The latest Medix survey of 1,000 doctors' attitudes to the £12.4bn National Programme for IT in the NHS paints a picture of a good idea poorly implemented
More than half of doctors support the objectives of the NHS National Programme for IT (NPfIT), but most think progress on the scheme has been unacceptably slow and the money could be better spent elsewhere in the NHS.
These are some of the findings of the latest survey of 1,000 doctors by medical research firm Medix. Conducted between 30 October and 5 November 2007, the Computer Weekly-sponsored research raises fundamental questions about the implementation and costs of the £12.4bn programme.
One of the main aims of the NPfIT is to provide electronic medical records for 50 million people in England. The idea is that the records can be accessed wherever the patient is being treated. The programme also includes the Choose and Book system for booking hospital appointments electronically, e-prescriptions, and a national broadband network for the health service.
In its report, Medix said doctors still support the principles of the NPfIT, but most are critical of its costs and believe it is being poorly implemented.
"When this all started there was lots of goodwill and optimism, but it has been squandered by the poor choice of projects and poor implementation," said one of the doctors surveyed.
Value for money
The success of the NPfIT is measured against improvements in medical care, but 34% of the medics questioned said they believed it would make no difference to clinical care, and 19% believed it would make it worse.
Given these figures, doctors are questioning the appropriateness of the multimillion-pound programme in an organisation built on the promise of providing the best possible healthcare "from the cradle to the grave".
Seventy per cent of the doctors surveyed did not think that the IT programme was a good use of NHS resources, against 8% who believed it was. When asked the same question in February 2003, 47% of doctors said the NPfIT was a good use of resources.
"£12bn could have been used to improve clinical outcomes immeasurably. The NPfIT is unlikely to make any difference to clinical outcomes and will just become another bean-counting tool," said one survey respondent.
Not enough information
Gaining buy-in from end-users is essential for any IT-enabled change programme, but the Department of Health appears to be struggling to garner support from doctors. Most said they did not receive enough information about the project, and they felt the information they did receive was inaccurate.
Although 89% said personal consultation with doctors about the project was important, only 6% said they had been adequately consulted about the NPfIT. Twenty seven per cent had received no information on the NPfIT, and 7% said the survey was the first they had heard of the project.
"I am not adequately informed about the NPfIT and would like updates," said one doctor.
Of the information about the project that does filter down to doctors, many doubt its reliability. Of the doctors surveyed, 34% did not trust the information they received from the Department of Health 7% believed the information was reliable and accurate.
Five years into the project, doctors have been able to witness the changes it has made to the daily lives of patients and clinicians.
Medix found that 7% rated the progress of the NPfIT as satisfactory, whereas 71% rated it poor or unacceptable.
"A good idea in theory, but introduced without proper planning or trialling of the system and far too fast in an attempt to meet political targets," said one respondent.
Another said, "The principles and goals of the NPfIT are great, but the delay in implementing it is unacceptable, and the cost, which should have been used for patient care, is, to say the least, quite objectionable."
In the project's defence, Simon Eccles, national clinical director at NHS Connecting for Health, which runs the NPfIT, said it was potentially the biggest advance in the way healthcare is delivered since the founding of the NHS.
"Sadly, that is not widely appreciated. The programme is being actively obstructed by a minority of GPs for essentially selfish reasons," he said.
The Choose and Book system is a good measure of the progress of the NHS National Programme for IT. The electronic appointments booking system is a cornerstone of the scheme.
The Medix survey revealed that 30% of doctors have had no experience of the system, and 27% believe it has had a detrimental effect on patient outcomes.
One doctor said, "It is essential for the NHS to embrace this facility to improve information and communication about patients. However, I fear that it may be mismanaged and turn out to be more expensive than predicted."