Doctors feel left out of NHSIT plans

Support from clinicians for the government's £2.3bn national programme for IT (NPfIT) in the NHS seems to be faltering just as...

Support from clinicians for the government's £2.3bn national programme for IT (NPfIT) in the NHS seems to be faltering just as the first national system, the Choose and Book hospital appointment system, is due to be introduced.

The latest Medix survey found that doctors are generally supportive of NPfIT. For example, 65% think it is an important NHS priority but this is down from 75% in a similar survey in February. Similarly, 54% are enthusiastic about the NPfIT, but this too was down from 66% in February.

There has been no great increase in the number of doctors who feel they have been consulted on the programme or who have knowledge of it, the survey showed. In February, 75% said they had not been consulted on the programme and, in the latest survey, this was down to just 70%. In February 11% described consultation as inadequate, which rose to 15% in the latest survey.

Commenting on the survey, Glyn Hayes, chairman of the BCS health informatics committee, said, "Unless doctors feel they have been consulted they are less likely to take up the challenge of using new systems.

"A lot of consultation is going on, but it is at a senior level. The national programme makes sure senior management know about it and assume it will be cascaded down, but I am not sure it is. Strategic health authorities are well aware of what is going on, but I find little evidence that local acute or primary care trusts do."

The need for consultation was highlighted when 86% of respondents said the alignment of local working practices with the NPfIT before new systems were introduced locally was important or very important.

The survey, sponsored by Computer Weekly and the Financial Times, showed considerable support for the creation of electronic patient records, which are at the heart of the national programme. Some 83% supported the development of the NHS Care Records Service, which will hold electronic health records for 50 million patients in England.

However, doctors taking part in the Medix survey also supported a motion passed by the British Medical Association's local medical committees in June, which was not to engage with the Care Records Service until concerns about confidentiality and how the system would work had been met. This motion was agreed with by 69% of doctors.

The NPfIT plans to upload GPs' patient data onto a "data spine" that can be accessed and added to by other appropriate medical professionals. But according to Hayes, the national programme does not understand how GPs value patient data.

"There appears to be a feeling that it is the NHS' data, when in fact it is the patient's data. The people that are close to the patients are the GPs," he said.

"GPs regard themselves as the patients' advocate. There is a feeling they are responsible and they need to keep the confidence of the patients. It is a serious problem, but not insurmountable."

Mary Hawking, a Bedfordshire GP with considerable IT experience, was also concerned about patient confidentiality and how data would be handled once it was uploaded onto the spine.

"There needs to be a clear audit trail. There are no clear plans about how the transfer of records will take place. The programme seems to oscillate between thinking [the spine] should be entirely drawn from GP records, or that there is nothing worth preserving," she said.

Hawking was also concerned that systems being built by local service providers - private consortia supporting each of the five regions - were not taking GPs' needs into account."

A spokesperson for the NPfIT said, "Clinical engagement and benefits realisation is a key element of the NPfIT and we are further developing the work done to date.

"The recently-established Care Record Development Board will provide the structure for clinicians and patients formally to inform the work of the NPfIT.

"Professor Halligan [joint senior responsible owner of the programme] has already undertaken a number of roadshows in which he has had the opportunity to discuss the programme with staff in front-line trusts. He has an on-going programme of such roadshows planned for the rest of the year. Professor Halligan has also announced initiatives like the Frontline Support Academy."

What doctors really think      

 I am concerned the NPfIT has the hallmarks of previous government IT failures, such as failure to consult with end-users about how it will integrate with daily work and make it easier. If the plan is perceived as a management- or government-driven additional task (which it is, by the few who have heard of it), it will fail.  

General practice has been at the forefront of medical computing. There is a danger there will be a levelling down to make a system that tries to be all things to everybody, and becomes no use to anyone. 

Get the users involved and ensure software designers speak to, listen to and do as the users want. Computers are a tool and I do not need them to do my job. They should assist me, not inhibit me, nor take up too much time because of instability.  

I fear the plan will impose an IT solution that for a number of GPs (especially those with paper-light systems) will have less functionality.  

This government is ahead of its time in the emphasis it places on IT. In the future we will marvel at its astuteness. 

I think this is a very positive development with huge potential gains to patient care and clinicians. Full realisation may take years, but is doubtlessly the right way to go. 

I support the idea of a modern NHS with the latest technology and, as a GP, I am possibly the most important cog in the wheel, but as yet I have had barely any information. 

IT has radically altered the working lives of medical scientists and will revolutionise the work of clinicians. It is vital we do not make mistakes by imposing a structure on an evolving IT environment and freeze it in time. The money would be best spent by allowing individuals and trusts to experiment with what is available The optimum strategy will emerge with people voting for the best informatics.  

The correct use of the correct information about patients, their care and their medical condition is absolutely vital. It is a pity the NPfIT has chosen to surround itself with a cloak of secrecy. History in the UK and the US has shown that the systems that work are those that are developed by, and with the full involvement of the users. 

This is the best chance the NHS will have to improve its efficiency. However, choosing the cheapest solutions and not funding clinical involvement and implementation costs poses a serious risk to the continued smooth running of trusts.  

About the survey   

In the fourth survey undertaken on behalf of Computer Weekly and the Financial Times, medical research firm Medix questioned doctors via the internet.  

A total of 852 doctors responded, comprising 1% of relevant clinicians across a balanced range of specialties.   

NHS most wanted   

IT projects doctors would most like to see implemented in the NHS: 

  • Electronic patient records - 43% 
  • Improved electronic communications - 10% 
  • Standardised computer systems - 8% 
  • Electronic transfer of patient records - 8%

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