One in two GPs have signalled their intention not to upload patients’ clinical details to the NHS Care Records Service (NCRS) without explicit patient consent, in direct opposition to Department of Health (DH) policy.
The position being adopted by doctors in primary care, is revealed in a survey of 1026 doctors’ views about the National Programme for IT (NPfIT) carried out this month and commissioned by EHI Primary Care. The survey is the latest of seven polls on the subject conducted by the healthcare online research organisation Medix and also found doctors are increasingly critical of the cost of NPfIT and how it is being implemented.
The extent of doctors concerns about confidentiality are highlighted by the survey results with 51% of GPs, and 47% of non-GPs, saying they will not or are unlikely to upload a patient’s clinical details to the NCRS without specific consent, just months ahead of DH plans to begin uploading patients’ details as part of a pilot for the Summary Care Record.
Almost four out of five GPs (79%) also think the NCRS will lessen patient record confidentiality.
Dr Andrew Sanderson, a GP in Spennymoor, County Durham, took part in the survey and argues that the NCRS should be based on an opt-in explicit consent model rather than the implied consent model currently being proposed by the DH. GP organisations including the British Medical Association and the Royal College of General Practitioners also back an opt-in model.
Dr Sanderson told EHI Primary Care: “Patients give information to doctors for a specific purpose and when that information becomes more widely available the patient is not in control of where that information goes.”
Dr Sanderson said he would be recommending to his partners that a code is put on all patients’ records in the practice indicating that they have refused consent to participate in the NCRS and that the practice then widely advertise the NCRS so that patients can opt in if they wish to do so.
He added: “Proper informed consent is not just saying that if you let us upload your information then you’ll get better treatment if you happen to fall ill while you are on holiday in Torquay.”
Overall support for NPfIT appears to be continuing to fall with only 35% of GPs now rating it an important priority for the NHS compared to 67% four years ago. In the longer term just under one in five GPs (19%) believe NPfIT is likely to lead to a significant improvement in patient care with 39% expecting a slight improvement and 21% believing it will make no difference.
London GP Dr Fiona Underhill is among those who are critical of progress to date. She commented: “Experience so far shows this is an expensive disaster, doesn’t work, and is time-consuming and frustrating for doctors and patients.”
Another GP, Dr Andrew Rigby, said he was a keen and committed supporter of IT but feared the NHS could end up saddled with “a huge behemoth” which was not fit for purpose for delivering clinical care.
He added: “The establishment of a huge central database was too ambitious – we should have started with smaller locally managed systems built to common standards with common protocols for communication. That way we would have been able to engage clinicians fully in the choice of system and design for the environment in which they have to function.”
On a slightly more positive note the survey shows support for Choose and Book is growing, up from 17% at the beginning of this year to 26% today. Four out of five GPs now have experience of Choose and Book and about half of those now say they use it for more than 40% of referrals. However, of those using it regularly, more than 90% say that it increases the time in dealing with a referral and more than 70% think it either make no difference to or is detrimental to patient outcomes.
One GP commented: “Choose and Book is a colossal waste of resources which pleases politicians but makes no difference to the vast majority of patients.”
The survey also appears to show continuing concerns among GPs about consultation over the programme with 92% of GPs rating personal consultation important but only 5% saying that they have had adequate consultation, only slightly up on the 2% of doctors who felt they had been adequately consulted in 2002.
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