With the blue touch paper for a big new push on NHS IT apparently about to be lit, E-Health Insider spoke to Dr Grant Kelly, a general practitioner and head of the BMA’s IT committee, about how he views the new draft IT strategy.
The British Medical Association’s IT lead questions whether the new NHS IT strategy provides a long-term blueprint for an electronic NHS, suggesting that it is instead politically driven and focused on short-term objectives
While welcoming the prospect of new investment, Dr Kelly characterises the new strategy as being based on short-term political objectives rather than being a long-term programme to achieve an electronic NHS. "This is a very long game, there are no short cuts," he stresses.
Although the BMA has been consulted on the new strategy Dr Kelly says few in the civil service want to report the BMA’s advice back to the ministers. "The message we deliver is not usually a welcome one".
The problem, he believes, is that because politicians want quick results new money is likely to be channelled into systems that have little real impact on patient care such as a national bookings service and electronic transfer of prescriptions.
"Politicians want to see a very visible return within a few years to ensure the votes come in, so while there may be a lot of money invested it will be invested in things like central bookings."
Asked to elaborate he pointed out that 90 per cent of all health treatment is local and that a centralised bookings system would have virtually no impact on patient care: "If I were ever to find an irrelevant system national bookings would be it."
The BMA IT lead believes the introduction of electronic transfer of prescriptions (ETP) may eventually offer some benefits around the treatment of patient with chronic conditions such as diabetes and asthma, but suggests that overall the benefits to patients will be marginal.
"ETP may help, but it’s not a big issue for me as a GP, its just replacing a piece of paper with an electronic flow".
The two pillars of the new strategy that potentially offer real clinical benefits, he says, are electronic records and providing clinicians with broadband access to networked applications.
However, Dr Kelly believes that electronic records are a long-term goal which cannot be simply specified and mandated in a national strategy but must be built up from local legacy systems and organisations. He says the first step should be to undertake a major stock-taking exercise to define what is needed, and then begin building up — a process he says that would take at least a year.
"You have to start as a sub-set and build them up as the legacy systems begin to be pulled together," says Dr Kelly
He also remains sceptical about whether a centralised electronic record can be made to work and questions how dynamically generated records can provide legal and attributable medical records. In his view there is a massive amount of work yet to be done to even appreciate the scale of the challenge.
Basic questions about the electronic remain to be asked or answered, he stresses. "Is the electronic record a representation of the paper record? If so, it needs to be done locally but if you take a view it’s a whole life record it’s obviously got to be structured completely differently."
Dr Kelly argues that the fundamental problem with the new strategy is that it does not provide a clear, long-term vision for computerising the NHS focused on delivering real clinical benefits to patients. "There is a continuing confusion over aims and objectives."
The starting point, he says should be the question "what are we doing this for?" Dr Kelly adds the sheer complexity of the NHS, and different priorities of the centre and local organisations, means it is much harder to deliver an IT strategy to support key business processes than in an organisations like a bank.
"It’s very difficult to draw up an IT strategy, hospitals have very different aims to general practice," says Dr Kelly.
He describes the latest draft NHS IT strategy ‘Delivering 21st Century IT Support’ as the latest in a long line of IT strategies, each ripped up and superseded every few years.
Because of the degree of uncertainty and risk inherent in the new strategy Dr Kelly says the suppliers will include a hefty margin. "Suppliers will build in a hefty safety margin — and that means bad value for the NHS".
Despite his scepticism of key parts of the strategy Dr Kelly stresses that the BMA is not obstructive but simply thinking long-term about complex issues. In particular, he points to the way the BMA has championed the position that confidential patient data should only be available electronically to specific health professionals with the patient’s active consent, as now having been adopted as government policy.
“We’re very keen to advise, but our advice is rarely taken,” he concludes. "The perception is that the strategy is developed behind closed doors and just comes to use for improvement."