest.
The other key elements of the NPfIT are digitised x-rays, e-prescriptions and a broadband network.
Last month on BBC's Today programme, the health secretary John Reid spoke of the support among clinicians for the idea of booked appointments. On the issue of whether the national programme had engaged GPs enough, Reid said, "We have now been doing that for the last four months."
But the Medix survey, carried out last week, found that only 11% of GPs thought that Choose and Book was important, although the figure rose to 28% for non-GPs.
Support was higher for the care records service but still not encouraging. A year ago 58% of GPs thought it very important, and now the figure is down to 20%. For non-GPs the figure is 34%, compared with 66% a year ago.
The national programme has a "back-loaded" publicity strategy in which it has deferred campaigning to win the full support of doctors until it has working systems to show them.
But Cundy, who is IT representative on the British Medical Association's GP committee, is critical of this strategy, which he said has not worked in the past.
Cundy is also critical of the design of Choose and Book systems, which he said required too many steps. He said one of the problems facing the national programme was that the doctors it had consulted on the design of systems were largely "self-nominated enthusiasts". These were not representative of most GPs, he said.
The systems architecture to support the work of the Criminal Records Bureau, the magistrates' courts and air traffic control systems in Hampshire was also marred, in part because end-users on the design teams were not seen as representative of most of their colleagues.
NPfIT officials are worried about the failure to engage GPs, but their concern is rarely reflected in their public statements, or ministerial comments, which emphasise only the success of their work so far.
National programme officials plan a nationally co-ordinated publicity campaign this year to engage the public, doctors and other health service workers.
The Medix survey highlights some of the difficulties they will face.
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Highlights of the Medix survey
- 81% of clinicians said working practices should be aligned before the NPfIT is introduced locally, although this is not NHS policy.
- Only 5% of doctors said they were adequately consulted - 71% were not consulted at all. These findings have hardly changed over two years.
- 89% of doctors believe early consultation is more effective than waiting until there are working systems available to show them, which is the policy of the national programme for IT in the NHS.
- Only 13% of GPs think that, in the long term, the NPfIT will significantly improve clinical care, and just 2% believe it will do so in the short term.
- A year ago, 70% of GPs said the NPfIT was an important priority for the NHS. Now only 41% believe this to be the case.
- Only 21% of GPs (51% of non-GPs) are enthusiastic about the NPfIT - down from 56% and 75% a year ago. l 61% of GPs said Choose and Book is unimportant - only 11% thought it is important.
- A year ago, 58% of GPs (66% of non-GPs) said the Care Records Service was very important. Today that is down to 20% and 34%.
- 70% of GPs thought the Care Records Service would lessen patient record security - only 6% thought it would improve it.