Doctors question NHS IT priorities and lack of consultation about national plan

Doctors give more support to e-records than booking appointments online.

Doctors give more support to e-records than booking appointments online.

A key initiative for the NHS, to allow GPs and the public to book medical appointments electronically, has the firm support of fewer than 50% of doctors, a Computer Weekly survey has revealed.

The result is grim news for the government which needs the support of a majority doctors if the project is to be a success.

A national electronic booking system, supplied by Atos Origin (formerly SchlumbergerSema), is due to go live in the summer. E- booking is one of the government's highest priorities for the NHS, having been launched as a result of an IT seminar in Downing Street in February 2002 chaired by the prime minister, Tony Blair. By the end of 2005, electronic booking is due to replace hospital waiting lists.

Last October, John Reid, the secretary of state for health, announcing the award of a contract to SchlumbergerSema for a national booking system, said, "Electronic booking will mean that when patients are seeing their GPs they will be able to choose, from a menu of options, which hospital they would like to attend at a date to suit them."

Medix, the online polling firm that conducted the survey, asked doctors whether the national programme for IT (NPfIT), of which electronic booking is a key component, was focusing on the right projects.

Only 35% of the 1,026 doctors who responded to the survey, which was commissioned by Computer Weekly and the NHS national programme for IT, said e-booking was an "important" or "very important" priority. This means even fewer doctors support e-booking than last year, when 38% thought it was a priority.

In the latest survey, doctors were asked to list projects they would most like to see implemented in the NHS, and 63% did so. But, of these, only 3% mentioned electronic booking.

In contrast, there was overwhelming support for plans for integrated care records, which will give 50 million people in England an electronic health record: 82% of doctors rated them "important" or "very important".

Ministers have categorised the support of doctors as critical to the success of the £2.3bn national programme, but the survey found that 26% of them had not heard of the programme until told about it by Medix. The NPfIT was launched more than 18 months ago, contracts have been signed with national and local service providers, and the first major systems are due to be delivered by the end of this year.

Despite claims by the national programme that it has engaged the stakeholder community, only 4% of doctors who responded to the survey described consultation with them personally as "adequate" or "more than adequate": 75% said they had not been consulted at all. Nearly 90% said consultation was "important" or "very important". Only 22% said they had received "a lot" or "some" information.

However, the lack of consultation, the Department of Health is likely to be pleased with the high level of support for the programme in general: 75% of those who responded to the survey thought the IT-led modernisation of the NHS was an important priority and 66% were "fairly" or "very" enthusiastic about it.

More than 40% were willing to make available up to two hours a week to engage with the national programme and a further 30% said they would like to engage with it but did not have the time.

More than 6o% said it would bring about a significant or slight improvement in clinical care, and 31% thought the £2.3bn allocated to the programme was a good use of resources. A further 39% were unsure and 30% said it was not a good use of resources.

Nearly 90% of doctors said it was important to align local working practices with the national programme before it was introduced, although changes in working practices have yet to be fully mapped out or costed.

The national programme provided a written brief for doctors who took part in the survey. It said that the national programme has "involved many clinicians in system design", and added, "Time constraints on doctors have meant that few have detailed information about the programme.

"NPfIT, however, considers it best for information to be made available to doctors as each element of the programme is developed and introduced. NPfIT is undertaking a wide consultation with clinicians and publishing specifications on the internet."

Rino Coladangelo, chief executive of Medix and a part-time GP, said, "Most doctors are supportive of the NPfIT initiative - but doctors know far too little about it and are anxious to get involved. Now the commercial arrangements are largely in place, an urgent challenge for NPfIT is to engage individual front-line clinicians."

Methodology

In the third such survey undertaken on behalf of Computer Weekly, medical research firm Medix questioned doctors via the internet. This year the study was co-commissioned by the NHS national programme for IT, which submitted a briefing to doctors.

A total of 1,026 doctors responded, which is more than 1% of the number practising in England. About 50% of them were in general practice; the rest had a range of specialities. Respondents included 232 consultants, 156 registrars and 52 senior house officers.

Clinicians spell out their views       

"Spending billions of pounds on an IT system in a health service that is desperately short of nursing staff, that restricts the prescribing of particular chemotherapy drugs because they are too expensive, even though they are proven to work, is a disgrace."   

"Although well-meaning and sorely overdue, the initiative will do badly because of the apparent deliberate shutting out of the single biggest group who can help the NPfIT: the most experienced users, the GPs." 

"Current NHS IT is variable and in some trusts rudimentary, so any investment should be encouraged."   

"Any enforced changes in systems of individual GPs will need to be backed up with funding above and beyond that of system implementation."   

"In principal we must have this, but I have grave worries that it might go the way of all big IT projects. Having been involved in these since 1981, I am struck by the way IT professionals do not really understand the processes of healthcare. This is why clinicians must be involved."   

"The NHS needs to be in the 21st century with IT. Good IT saves time and improves patient care."   

"Individual clusters have had no say in the selection of local service providers. They may have auditioned them but this was sheer theatre - their views had no say in the actual choice of LSP 'partners' that were chosen."   

"This is an excellent project and should be supported wholeheartedly by practising clinicians."

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