Doctors demand process change before IT roll-out

Lack of change management could jeopardise national IT programme.

A survey for Computer Weekly and The Times has highlighted fundamental weaknesses in the way NHS officials are managing the £2.3bn national programme for IT.

Three-quarters of the 1,000 doctors who took part in the survey wanted local working practices aligned with new NHS systems before the technology is introduced.

But there are no indications that the Department of Health plans to make any systemic changes to working practices before systems are rolled out.

This lack of a major change management project is seen by many doctors and IT specialists as a fundamental flaw in the national programme.

This oversight has, in the past, contributed to the failure of other public sector IT projects. The Libra caseworking project for magistrates courts failed in part owing to the lack of alignment of working practices with new systems, government watchdog the National Audit Office found. "IT applications support the operation of business processes," it said. "Standard IT systems need standard business processes."

Those running the health service national IT programme say they are consulting doctors and are considering plans to change working practices. But officials have also said the programme is being managed mainly as an IT procurement exercise.

This is despite trials in NHS trusts of electronic patient records systems - a key part of the national IT programme - which have shown that changes need to be made to staffing; the structures of organisations; pay scales; working practices and other non-technical aspects if the introduction of systems is to be successful.

A trial of electronic records in Cornwall, for example, called for processes to be re-engineered. It found computerisation caused increased workloads for data entry which "reduced the quality of care given".

Trusts in the county found that the parallel use of paper and electronic files "adds a huge burden to staff who duplicate data collection". It said the focus had to be on examining processes, developing procedures, educating staff and specific training programmes.

Despite weaknesses in the national programme, the department plans to appoint the first of five local service providers within five months to run new and existing IT systems covering England. Each of the winning consortia will receive a contract worth potentially more than £1bn over five years. The closing date for bids was yesterday (Monday).

Many doctors support the national IT programme. But when asked if they - as opposed to their specialist institutions - had been consulted, less than 1% of doctors said the consultation had been "more than adequate", and 91% said there had been no consultation or that it was inadequate.

A spokesman for the national IT programme did not consider the survey to be representative unless those responding made up 2%-3% of the population of GPs. The survey elicited responses from 1.5% of all GPs in England. It did not ask doctors in Wales or Scotland because the national programme does not cover these countries.

The survey was carried out by an e-polling company Medix, whose co-founder is a former IT director at a northern health authority.

Over 80% of doctors not consulted over NHS IT >>

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