Survey shows waning medical support for NPfIT

Tags: Choose and Book Community Confidentiality GMC Government GP hospital doctors Information iS Labour NPfIT PACS Spine

21 Nov 2006

A picture of declining support among doctors for the National Programme for IT emerges from the latest Medix survey of medical opinion on IT modernisation, sponsored by E-Health Insider.

One of the key findings of the survey is that half of all GPs surveyed said they do not plan to upload patient details onto the spine unless individual patients give their explicit consent (see EHI Primary Care for full story: GPs threaten to block national patient database)

Confidentiality again emerged as a key concern of the survey, with four out of five doctors saying they thought the confidentiality of their patients' records would be at risk.

More than 60% said they feared the system would be vulnerable to hackers and unauthorised access by public officials from outside the NHS and social care.

While 58% of GPs and 69% of non-GPs from the survey’s 1026 sample felt there were long term benefits to be gained from the National Programme for IT (NPfIT), overall support for the programme showed a pattern of continuing decline on previous Medix surveys.

Asked to rate how successful the programme has been to date, just 1% of hospital doctors and GPs said good or excellent, while 76% said poor or unacceptable.

Four years ago 67% of GPs said the programme was an important priority, now just 35% do so. For non-GPs, the same figure fell from 80% to 51%. While 56% of GPs and 75% of non-GPs said they were enthusiastic about the programme nearly three years ago, the respective figures stand at 25% and 41% now.

There also appears to be growing unease about the funding for the programme: in the first survey in February 2003, 47% of all respondents felt it was a good use of NHS resources and 27% said it wasn’t. The latest survey reflects a reversal of that view and a polarisation of opinion with only 11% now saying the programme is a good use of resources and 68% saying it is not.

Comments submitted by respondents to the survey reflect the quantitative findings. Many complain about wasted money and lack of consultation. Others support the ideas behind NPfIT but express concern about progress. Many doctors feel politics are to blame.

“An almost complete waste of time and money by a government who [sic] does not consult the doctors enough…”

“Appears to be driven by political requirements rather than health requirements.”

“In theory a good idea but in reality a disaster…”

“The aim is laudable, but I have never been consulted about what would save me time.”

“Tremendous waste of money in a programme that is excellent in concept but very ill conceived with totally unrealistic and unattainable timescales…”

“Get on with it.”

Choose and Book continues to provide wildly contrasting views from the medical community with some GPs commenting that they use the system for most referrals and others saying it has wasted their time and been abandoned. But there was some encouragement for Choose and Book champions as overall GP support for the system rose from 17% in February this year to 26% in the latest survey.

Eighty per cent of GPs say they have used Choose and Book and half report using it for more than 40% of referrals. However, 90% say it takes up more time than the old system and over 70% feel it either makes no difference to or is detrimental to patient outcomes.

One GP wrote: “I enthusiastically embraced the idea of starting with Choose and Book. We were one of the pilot practices on the Isle of Wight. Two years down the line it does not appear to have delivered its promise…”

Questions about the confidentiality of information stored in the forthcoming Care Records Service produced strong opinions with 79% of GPs and 55% of non-GPs feeling that the new system would lessen patient confidentiality – though some felt the benefits made this acceptable.

Respondents felt likely sources of breaches of confidentiality were: access by public officials outside health or social care (62%), outside hackers (62%) and inadequate access controls (48%).

A small majority of GPs (51%) and 47% of non-GPs said they would not or were unlikely to load up patients’ clinical details without specific content.

One GP commented: “I am extremely concerned that the public is unaware that their personal medical records may be uploaded to the national spine without any real safeguard about who can access them. I believe such a move will destroy the concept of medical confidentiality and that patients will be unwilling to confide in their doctors and doctors may well be unwilling to record information given in confidence.”

Another wrote: “I feel we are being pressured into disclosures that would have been actionable by the GMC a few years ago.”

Some non-GPs, mostly hospital doctors, expressed concerns. “In principle a good idea, but I have reservations regarding confidentiality,” a Cheltenham doctor wrote. “Could be potentially labour saving and improve clinical care, but it is fraught with dangers, particularly in regard to confidentiality,” commented a child and adolescent psychiatrist.

PACS was more popular with the hospital doctors whose comments included: “Our PACS service is excellent and has palpably improved patient care.” “Local implementation of PACS has worked well and brought benefits.”

One respondent said, however: “We had PACS before NPfIT and it is superb and would have happened anyway.”

Link

EHI Primary Care: GPs threaten to block national patient database

Readers Comments

Misinformation and Scare Mongering

21 Nov 06 23:47

Once again, the media is painting a picture of massive negativity and security risk relating to the NHS IT Project. It is widely accepted that the program is currently behind schedule, however the NASP, LSPs and most trusts are commited to developing better IT strategies which benefit the clinicians and patients. How are paper casenotes dotted over many sites in no order not a massive risk to confidentiality, why is a paper based booking system more effective and secure, my questions go on but this indeed effects patient care massively.

Ask a young Junior Doctor at 4am in the morning if accessing a patients historical test results immediately when a patient has presented themselves to A&E, would be a good idea? Ask the patient themselves if them turning up to A&E and not getting the correct treatment is a problem because the Medical Records department could not locate their history, is an issue? Of course it is.

By letting CfH, the LSPs and NASP get on with their job, ensuring they liase effectively with all parties, to provide good clinical systems which can be used to improve peoples lives, using Secure encrypted systems over a secure network, using Legitimate relationships to ensure only the correct people see the correct patient data and so on so forth, this project is a massive benefit to most trusts and is far more secure than current practices.

I work with many trusts on a day to day basis at all levels, have family and friends in all sectors of the NHS and can asure everybody that the biggest problem with Connecting for Health is that the people who work in the trusts do not fully understand what is happening. Good media coverage, trusts engaging their staff, the LSP's and NASP telling the trusts what is going on by using well placed communication methods is the way forward. Scare mongering and playing the same record again and again is NOT. We accept CfH is a massive change project over a massive organisation but it is definately worthwhile and it definately needs to be done.

outside hackers (62%) ?

nhstechie@btinternet.com

21 Nov 06 23:54

Incredible - on a par with an IT professional in hospital as a patient worrying that the surgeons don't bother cleaning scalpels or washing their hands between operations. I'll bet the same 62% don't use ATMs or online banking for the same reason.

Hackers

22 Nov 06 11:36

I was an IT security consultant for many years. I shred everything. I run antivirus and anti spam on my PC. I buy stuff on the internet. My credit card security has been compromised twice in the past three years. It had never been compromised before in my lifetime. Explanation? If there is enough money in it hackers will enter systems, usually through soft weaknesses, such as bribing personnel. There are millions at stake in health care information.

I do not bank over the internet and I have an internet only credit card which I check very very carefully every month. I cover the key pad when I enter my pin. I change the pin every few months. I am in control. If the NHS scheme goes ahead I have no control and neither do you. The people who are in control, CfH, I believe are incompetent dealing with any large system implementation. I have no confidence in them to properly govern my information.

Finally, Doctors not washing their hands is the biggest cause of cross infection in the NHS and is probably indirectly responsible for many thousands of deaths each year. This has been such a problem that the NHS introduced a special initiative to introduce alcohol hand rub on every ward. Welcome to the real world.

(post edited by EHI)

re: Misinformation and scaremongering

22 Nov 06 15:11

I'm with the comment "excellent in concept but very ill conceived with totally unrealistic and unattainable timescales".

Your first correspondent, as so many in CfH, seems oblivious that most hospitals already have systems that give doctors test results at 4am, and that the "pick 'n mix" approach of CfH does not include the laboratory system, or interfacing, or any guarantees about preserving those historic tests on data take-on.

The biggest problem with CfH is not that they have kept staff in Trusts in the dark (though that is a problem), but that they have massively oversold the vision and underdelivered on the reality. The more I learn of what has been negotiated in our name by CfH, the more I understand why it will fail to deliver electronic practice.

The LSPs and NASPS have not in my experience shown the knowledge of the NHS requirement, or public interest that is claimed here, they have clearly shown commercial interests as their key driver, and passing blame wherever possible. And CfH seem to defend the suppliers rather than the NHS.

Well placed communication methods involve listening, accepting problems (like C&B performance) and adapting, not just presenting glossy "myth busting" spin, and pretending that everything is perfect at the centre.

Will the 1% please stand up.

22 Nov 06 15:53

Who are the 1% of Hospital Doctors and GP's who think that progress so far has been good/excellent?

The 1% are

22 Nov 06 22:53

Radiologists of course ......... but of course we are dealing with a tried and tested solution with demonstrable and proven benefits that had clinical buy in, suppliers that new their business etc etc

Any lessons here other than it not being a leap of faith?

"Excellent in concept"

23 Nov 06 08:10

Isn't part of the problem that even the concept was deeply flawed. I believe that a lot of your correspondents could have pretty asccurately guessed where we would be in late 2006 from the start

Flawed from the start

23 Nov 06 09:03

I can't agree that NPfIT was ever excellent in concept but - IMHO - the roots of the problem go back a lot further than its inception in late 2002.

TI'd suggest that there are some fundamental truths relating to the NHS:

1. Most healthcare is provided locally and the NHS remains a fragmented and diverse collection of organisations (as it has since 1948).

2. GPs have for years held the best repository of personal health information and are still uniquely placed to exercise the all-important gatekeeper function that can prevent a shared health record becoming overloaded with irrelevant, conflicting and inconsistent content.

3. GPs purchased the systems they wanted (locally) - as traditionally have many hospitals - and the risks and costs of any ensuing "interoperability" problems have - as far as I am aware - never been convincing quantified. (Nevertheless, "joining-up" does seem, intuitively, like a good idea.)

4. There are some recognised problems with the quality of data in all sectors of the NHS, and this applies to all record formats (paper, electronic etc).

Could somebody explain - then - the underlying logic of the DH's series of strategies over the last 10 or so years which have:

1. Placed undue emphasis on systems integration within and across sectors / organisations / geographical locations.

2. Played down the potential to exploit the strengths of existing primary care systems (content, ownership etc).

3. Failed to recognise the NHS's organisational characteristics and their impact on IT implementation.

IMHO, CfH is the victim of years of woolly thinking by DH's "blue sky" policy makers. Focussing predominantly on developing local solutions to local problems would - I believe - regain the support of many clinicians.

It could have worked

24 Nov 06 00:16

Had someone tried to find out how doctors and nurses and other clinicians work, then they could have devised a system to help us now. However the deisigners wanted a revolution in how we worked (e.g. choose and book = book to the shortest waiting list in 5 hospitals, compared with I will refer you to the expert that I know and trust, and trust me it is worth the wait). Either to the software firsst to match how we work, or the revolution first(clinicians are drones to the politicians and good medicine = whatever is in the headlines or worked on Eastenders) - the two together do not work out!

Flawed concept

24 Nov 06 09:38

The methodology behind I4H would have delivered good local solutions, bringing secondary care up to the state that GPs have been at for a while. When all running well locally, the connections could have been made to link between related organisations (ie following the extant patient referral flows). This was all stopped by NPfIT and the prgress made to 2003 dumped.

The only way to implement a large project is to start small. If it works locally, there will be support for development and spread. I think it was Linus torvolds who originally espoused this philosophy.

NpFIT has left us with a system that is trying to run before it walks, resulting in regular trips and falls. And a weird architecture!

The Definition of Coinfidentiality

robert_uscroft@hotmail.com

28 Nov 06 08:08

It seems to me that the goverment has proceded with a political concept of confidentiality ie as long as the majority are happy then it's ok. However confidentiality in health is only ever needed by a minority population (the population changes with the circumstances of the individuals). So any person in the country may become a member of this minority at some period in their life. Hence the implementers have put confidentiality last on their agenda because to them it is not a significant issue since only a few people will be affected. the impetus is to implement at all costs and because those needing confidentiality are a minority they have no voice. Thank god clinicians are standing up for them, keep up the good work.