The results of the latest Medix survey of more than 1,000 doctors, who were questioned on the NHS’s National Programme for IT [NPfIT], make grim reading.
Looked at on their own, the results imply that the NPfIT is failing, at least in terms of its big objectives and gaining the support of doctors.
This survey was commissioned by Computer Weekly, E-Health Insider, the Guardian and GP to investigate the views of doctors in England about the NPfIT. The programme is led by the NHS, the Department of Health, and NHS Connecting for Health. The overall senior responsible owner is David Nicholson, the Chief Executive of the NHS.
The survey ran from 30 October to 5 November 2007 and is the eighth that online market researcher Medix has conducted on this subject, starting from February 2003.
The findings confirm earlier Medix findings that many doctors support NPfIT and most of its key features and believe it is likely to benefit clinical care. But their support has weakened over the years.
Doctors are becoming increasingly critical of the project, with large majorities very concerned about its costs and implementation.
The most important findings:
– Very few respondents (8%) think that information about NPfIT received from the Department of Health is reliable and accurate
– 74% of respondents say that, to a greater or lesser extent, they are not engaged in the programme, with 27% saying they are not at all engaged compared with only 2% saying they are very engaged
– 76% agree that an independent review of the NPfIT is important – only 6% object to one
– 55% think the NPfIT will improve clinical care in the longer term.
– 47% of respondents agree that the Care Records Service – the heart of the NPfIT – will enable clinicians to make better decisions. Only 20% disagree.
– Support for NPfIT has deteriorated markedly: five years ago 67% of GPs said that it was an important priority for the NHS – now it’s 30%. For non-GPs, the equivalent figures are 80% then and 45% now. Although today 23% of GPs and 35% of non-GPs are enthusiastic about the project, it was 56% and 75% four years ago.
– 70% of doctors do not consider NPfIT a good use of NHS resources and only 1% rate its progress so far as good or excellent.
– 49% of GPs say they use Choose and Book for more than 40% of referrals [referring a patient to a hospital or clinic appointment]. But more than 90% of GPs using Choose and Book say that it increases the time of dealing with a referral and 69% say it either makes no difference or is detrimental to patient outcomes.
– 76% of GPs and 55% of non-GPs think the Care Records Service [centralised medical records] will weaken patient record confidentiality and 59% of GPs and 49% of non-GPs say they will not or are unlikely to upload a patient’s clinical details without specific consent. Their main concerns are hackers and access by public officials from outside health or social care.
In addition to the main survey, respondents were invited to write in their comments on NPfIT. Where doctors have given their names with their comments these are summarised in a separate blog entry.
Medix says of its latest survey:
“Earlier Medix surveys indicated that doctors were positive about NPfIT’s potential for patient benefit. That has continued … However, this survey confirms the earlier finding of a marked and continuing decline in overall support for NPfIT. For example, whereas in early 2004, 56% of GPs and 75% of non-GPs were fairly or very enthusiastic about it, today the figures are 23% and 35%.
“And, whereas in 2003, 47% of all respondents thought NPfIT a good use of NHS resources and 27% judged it a poor use, the figures today are down to 8% good and 70% poor.
“As before, the decline in GPs’ support is particularly striking: for example, the 30% who agree that NPfIT is an important priority for the NHS is down from 67% in 2003. When asked how they rated the progress of NPfIT so far, only 1% of all respondents considered it excellent or good and 7% as satisfactory.
“However, although 77% of GPs and 66% of non-GPs rate progress as poor or unacceptable, that is an improvement on the 82% and 72% who did so a year ago.”
Medix also found that 40% of respondents know little or nothing about the NPfIT Local Ownership Programme which moves responsibility for delivering NPfIT from the centre to strategic health authorities local trusts. In any case, only 8% of respondents think that their acute trust or primary care trust has, or is likely to have, sufficient funds to properly implement NPfIT in its area.
“When NPfIT was launched, most doctors, recognising the critical need for greater investment in IT systems for the NHS and in particular in the benefit to patients of an integrated clinical record, were pleased that the Government had decided to allocate substantial funds to a radical update of NHS IT systems. They were enthusiastic supporters of the initiative. Today, five years later, doctors still support the principles of the project but most are critical of its costs and believe it is being poorly implemented. In particular, the majority knows little about the project and hardly any believe they have had adequate consultation. It seems probable that it is because of this that, despite their continuing belief in its potential benefits, doctors’ confidence that NPfIT will deliver those benefits has been weakened and their initial enthusiasm has greatly declined.”
Officials at the Department of Health suggest that the findings of the Medix survey are unrepresentative. I suspect they would dismiss the results of every survey that didn’t find that the NPfIT has been, as the former health minister Lord Warner put it, a “stunning” success.
NHS Connecting for Health used to conduct its own survey on the NPfIT, which was commissioned from Ipsos Mori. It did one in 2005 and then again in 2006 but this was not quite as positive about the NPfIT. Then the Ipsos Mori surveys on the NPfIT stopped altogether. The Medix surveys have carried on however.
For the Department of Health it makes sense to be able to criticise a Medix survey rather than one it has commissioned. Their criticism of the Medix survey will be a comfort to those officials who would rather turn a blind eye to evidence that, in the eyes of some doctors, the NPfIT may be failing, despite the huge commitment to the scheme by so many in the NHS and within supplier organisations.