BMA votes for non co-operation on central records

Tags: BMA CfH GP Information iS NPfIT PACS

29 Jun 2007

Doctors have voted for a public inquiry into NHS Connecting for Health (CfH) and have called on the BMA to advise doctors not to co-operate with the centralised storage of medical records.

The National Programme for IT was the subject of strong criticism at the association’s annual representative meeting (ARM) this week where doctors claimed the NHS IT project was doomed to failure unless a grip was taken on the project and that patient information held on the NHS Care Records Service (NCRS) was not secure and confidential.

Dr Charlie Daniels, a GP in Torquay and chairman of Devon Local Medical Committee (LMC), told colleagues that patients and doctors would be the biggest losers if there was no public inquiry to into NPfIT.

He claimed key elements of the programme were not working and that costs were escalating, suppliers were in trouble and stakeholders were being ignored. He said that in 2002 everyone had hoped that NPfIT would drag local hospitals out of the IT Stone Age and connect them with GP surgeries

He added: “Do I see Torbay Hospital with an all singing and dancing IT system that can give me a basic e-mail discharge summary? No – we still get a badly handwritten flimsy note which arrives days later.”

Dr Grant Ingrams, secretary of West Midlands Regional LMC, failed to convince colleagues that CfH had started to listen more carefully to what clinicians and patients needed and that calls for an inquiry were unnecessary.

He added: “Do we really need a public inquiry to state the obvious?”

On the NCRS Dr Daniels described the smartcards already in circulation in the NHS as “300,000 keys to open one lock” and said many patients had reasons for not wanting to have their details on the spine.

“Patients are being bullied when they are told that their care will suffer or that they are putting their lives at risk if they do not have their details on the spine. Patients are also being bullied when they are being told that they will not be able to access services if they do not have their details on the spine. This is disgraceful and should be deplored.”

Doctors backed a motion, against the advice of Dr Richard Vautrey from the BMA’s working party on NHS IT, which called on the association to advise doctors not to co-operate with the proposed centralised storage of all medical records which they claimed seriously endangered patient confidentiality.

Dr Paddy Glackin, a GP in Brent, London, claimed doctors did not need to be involved with CfH as a national system was unnecessary.

He added: “I’ve looked back on my patients – of 6,000 patients in our practice over the last four years two have become ill outside our region. That’s one for 10,000 patient years.”

The conference also backed a call for medical students to have access to electronic patient records after hearing that in much of the country students were unable to view PACS images and other electronic data.

Readers Comments

Disingenuous

29 Jun 07 11:36

Appalling reporting - one London based GP determines the National Record unnecessary based on his own experience, so are we supposed to infer that holds true for the whole country?

How about we balance it up by asking a GP from the wide commuter belt around London - I suspect we'll find many more of his/her patients have sought medical care away from the region.

a perfect example...

peter.c@nhs.net

29 Jun 07 14:02

Your quoted GP who could only find records for 4 patients getting ill 'outside [his] region' makes the perfect self-defeating point. All of those patients that DID get ill were treated without the benefit of a medical history and their treatment, along with any outcome of it failed to become part of their history.

Thanks for making such an effective argument for an available and effective electronic record

A perfect example II

nhstechie@btinternet.com

29 Jun 07 23:43

How many of his patients moved practice and had to have their details printed off, stuffed into an envelope and posted to their new GP (if they could find one that was taking on new patients)? How many times has his server been nicked from the practice? How many of his attended hospital and didn't bother telling him? How many died and he still doesn't know yet

... and Campbell wants this lot to run the NHS?

There is a lot wrong with CfH but NPfIT as a concept is still valid. Pity the emphasis didn't include the non-sexy issues which would improve patient care relatively easily - electronic discharges being the best example of an early opportunity squandered. However, having listened to so-called clinical risk and tenuous confidentiality/IG issues and objections raised by BMA members over the past three years to the content of these discharge letters and whether or no certain TTO meds should/shouldn't be included (no two doctors seem to agree) I wonder whether these guys are taking the micturition!

Follow NHS and GMC codes of practice

stressfreedave@hotmail.com

30 Jun 07 08:41

A lot of this seems to miss the point and still seems rather stupid. People like me are not against electronic records, we are for patient choice. Saying things like "Thanks for making such an effective argument for an available and effective electronic record " would only make sense if the patients medical history was a crucial part of their care. How many of the 4 died because their file was not national? If they died due to an alergy, could their lives have been saved by carrying that info on them?

There are some things about me I would not mind the doctor/nurse treating me knowing about and I would not share, however there are a few things that I would never want shared and would not want SUS to know. The national system will not allow data not to be shared as all data would be shared with SUS and whoever they sell it to.

Therre is a huge difference between making relevant data available to a doctor/nurse and sharing all data with SUS etc. There is also a big difference between alloing the doc/nurse know about your alergy and allowing them to know you had sexual problems.

As for quick and easy access. I got an email from CfH that pointed out that in most cases clinitians will be to busy treating patients to access thier file to find relevant info (I can supply the enail to EHI if they want it).

If you are going to talk about doctors accessing the file, please follow GMC and NHS codes of practice and identify the others that will have data shared with them or copied to.

Appaling reporting?

30 Jun 07 11:38

~Primary sources. Can we please be told which of the webcasts to listen to on the BMA site at http://www.bma.org.uk/ap.nsf/Content/HubARM2007 Or better, have a transcript of the motions passed, and some clarity on when these become BMA policy rather than adopted conference motions.

Then and only then we may wish to note the luddites in the medical profession dont always win, 1948 being one example of democratic politics winning out over vested interests.

Did the conference vote in solidarity with the striking postal workers, a more prolitarian dispute over vast job losses and a massive diminution of public service?

Onwards to CRS, whatever it ends up being - and then we will have something of value to patients, as well as enlightened doctors, not that I want to patronise them.

Webcast

Neil.Bhatia@nhs.net

30 Jun 07 15:16

http://tinyurl.com/yow8ds

The motions passed are already BMA policy:

Keyword(s): NHS Information Technology That this Meeting believes that the present exorbitantly expensive NHS national computer scheme (Connecting for Health) is doomed to fail and calls on the BMA to demand an urgent public inquiry to review the problems of the Connecting for Health scheme, the cost to the taxpayer to date of the implementation of the electronic national data base and whether this has been a cost effective use of public funds. Policy group: Annual Representative Meeting, 2007

Keyword(s): NHS Information Technology That this Meeting believes that: (i) patient information and data uploaded into the proposed NHS clinical care record is not secure and confidential; (ii) the BMA should advise all its members not to co-operate with the proposed centralised storage of all medical records as this seriously endangers patient confidentiality; (iii) any potential restriction of access to services for patients who refuse permission for their data to be placed on the spine is to be deplored;

Policy group: Annual Representative Meeting, 2007 Keyword(s): NHS Information Technology That this Meeting believes, in light of the increasing use of electronic patient records, that all medical students should have timely and appropriate access to these records as required for completion of their training and calls upon the relevant bodies, such as Connecting for Health and the NHS IT Working Party and The Medical Schools, to incorporate specific guidelines to allow this. Policy group: Annual Representative Meeting, 2007

GPs should be cautious!

rf@medicineit.com

01 Jul 07 19:55

To all those patronising 'techies' out there....

Please take note of the saying developed by the much venerated team on the Wirral : "You can teach medical staff about how to do IT but you cannot teach IT staff how to do medicine".

I get very annoyed with all these 'technical blow-ins' who think they can revolutionise the NHS because they implemented SAP or CRM solutions into large multi-national organisations. Technology is a means and not an end.

GPs are right to be VERY cautious about the influx of well intentioned bulls in this very delicate china shop. Don't forget, GPs have been using IT in their practices for over 2 decades and the UK GP population has one of the leading IT user bases in the world. They are not luddites! They have just been around much longer in healthcare and IT than most of these IT career demons.

Ask any of the 6,000 pensioners who had their details mailed to the wrong people earlier this year by the Dept. of Work & Pensions. Is it luddite to be scared of huge mistakes like this? If you think so, then you're wrong.

Give the GPs a chance. Politicians come & go. IT managers get promoted. Projects start and never deliver. Only GPs stay in the one place trying to serve and be responsible for a dedicated patient community who place their trust in them.

I wish I could say the same about my NHS IT career.

The problem with CfH

gji@nhs.net

02 Jul 07 09:35

The problem with CfH is that the 'users' view is of: delays caused by the system, national systems rolled out before they are fit for purpose, systems which are not designed from a user/patient perspective, and a 4-5 year period of no co-ordinated improvements to general practice systems. Paddy Glackin - similar to many GPs - is harking back to a time when GPs bought their own systems (which were designed by other GPs). Together with the RFA system this lead to NHS General Practice IT being in the forefront in the world. CfH has caused this lead to be eroded - which is now well recognised, hence GPSoC.

This is now BMA policy. I spoke against the motion (even though I understand the sentiments of the proposer) as I believe there will be benefits for patients (although the CRS will not produce the huge health benefit that is frequently wildly claimed), and that CfH are beginning to try and engage properly. This does not mean that I support the disasterous roll out of C&B which ws done before it was fit for purpose, the complete lack of meaningful engagement with users/patientsat the start of the project, the initial lack of any wish to repect a patient's privacy, and huge concerns regarding confidentiality and SUS.

Grant Ingrams

Co-operation needs to be earned

02 Jul 07 09:56

It's all-too-easy to blame the medics, labelling them as luddites or whatever, because they are an influential and vocal constituency in health-related matters. But one can't help wondering whether - if NPfIT was a well-planned, user-focussed initiative , shown to be technically robust, with clear benefits and supported by effective programme management - the professions (and it's not just the medics who have concerns) might be more supportive.

As none of the above appear to apply, non-cooperation seems like a very reasonable approach.

Well done BMA!

02 Jul 07 17:37

I left the BMA years ago because I despaired of it ever doing anything genuinely to oppose insane government policies like NCRS. A little more courageous leadership on this and other important issues and I'm going to have to think again.

Patronising techies?

nhstechie@btinternet.com

05 Jul 07 00:09

You may not be able to teach IT staff how to do medicine, but few of the comments from the BMA conference quoted here are about medicine per sé, they are about Information Governance, common law confidentiality and concerns about security on NPfIT systems.

The advice of better informed GPs such as Drs Vautrey and Ingrams was ignored and instead this ill-advised and potentially counter-productive motion was carried.

NPfIT is at a tipping point. If the BMA presents itself to the government as part of the solution to the mess CfH and its suppliers have made of the programme, its members will have a unique opportunity to influence the way the programme evolves. Scrapping the programme would probably just lead to decades of legal wrangling and the squandering of billions of pounds in legal fees and ultimately in compensation to suppliers.

A blanket policy of non-cooperation would surely be counter-productive? Many GPs and others (including myself) do have genuine concerns about the usefulness and clinical content of the spine record and the adequacy of the safeguards currently in place to protect them. RBAC is a good first step but, without more granular legitimate relationship services producing exception reports for local Caldicott guardians and the like, isn't ideal for records shared at National level.

Perhaps a good tack would be to present CfH with a list of the top ten priorities BMA members would like to see delivered within 12 months, with a promise that the non-cooperation motion would be reversed if these are delivered by next year's conference?