Users of systems worth billions of pounds due to be installed in the NHS, last week expressed strong criticisms of the way they were being implemented.
The criticisms by GP representatives across England are unprecedented in their ferocity and highlight a widespread scepticism over aspects of the national programme for IT in the NHS.
Concerns centred on a perceived lack of consultation about changes to IT, a rush to implement systems and a lack of funding.
The views of doctors at the annual conference of local medical committees of the British Medical Association reinforced similar concerns expressed privately by some of the 20,000 IT professionals in the NHS.
At the conference addressed by Aidan Halligan, joint senior responsible owner of the national programme, there was widespread support for the broad goals of the NHS IT programme. But criticisms from delegates, who represent thousands of GPs, indicated that health service IT staff could face strong resistance from users, particularly doctors, as they roll out national systems.
Medical committees in Derbyshire, Manchester, Gloucestershire, Suffolk and parts of South London, went as far as recommending a boycott of the care records service.
Their motion said that in view of the "uncertainties and lack of consultation on the care records service", and "until GPs legitimate concerns are answered" that "GPs should not engage with the care records service".
The government has allocated £2.3bn for new systems under the NHS IT programme, but in facthas awarded contracts worth more than £6bn to national and local service providers.
Delegates at the conference attacked what they saw as a poor understanding among local service providers of the way the medical professions work.
They believed end-users were given little choice but to comply with the strategy, that the intention to use IT to force change in working practices was doomed to fail, and described plans for a national database of medical records as "Big Brother's dream".
Officials on the national programme hope that the worries of
doctors and nurses will evaporate once they see "early wins" from trusts that manage to go live successfully with national systems this year and next.
Halligan told the conference that the new systems will "match or exceed" the expectations of the medical professions. He also said, "I really do apologise that we have not engaged in a more fulsome debate with primary care [GP's]."
There was also criticism of the hospital appointments booking system.
A London motion said that e-booking could be dangerous where there is a shortage of capacity because it bypasses a consultant's review of priorities.
A further motion was that the conference agrees to have "no confidence in the ability of the national programme for IT to improve patient care because of the impossible timescales and lack of engagement of clinicians."
At best the outbursts against aspects of the programme at the conference will not lead to active opposition. At worst, the Department of Health could find that billions of pounds' worth of new systems are little used by most local clinicians who may feel disenfranchised by a centrally-driven initiative.
Paul Cundy, chairman of the IT subcommittee of the British Medical Association's GP committee, said, "The sentiments expressed at the conference were clear about the lack of clinical engagement thus far. I am reassured that the presence of Aidan Halligan [at the conference] is a statement that this is about to change."
Patient information must be protected
One of the main projects in the national programme for IT in the NHS is a care records service, including a national database, called a data spine,which will allow the health records of 50 million people to be shared among healthcare staff.
But many doctors are concerned about plans to allow patient data to be automatically uploaded from GP systems to the spine, where it could be accessed by government agencies without the knowledge or specific consent of patients.
Last week's conference passed a motion which called for the GP committee of the British Medical Association to take "appropriate action" to stop the government revising legislation which would allow increased access to identifiable patient information.