Plans by the government and BT to build a national database holding personal medical records on 50 million people will face a challenge this week at an annual meeting of GPs.
Doctors at the conference of local medical committees of the British Medical Association, whose support is vital to the project's success, will decide whether to oppose proposals to automatically upload patient records onto a national database spine.
Some influential GPs oppose the plan and, if they are backed by the conference, they could undermine ministerial plans for every patient in England to have a summary electronic medical record on the national database. Senior health officials will be on the conference platform to dissuade doctors from opposing the plan.
Health secretary John Reid has said every patient in England will eventually be able to access an electronic summary of his or her medical record under a £620m contract awarded to BT to build the national database. The plan is a key part of the reform of the NHS, said Reid.
The spine is at the heart of the National Care Records Service, in which patient data will be accessible by legitimate users across the health service; mainly doctors and nurses who will be issued with a form of ID card which will give them access to the system.
But many doctors are concerned that the government's plans assume that GPs will allow sensitive data on their patients to be transferred to the national database. At this week's conference, GPs will debate on whether to oppose the plan by insisting that data from medical records is uploaded to the spine only with the patient's specific consent.
Under the government's "opt out" plans, there will be an advertising campaign aimed at making patients aware of the benefits of the national system.
When the campaign is complete, patients will be assumed to have consented to their records going onto the spine, unless they specifically "opt out". Even if patients opt out, their data will still be on the data spine but in a "pseudonymised" form and not accessible unless in exceptional circumstances or emergencies.
But some doctors believe that the confidential relationship between GPs and patients could be undermined if raw data from medical records were automatically uploaded to the database.
Because of this concern, motions from grass-roots GPs will be put to the BMA conference, recommending that medical information should be transferred from GPs to the national spine only if patients opt in and give consent for this to happen.
"We were not formally engaged in the specification for the spine," said Paul Cundy, a GP and chair of the IT subcommittee of the BMA. "The current plan is to vacuum up patient data from GPs' systems. That causes us some concern."
Cundy said he believed doctors should in effect have a switch on their systems which allows them to send or stop information on patients going to the spine.
But health officials are concerned that obtaining the patient's specific consent before their medical information is uploaded will burden doctors with explaining the benefits of the spine to patients, reducing the time for consultations. It could also mean that the spine will not contain records on everyone in England, despite an announcement by Reid that it will.
The national data spine is one of four main projects that comprise the national programme for IT in the NHS. The programme is due to cost more than £6bn - £2.3bn has been allocated so far.
A spokesman for the national programme said, "Consultation on the issue of confidentiality and research into the requirements for the management of confidentiality were undertaken with patients, regulatory bodies, care services and suppliers from 2001 to 2003. The benefits and risks of a number of consent models were considered by NPfIT clinical and patient groups, which recommended the 'opt-out' consent model.
"The national programme has adopted the consent model by means of 'opt-out' with a warning period. It will therefore be assumed that clinical information can be used unless a patient says otherwise but individuals will be given a defined period of time in which to refuse access, in other words 'opt-out'."
BT to pay damages
BT is to pay a six-figure sum in damages to the Department of Health having missed two of its 56 milestone "deliverables" under a £530m seven-year contract to deploy an N3 broadband infrastructure across the NHS.
A BTspokesman said the company did not meet the 16 April deadline for the delivery of the first phase of N3. Compensation has not yet been agreed and is likely to be based on the additional costs for trusts caused by the delay. A spokesman for the national programme said, "BT is striving to address a small number of shortcomings. The contracts are proving to be effective."
Analyst firm Ovum Holway said BT has also missed interim targets in the contract to deliver the national data spine, but it had not been penalised.