Doctors call for input in UK NHS IT project

The British Medical Association (BMA) has made an urgent call on the heads of the UK National Health Service (NHS) IT project to...

The British Medical Association (BMA) has made an urgent call on the heads of the UK National Health Service (NHS) IT project to reach out to doctors and other health workers, as the current lack of engagement with the medical profession may doom the entire project to failure.

"Large-scale public IT projects do not have a good track record in the UK and so it is paramount that the NHS learns the lessons of history and engages with the frontline staff who will be using the new systems," said John Powell, chairman of the BMA's IT committee.

"So far the level of engagement and consultation with the medical profession has been wholly inadequate."

As the massive project for upgrading the IT infrastructure of the state-run health system moves on from the procurement stage to the implementation stage, the NHS National Programme for IT (NPfIT) has come under heavy criticism for budget overruns and for a lack of openness, including evaluation of its various IT projects.

Last month, the UK Department of Health announced that its 10-year estimate for the project had jumped from £6.2bn to between £15bn and £30bn.

On Monday (1 November), the new NHS e-mail system, called Connect, finally went live to its 95,000 existing users but began suffering outages and delays within the first few hours and into Tuesday.

Cable and Wireless was contracted to manage the NHS e-mail and directory system after the NPfIT canceled its original 2002 contract with Electronic Data Systems, though terms of the settlement have been kept confidential.

Along with new local IT infrastructures and a system for transmitting prescriptions electronically, the NPfIT includes plans for a database of electronic health records for 50 million patients in England, accessible by 30,000 doctors and handling five billion transactions a year by 2008.

Also in the IT plan is an e-booking program called Choose and Book, designed to allow patients to make hospital appointments online from a choice of locations.

Powell said the BMA has been supportive of the national approach to the NHS IT project, attempting to reach out to the NPfIT, but those leading the project have been slow to realise the importance of engagement with doctors and instead have taken a seemingly oppositional stance against the medical profession.

The NHS IT programme "should support healthcare workers in delivering a better service to their patients. We hope that improvements to IT systems will reduce the administrative burden on doctors so they can spend more time treating patients.

"But this goal will only be realised if the [NPfIT] can provide systems that are at least as effective as those currently in use," Powell said.

"Clinical staff must be consulted. There is no point investing billions of pounds in systems that do not have the confidence of users."

The NHS IT programme asserted that it consults with thousands of doctors and nurses throughout the UK every day but conceded that there is room for improvement.

"We are also strengthening the arrangements for clinical engagement, building a team of senior GPs, hospital doctors, nurses and other health professionals to lead this work," said NPfIT.

The NPfIT also created a national body, the Care Record Development Board, which includes healthcare professionals and will serve as a key channel for clinicians to share information about the NHS IT project, NPfIT said.

When Powell took the chairman position of the BMA's IT committee in January, he said he immediately wrote to Richard Granger, director general of NHS IT, asking to develop a strong working relationship, but after repeated attempts, has yet to receive a reply from Granger or his staff.

"It has taken me awhile to be this publically negative," Powell said.

The BMA is not alone in its frustration with the NPfIT leadership. One healthcare worker who is working to launch and run the Choose and Book system in a regional hospital alliance said that the lack to coordination between those implementing the system and the clinicians is hampering the project's success.

"I have been in the front line of the e-booking system since we started the programme in May, and though we have been trying to lobby from the middle for direction and a partnership at the top, it is not happening," said the administrator who asked not to be named.

Laura Rohde writes for IDG News Service

Read more on IT legislation and regulation