NHS - National Programme for IT (NPfIT)
(This briefing applies to England only)
August 2006
Overview
Connecting for Health will deliver the National Programme for IT, a multi billion pound programme which will provide new integrated systems and services across the NHS in England. The main deliverables of the programme are:
- The NHS Care Records Service (NHS CRS) – delivering an individual electronic record for each NHS patient
- Choose and Book – an electronic system for booking hospital appointments, which allows patients to choose the time and place of their appointment
- Electronic Prescription Service (EPS) – to enable the transferral of electronic prescriptions from the GP practice directly to the pharmacy
- Picture Archiving and Communications Systems (PACs) – which will enable digital images, like scans and x-rays, to be captured, distributed, stored and displayed electronically
- Contact – The NHS email and directory service
- N3 – the broadband network infrastructure to support the programme
Summary of the BMA’s position
The BMA welcomes additional investment in information technology in the NHS. The BMA agrees that greater sharing of healthcare information has the potential to improve patient care. The challenge is in achieving a balance between greater sharing and ensuring the security and confidentiality of the data. The BMA’s policy is that explicit consent should be obtained before any healthcare information is uploaded onto the system.
Doctors have a duty to maintain the confidentiality of patient information and therefore their trust in the programme is vital. Many doctors are sceptical and this is exacerbated by delays in the delivery of systems and problems with the Choose and Book system, which have been highlighted in the media.
Engagement with stakeholders remains an issue and for some areas of the programme there is still a sense of information being shared once decisions have been made rather than consulted on. With such a significant amount of investment at stake, it is essential that stakeholders, doctors and patients are consulted and on board.
Further information
The BMA supports any IT investment and development which helps to improve patient care. Such a programme could revolutionise patient care and fundamentally alter doctors' working practices and the doctor-patient relationship.
The BMA is keen to engage with Connecting for Health to ensure that the programme meets the needs of both doctors and patients. Although engagement with stakeholders has improved, it remains an issue. For a £30 billion programme there should be frequent consultations and meetings with stakeholders but this has not been the case in every area. There is still a sense, in some areas of the programme, that the process of engagement with stakeholders is one of sharing rather than consulting. This was one of the key findings of the National Audit Office Report, published in June 2006. We hope that there will increasingly be opportunities to shape the work of the programme so that it delivers what the medical profession and patients need.
The BMA has met with senior Connecting for Health figures and has been working hard to establish dialogue. The BMA is committed to continue its work and hopes for further dialogue with Connecting for Health.
Given a backdrop of high-profile failures of Government IT programmes, and the poor history of IT initiatives in the NHS, doctors have been understandably sceptical about embracing the proposed changes without appropriate consultation. Delays in system delivery and problems with the Choose and Book system, as highlighted in the media, have increased this concern. Connecting for Health representatives are always keen to emphasise that their programme is about patient care, but they must recognise that it is also about changing the working practices of those who work at the frontline of the NHS, delivering patient care.
As the June 2006 NAO report highlighted, only through the involvement of doctors will it be possible to develop, implement and use systems that can deliver the benefits expected from the massive investment through the programme.
Centralised health record system
The NHS Care Records Service will deliver a single record for each NHS patient. The system is designed to link every GP surgery and hospital in England and provide online records for up to 50 million patients. The Government hopes that every patient will have their own online record by 2010. The BMA supports in principle the concept of an integrated centralised health record system.
Greater sharing of health information between healthcare professionals has the potential to improve significantly the care provided to patients. Increased sharing of healthcare information could have implications for patient confidentiality and the challenge is in achieving a balance between greater sharing and ensuring the security and confidentiality of the data.
From a doctor’s perspective, maintaining the trust and confidence of patients is absolutely necessary for the successful implementation of any new technology. Secure systems are required to ensure that only authorised staff can change the content of records by adding or deleting information. Such amendments can have serious impact on the welfare of patients and systems need to guarantee that access is authorised and appropriately recorded (in an audit trail). These seemingly technical issues have real consequences for doctors’ actions, reputations and relationships with patients. They have also real consequences for patients with respect to their safety, treatment outcomes and trust in the medical profession.
Patients’ consent
The BMA has also debated the consent model of sharing healthcare information. The CRDB (Care Records Development Board) position is that implied consent is appropriate for sharing summary healthcare information. Confidential patient healthcare information will therefore be shared on a central system unless a patient informs a healthcare professional that they do not wish this to happen.
The BMA’s policy is that explicit consent should be obtained before any healthcare information is uploaded onto the system. Doctors feel that some patients may be unhappy about having their sensitive personal data uploaded onto a central system and a more gradual approach will allow patients to fully consider what information is contained in their records and whether they wish this information to be shared. Confidentiality is central to trust between doctors and patients. The BMA is seeking clarification from the General Medical Council and the medical defence organisations on how exactly this would affect doctors.
Implementing the system
The BMA is in agreement that patients do need to be adequately informed before any information is uploaded on to the system and therefore the success of the planned information campaign is vital. The BMA has requested to see draft material. The BMA has also insisted that the NHS Care Records Service is properly piloted with the views of patients being sought during the pilot phase. Connecting for Health has been asked for a commitment that changes will be made if concerns are expressed by patients during this pilot phase.
The BMA has also highlighted other issues including the need to ensure the accuracy and quality of a shared record and the importance of UK interoperability as well as the choice for patients being a true choice.
The integration of new systems into working practices offers an opportunity for a process of improvement that could be missed if these systems are imposed without consultation. The technology must fit seamlessly and unobtrusively into patient-doctor encounters, and both sides must be convinced that the benefits outweigh the effort involved in adapting to change.
The BMA aims to influence this process of change in the most constructive way to ensure that the interests of doctors and patients are not submerged by an agenda of early delivery for the sake of political expediency.
For further information, please contact the Parliamentary Unit:
Email: parliamentaryunit@bma.org.uk