A picture of declining support among doctors for the National Programme for IT emerges from the latest Medix survey of medical opinion on IT modernisation, sponsored by E-Health Insider.
One of the key findings of the survey is that half of all GPs surveyed said they do not plan to upload patient details onto the spine unless individual patients give their explicit consent (see EHI Primary Care for full story: GPs threaten to block national patient database)
Confidentiality again emerged as a key concern of the survey, with four out of five doctors saying they thought the confidentiality of their patients’ records would be at risk.
More than 60% said they feared the system would be vulnerable to hackers and unauthorised access by public officials from outside the NHS and social care.
While 58% of GPs and 69% of non-GPs from the survey’s 1026 sample felt there were long term benefits to be gained from the National Programme for IT (NPfIT), overall support for the programme showed a pattern of continuing decline on previous Medix surveys.
Asked to rate how successful the programme has been to date, just 1% of hospital doctors and GPs said good or excellent, while 76% said poor or unacceptable.
Four years ago 67% of GPs said the programme was an important priority, now just 35% do so. For non-GPs, the same figure fell from 80% to 51%. While 56% of GPs and 75% of non-GPs said they were enthusiastic about the programme nearly three years ago, the respective figures stand at 25% and 41% now.
There also appears to be growing unease about the funding for the programme: in the first survey in February 2003, 47% of all respondents felt it was a good use of NHS resources and 27% said it wasn’t. The latest survey reflects a reversal of that view and a polarisation of opinion with only 11% now saying the programme is a good use of resources and 68% saying it is not.
Comments submitted by respondents to the survey reflect the quantitative findings. Many complain about wasted money and lack of consultation. Others support the ideas behind NPfIT but express concern about progress. Many doctors feel politics are to blame.
“An almost complete waste of time and money by a government who [sic] does not consult the doctors enough…”
“Appears to be driven by political requirements rather than health requirements.”
“In theory a good idea but in reality a disaster…”
“The aim is laudable, but I have never been consulted about what would save me time.”
“Tremendous waste of money in a programme that is excellent in concept but very ill conceived with totally unrealistic and unattainable timescales…”
“Get on with it.”
Choose and Book continues to provide wildly contrasting views from the medical community with some GPs commenting that they use the system for most referrals and others saying it has wasted their time and been abandoned. But there was some encouragement for Choose and Book champions as overall GP support for the system rose from 17% in February this year to 26% in the latest survey.
Eighty per cent of GPs say they have used Choose and Book and half report using it for more than 40% of referrals. However, 90% say it takes up more time than the old system and over 70% feel it either makes no difference to or is detrimental to patient outcomes.
One GP wrote: “I enthusiastically embraced the idea of starting with Choose and Book. We were one of the pilot practices on the Isle of Wight. Two years down the line it does not appear to have delivered its promise…”
Questions about the confidentiality of information stored in the forthcoming Care Records Service produced strong opinions with 79% of GPs and 55% of non-GPs feeling that the new system would lessen patient confidentiality – though some felt the benefits made this acceptable.
Respondents felt likely sources of breaches of confidentiality were: access by public officials outside health or social care (62%), outside hackers (62%) and inadequate access controls (48%).
A small majority of GPs (51%) and 47% of non-GPs said they would not or were unlikely to load up patients’ clinical details without specific content.
One GP commented: “I am extremely concerned that the public is unaware that their personal medical records may be uploaded to the national spine without any real safeguard about who can access them. I believe such a move will destroy the concept of medical confidentiality and that patients will be unwilling to confide in their doctors and doctors may well be unwilling to record information given in confidence.”
Another wrote: “I feel we are being pressured into disclosures that would have been actionable by the GMC a few years ago.”
Some non-GPs, mostly hospital doctors, expressed concerns. “In principle a good idea, but I have reservations regarding confidentiality,” a Cheltenham doctor wrote. “Could be potentially labour saving and improve clinical care, but it is fraught with dangers, particularly in regard to confidentiality,” commented a child and adolescent psychiatrist.
PACS was more popular with the hospital doctors whose comments included: “Our PACS service is excellent and has palpably improved patient care.” “Local implementation of PACS has worked well and brought benefits.”
One respondent said, however: “We had PACS before NPfIT and it is superb and would have happened anyway.”
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EHI Primary Care: GPs threaten to block national patient database