BT has been warned by NHS IT boss Richard Granger that they must hit a 28 November deadline to switch on a Patient Administration System at Queen Mary and Sidcup NHS Trust or risk incurring penalties.

The company confirmed that it is up to a year behind schedule on its £996m computer network-services contract with the NHS, to deliver new IT systems in London and runs the risk of a second fine on an NHS contract.

A BT spokesperson said the company is "nine months to a year behind where we want to be”.

Connecting for Health (CfH), chief executive, Granger said he’s "closely monitoring” BT before a 28 November deadline to switch on patient administration software (PAS) at Queen Mary’s Sidcup NHS Trust in southeast London.

He warned of a "domino effect” with the 42 remaining hospitals in the London area if BT misses the latest November deadline at Queen Mary’s Sidcup. All five clusters have already previously missed major deadlines for delivery of the core local service provider (LSP) solutions.

"If you’re looking for an event to gauge whether they’ve got their London contract under control, then that’s the one I take,” he said. The BT spokesman said the company is "confident” it will meet the November target.

Lengthening delays against the original delivery schedule for new PAS and electronic healthcare record (EHR) systems are not confined to BT in London but are occurring across the whole of the NHS National Programme for IT in England. Only a handful of simple PAS systems have been implemented under CfH and not one major implementation of an electronic patient record system has occurred.

The latest warning indicates that Granger’s is pursuing an interesting strategy of trying to manage delivery by applying market pressure on the publicly quoted prime contractors of the NHS IT programme through the financial press.

That the Connecting for Health chief executive gave his latest prognosis and warning in an interview with US financial news service Bloomberg is in itself revealing, illustrative of the audience the CfH chief executive feels he must address.

Granger’s previous warnings to suppliers who fail to deliver have included such visceral threats as "putting a bullet in their head", and "burning their feet". BT alone among the LSPs has been singled out for such warnings.

Granger told Bloomberg that BT was struggling to create electronic medical records for Londoners, as LSP for London.

The three other LSPs, Accenture, Fujitsu and CSC are not thought to be much closer to delivering patient administration systems and integrated electronic patient records, but have received less public criticism.

One analyst told E-Health Insider, that Accenture – LSP in the North East and Eastern clusters – had proved extremely adept at "negotiating down the barriers they have to clear before they get paid by the client". The analyst added that "investors do think a line has been drawn under their losses on the NHS contracts and that by 2008 they will get back to the margins they want to see".

The Bloomberg report also quotes Richard Granger as saying that BT is also behind schedule on its separate £620m contract to build the NHS Care Records Service, an England-wide national database of electronic health records. BT denies being late on that deal.

BT last year was fined £4.5m in 2004 for missing a deadline on its third NHS contract, to deliver an NHS broadband infrastructure under the N3. Granger said that BT had "a very shaky start” to the contract and is "behind the original contracted schedule.”

"Their project management wasn’t good enough,” he said in the interview. "The people they had on the job weren’t good enough, and they still have some distance to go there.”

"They have a major software drop in December that had better not be late because I need it. This is a critical time for them.” BT said the company is on schedule and will deliver the software on time, the fifth installation of six due in 2005. BT met the previous four deadlines this year.

Granger said he’s had to be "far tougher” on the NHS contractors than in previous jobs.