The latest Medix-UK survey, co-sponsored by E-Health Insider, shows that three years into the NHS National Programme for IT confidence in and enthusiasm for the programme has declined among NHS doctors, with a particularly sharp fall among GPs.
Most doctors still believe that the national programme is an important priority for the NHS, though levels of support are falling. The problem is fundamental – a majority of doctors now doubt whether the programme will deliver significant improvements in patient care or improvements in their working lives.
If doctors cannot be convinced on these two key points the programme’s chances of success must be judged slim. A point clearly recognised by NPfIT, which said in a statement to E-Health Insider: "The national programme recognises clinical support is essential so that the benefits for the NHS of this investment in IT can be achieved."
Robin Guenier, chairman of Medix-UK, told EHI: "The survey identifies a marked deterioration in support by clinicians, but now when implementation of new systems is beginning is precisely when their support is needed most." In other words, the programme must now climb a steeper hill than before to win back ebbing clinician support.
He pointed out that although this was the fifth consecutive survey carried out on the national programme the numbers of clinicians saying they have been fully consulted had not risen above 5% in the past two and a half years. "In the first three surveys doctors said they didn’t know much about it but were strongly supportive – about 70%. That is no longer the case there has been a marked deterioration in support."
Dr Paul Cundy, joint chair of the GP IT committee, said the results of the survey made depressing reading: "It shows how far apart are what GPs want and what the national programme appears to want to deliver. What GPs want are improvements and ‘bells and whistles’ added to their current already very sophisticated systems but the national programme seems to think that what we need is all new."
Concerns about poor communications and clinical engagement have dogged the national programme throughout its three year history. And while NPfIT has stressed the work it has done on these fronts the latest survey results on clinician’s views make bleak reading.
A spokesperson for the NHS Confederation told EHI: “Since the inception of the National Programme for IT, the NHS Confederation has been clear that one of the major risks for the scheme is and remains clinical engagement." The spokesperson added that the NHS managers organisation was working with NPfIT to address the issues.
Asked whether the lack of clinician commitment reflected in the survey threatened the success of the programme, NPfIT said in a statement to EHI: "Clinicians and their support are important to us and we continue to view clinical engagement as a priority."
The statement went on to stress more could and was already being done on clinician engagement: "The national programme recognises the importance of clinical engagement and we know there is much more to do." It pointed to the appointment of "a number of senior clinicians to lead this work", as evidence of its commitment.
There have, however, now been four consecutive fresh starts to clinician engagement, and an apparent revolving door for successive clinical leads – first Professor Peter Hutton; then deputy Chief Medical Officer Professor Aidan Halligan; and now Trent Strategic Health Authority chief executive Alan Burns together with the recently appointed clinical champions.
These successive fresh starts have almost certainly helped foster the growing cynicism and disillusionment found in the latest survey. A senior clinician in the programme told EHI that this really was the last chance and the arrangements for involving and communicating with must be made to work this time.
Another part of the problem has been that on Choose and Book, and seemingly on other areas, the programme has sought to build working systems and only then communicate the merits of these solutions to clinicians. This “back-loaded” approach to communications was criticised by the National Audit Office in its January report as a factor that had contributed to the failure to secure GP commitment to Choose and Book. The survey found that only 16% of GPs and non-GPs think this approach to communications is a good idea.
Dr John Powell, chair of the BMA’s IT committee told EHI that although there had been improvements nationally, with the appointment of clinical champions, and "more meetings behind the scenes", there was still not enough happening on clinician engagement locally,
"We are seeing a shift in the programme’s stance on engagement nationally, but I feel that engagement is still not happening locally. Colleagues are trying to engage with LSPs [local service providers] locally and finding it very difficult."
Asked what it attributed the decline in support from GPs to, NPfIT said: "We know change can be unsettling and that GPs have expressed a number of concerns about aspects of the programme. We are working hard with GPs to explore ways to address their concerns".
Dr Powell suggested that part of the reason for the particular decline in support among GPs might be due to Choose and Book. “The fact the Government is pressing ahead with Choose and Book despite widespread concerns from GP leaders may be a cause for the fall off in support among GPs.”
Within its statement to EHI NPfIT sought to downplay the significance of the survey, stating: "The survey represents a very small percentage of the clinical community." NPfIT itself co-sponsored an earlier version of the poll.
In fact the survey, which only focused on doctors, had 900 responses representing almost 1% of the doctors practicing in England and provides a sample size and response that is both statistically accurate and reliable. Polls can be misleading but it’s worth noting that Medix-UK carried out polling on behalf of the BMA when doctors were balloted on the new GP contract. They forecast the final result to within 1.5%.
Intriguingly NPfIT revealed to EHI it soon plans to start its own private polling, mirroring the advice of January’s National Audit Office report into Choose and Book. It said: "The national programme recognises the need to evaluate its communications with clinicians. It has completed the procurement of a research firm and will shortly begin to mount regular surveys of clinician opinion both to evaluate its communication and to inform its wider work." It will interesting to see whether NPfIT’s own surveys produce similar results in another few months.
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