Will national database of patient records have a 50% shortfall?

Dozens of GPs in the Bolton area where the first trials are continuing of the summary care record – a central part of the NHS’s National Programme for IT [NPfIT] – have indicated that they are against proceeding with the scheme.

Their reservations – five years into the NPfIT – raise further questions about how ministers and the Department of Health were able in early 2002 to launch the programme before there was widespread support for its general principles from its main potential users – doctors.

It was announced in April 2007 that Bolton Primary Care Trust had been chosen as the first early adopter in England of the national summary care record. An aim of the scheme is to provide a database of allergies, medication and other important information that would be accessible to doctors out of hours or when a patient goes into hospital unexpectedly.


The Local Medical Committee had asked GPs in the Bolton area only one question about the summary care record. Local Medical Committees are statutory bodies that represent general practitioners.

The question was: “Are you in favour of proceeding with the summary care record?” The question was sent to the 169 GPs in the Bolton area and 98 responded, 67 of them negatively, and 20 were in favour. The rest were unsure.

One local GP, Chris Woods, a member of Bolton’s Local Medical Committee, said it was a statistically useful survey which seemed to indicate that the “majority of doctors don’t want it”.

But Dr Gillian Braunold, clinical director for the summary care record and a GP in Kilburn, north London, told “Pulse” magazine that a ‘critical mass’ of GPs were already on board with 34 of the town’s 57 practices signed up.

Dr Braunold was referring to GP practices – whereas the Local Medical Committee had put its question to individual doctors.

Dr Woods said GPs have three main concerns about the summary care record:

– Patients will have confidential details of their medication and allergies uploaded to a national summary care record unless they actively object. Some doctors would prefer an “opt in”. This would require that patients give their specific agreement to have their records uploaded to a summary care record.

– Information in the summary care record may not remain confidential. The disclosure of confidential information about junior doctors who had used the Medical Training Application Service [MTAS] system has knocked confidence in the integrity of information held in national systems.

– The cost of the NPfIT. Dr Woods said it was announced as costing about £2bn, which rose to £6bn and later £12bn. “This is an astonishing amount of money,” he said.

He was unsure how useful a summary care record would be if some doctors uploaded patient data and some didn’t. “It’s not clear to me whether it [uploading patient details to the summary care record] is in the interests of my patients. I have significant concerns.”

Comment:

More than 50 primary care trusts had applied to become an early adopter of the summary care record. After a formal assessment Bolton PCT was chosen to be the first.

It’s likely that the assessment of Bolton’s suitability would have included a check on the number of local GPs who were enthusiastic about the scheme.

Now it transpires that 67 of 169 GPs in the Bolton area are not willing participants. It’s important to remember though that about 70 GPs did not respond to the question.

If many of the 70 are in favour of the summary care record this would suggest that GPs in the Bolton area are split about half-half over on whether to upload to the national data spine some confidential information on their patients.

But Bolton is Britain’s showcase summary care record site. If only 50% are willing to participate, and it could be a smaller number, this is not a success.

Indeed if the split is about 50/50 across England the summary care record database could contain about half the records it needs to be reliable and comprehensive. Some GPs may change their minds and send information to the data spine. This improvement would be partly offset by some patients, an unknown number, refusing to allow their records to be uploaded.

It’s not the perfect conditions for triumphal messages from ministers about the summary care record.

In my view ministers could increase the scheme’s chances of success if they were to insist on honesty and candidness about its progress and problems, though this would conflict with political tradition.

GPs are more likely to engage in a scheme they fully understand than one they believe has been politicized and which ministers can discuss publicly only in Panglossian terms.

I have posted a separate entry on claims by Bolton Primary Care Trust about the local success of the summary care record.

Links

Pulse magazine article on the reaction of GPs in Bolton to the summary care record

Pioneering NHS trust reports “excellent progress” with summary care record – part of the NHS IT programme

Comments of Health Committee MPs on NPfIT Summary Care Record

BMA condemns appalling breach of junior doctors’ confidentiality

More GPs to introduce summary care record

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If OOH services are going to access anything on the spine, they will need both smartcards and role based access.

OOH services are frequently private companies, and often appear to employ EU locums on a short term basis.

Who will the Registration Authority be for anyone in the OOH service, and how will the smartcards be managed thereafter? I am told it is the duty of the sponsors to report any changes to the RA.

Basically, if the SCR is to be useful, does it require a complete overhaul of both the OOH service and the system of managing smartcards?

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