BMA working party on NHS IT - Spring newsletter


April 2007 Introduction
This is the third Newsletter giving an update of the work and discussions of the BMA Working Party on NHS IT. You can see the first newsletter here and the second newsletter here.

Local feedback from doctors is welcomed to inform our policy. Please email the Working Party on info.nhs-it@bma.org.uk if you have any views or comments on any of the issues raised in this, or earlier newsletters.

If you would like to join our mailing list and be kept up to date with IT issues, as well as having the opportunity to comment and add your input to BMA policy please email us at the above address with details of your name, grade and place of work.

The NHS Care Record
Ministerial Taskforce on the Summary Care Record
In December 2006, the Ministerial Taskforce on the Summary Care Record published its formal report to Lord Warner. The report is available here. Both Mr James Johnson (Chairman of Council and Chairman of the BMA Working Party on NHS IT) and Dr Hamish Meldrum (Chairman, GPC) were members of the Taskforce.

Main recommendations were:
  • An immediate start of the public information campaign
  • Patients to be able to check their records on Healthspace or via a printed or on screen version at their GP practice
  • Opportunity for patients to give explicit consent within a specified time (not defined by the taskforce), then deemed to have given implied consent for sharing
  • Only drugs and allergies to be uploaded in the initial upload
  • BMA to work with RCGP to produce standards for good electronic patient summaries
  • Recommendations to be carried forward by a new group chaired by the Deputy Chief Medical Officer (DCMO) Professor Martin Marshall.
The BMA welcomed the report as a 'good first step'. Guidance has been written for members on the report and is available on the BMA Website here.

At the time of the report, the Department of Health stated that patients could not prevent their healthcare data being uploaded unless they could demonstrate that it would cause substantial unwarranted distress. Since then in December 2006, Lord Warner stated that patients will have the right to say whether or not their data is uploaded and there will be no question of the data being uploaded and simply invisible if the patient doesn’t want a summary record. A letter has been sent to the Department of Health from the BMA Working Party to seek written confirmation and a formal response is awaited. However, a letter has been distributed by the NHS Connecting for Health (CfH) Clinical Leads which confirms this arrangement.

Following the taskforce report the Joint GP IT Committee will work with the RCGP on producing standards for good electronic patient summaries as recommended by the report. Dr Richard Vautrey (GPC Negotiator and BMA Working Party member) is representing the BMA on the new Summary Care Record Advisory Group, chaired by Professor Martin Marshall, the Deputy CMO. The BMA will now monitor the early adopter phase (see below) and ensure that it receives regular updates from NHS CfH on progress.

Summary Record early adopter phase
The first two PCTs to trial the Summary Care Record have been selected and some of their practices have begun uploading data. We expect an incremental upload which will slowly include more practices in the selected areas. There are potentially 4 other PCT areas where practices will become early adopters later this year. Until next year, the Summary Record will only comprise of data from GP practices. Once a practice has agreed to commence upload staff are given training and their patients will subsequently receive the public information campaign material. Healthspace is expected to go live in May 2007. The BMA Working Party have emphasised the need for the National Care Record Service to be properly piloted and will be carefully watching progress. The pilots will be evaluated by an independent evaluation team commissioned by Birmingham University.

Consent
For the purposes of the Early Adopters, patients will have 8 weeks from receiving a copy of the information leaflet to indicate whether they want a Summary Care Record or not. If the patient says nothing a Summary Care Record will be created but not shared. Patients then have a further 8 weeks to say whether the Summary Care Record can be shared or not. After this 16 week period, if patients have said nothing the consent model changes and practices will work on implied consent and the Summary Care Record will be shared.

Public information campaign
In January the BMA Working Party met with the CfH Group Director of Communications and Stakeholder Engagement to discuss the public information campaign. We believe that the success of the planned information campaign is vital if patients are to be properly informed of the changes so that they are equipped to make decisions about how their records are shared. The public information campaign has changed direction from a nationwide media campaign to a local-led information push. This strategy will be first tested at the early adopter sites so that the effectiveness of the campaign can be assessed. Public tracking research will be used to test patients’ understanding and awareness. The campaign will be nationally developed but tailored at a local level. Every adult will receive a locally tailored leaflet accompanied by a letter from their GP practice. There will also be some local media coverage (as appropriate) and a nationally operated telephone service line. It is likely that this will be reported in National Media too. Before the campaign starts, clinicians and staff in the local area will be trained and prepared with core scripts, Q&As and a communications toolkit.

Care Records development board
A children’s version of the Care Record Guarantee (which sets out the rules that will govern information held in the NHS Care Records Service) is currently being developed. Members of the BMA Working Party commented on a draft version at their January meeting. A cartoon version is also being drawn for young children but the Working Party has not yet seen this. An additional appendix to the adult’s Care Records Guarantee, directed at parents, has also been drafted and the BMA hopes to see a draft shortly for comment.

Health Select Committee Inquiry
The House of Commons Health Select Committee is to undertake an inquiry into the electronic patient record. The inquiry will focus particularly on the following areas:
  • What patient information will be held on the new local and national electronic record systems, including whether patients may prevent their personal data being placed on systems;
  • Who will have access to locally and nationally held information and under what circumstances;
  • Whether patient confidentiality can be adequately protected;
  • How data held on the new systems can and should be used for purposes other than the delivery of care e.g. clinical research; and
  • Current progress on the development of the NHS Care Records Service and the National Data Spine and why delivery of the new systems is up to 2 years behind schedule.
The BMA has drafted evidence which has been submitted to the inquiry and is now available on the BMA website here.

Information governance
Lord Hunt has confirmed arrangements for the National Governance Board on which the BMA will be represented. It is hoped that the terms of reference and proposed membership will be confirmed by the end of March in order to begin recruitment in April. It is expected to meet in the autumn.

Role Based Access controls (RBAC) will determine who has access to what parts of the record dependent on role. The BMA has supported Role Based Access and a move towards a less complex approach so that the system does not become overly bureaucratic as this might prevent or deter clinicians from accessing systems to provide care. The BMA is currently drafting a response to a consultation on RBAC from the DH/NHS CfH national Access Control (Registration) team.

Alerts will be an important confidentiality control providing some reassurance to patients that inappropriate access to summary and detailed records will be identified and addressed. They will also provide an important deterrence to staff from accessing confidential information where the circumstances do not justify it. However, alerts will only be effective if action is taken when appropriate. We note that a commitment that all alerts are reviewed is included in the Care Record Guarantee (Commitments 11 & 12). The BMA consider that this review process will be very important to protect confidentiality and promote public confidence in the NHS CRS. The BMA has already raised concerns with NHS Connecting for Health over the funding and resourcing of Caldicott Guardians and privacy officers. The BMA welcomes the establishment of the Caldicott Guardian Council, and the recent publication The Caldicott Guardian Manual 2006. However, we have not yet seen any plans put in place to make any realistic estimates of the numbers involved, consider the resources that will be necessary to service them, and budget for additional resources if necessary. Without such an exercise the BMA are concerned that local NHS organisations, and in particular their Caldicott Guardian functions, will be inundated and forced to ignore many alerts and therefore undermine a key confidentiality control. Mr James Johnson wrote to the NHS CfH Chief Clinical Officer to seek clarity on the issue. It is reported that NHS CfH are currently undertaking a review of how the Caldicott Guardian roles will operate in consultation with Trust’s and PCT’s. We have asked to be kept informed when they have more information.

NPfIT Local Ownership Programme (NLOP)
The DH announced in November that Connecting for Health was preparing for executive agency status. Its management was undertaking a review to ensure that it is correctly structured and staffed to deliver the projected programme to schedule. In effect, this is a move from central management to local Trust.

Subsequently, the National Programme for Information Technology Local Ownership Programme (NLOP) was formally announced. In a letter from Professor Michael Thick (NHS CfH Chief Clinical Officer) to the BMA Chairman to inform us of the changes, he explains that the programme was initiated ‘to reposition and embed accountabilities and responsibilities for delivering NPfIT with the NHS’ and ‘to further strengthen capacity and capability’ by shifting ownership to the local NHS. The programme will be overseen by Gordon Hextall (NHS CfH Chief Operating Officer).

An interactive workshop on NPfIT, entitled ‘Facing the issues, making progress’ was held in January to discuss some of the key issues raised in recent months, to learn more about plans, their implications for the NHS and the possible outcomes. Discussions focused on NLOP and Dr Richard Vautrey (GPC Negotiator and BMA Working Party member) attended this event, representing the BMA.

The final report is due to go to the Management Board in March and accountability should formally transfer to SHAs in April.

BMA/NHS CfH Conference
The joint BMA/ CFH Conference ‘What's in I.T. for me?’ was held on 1st February 2007 at the Birmingham NEC. The conference considered an overview of technological developments in the NHS and how it will affect doctors. It included demonstrations, debate and explanations of how to get involved and how IT can benefit patients and clinicians. Speakers included:
  • Professor Martin Marshall, Deputy Chief Medical Officer, DH
  • Mr James Johnson, Chairman BMA Council
  • Dr Richard Vautrey, GPC Negotiator and BMA Working Party on NHS IT Member
  • Mr Ian Hayes, Patients Representative
  • NHS CFH National Clinical Leads for Hospital Doctors and GPs
  • Dr Mark Davies, Primary Care Medical Director for Choose and Book
The event was fully booked and some 400 delegates attended. Feedback from the day was overwhelmingly positive (of the delegates that returned feedback forms some 93% reported the event as excellent or good overall) and it appeared as though the aim of attracting those new to IT had been accomplished. You can see more about the Conference (including presentations and press) on the website.

Choice of systems
The GP Systems of Choice (GPSoC) procurement process has begun. GPSoC will ensure GPs will have a choice of systems. Richard Granger has also announced that a catalogue of suppliers will be created to provide extra capacity. The BMA welcomes this move and supports freedom of choice of accredited suppliers.

Patient safety
The DH has published new guidance, ‘Coding for Success: Simple technology for safer patient care’ to promote and support use of auto identification (barcoding and similar technologies) to increase patient safety and improve efficiency. This document was drafted in partnership with NPSA, MHRA, CfH and PASA. It recommends both industry and NHS adopt the GS1 system of coding standards and sets out an action plan that supports both NHS and industry.

The NPSA is also shortly expected to publish a Safer Practice Notice on use of the NHS Number. The BMA fed their views into a consultation on this in December. The BMA would support use of the NHS number, whenever possible, as widely as possible throughout the NHS as a unique patient identifier but have raised a number of specific concerns about the draft Safer Practice Notice (SPN) which we hope will be addressed in the final version.

Choose and Book
Choose and Book has been continuously growing in usage and figures provided by NHS CfH from March show that there have already been nearly 3 million total bookings through Choose and Book with 85% of GP Practices using Choose and Book in January. However, by February only 36% of referrals were made through Choose and Book and it is still extremely unlikely that the Department of Health will be able to hit its 90% target for referrals made through Choose and Book by the end of March. The future of the Choose and Book Directed Enhanced Service (DES) remains unclear for GPs.

In light of the DDRB’s recommendation that GPs should receive no increase in pay, the BMAs General Practitioners Committee (GPC) is preparing guidance suggesting ways to practise cost-effectively, thereby helping GPs to maximise efficiency and help maintain practice profits in 07/08. The emphasis of this guidance will be on encouraging practices to refuse new, under-funded work and to reconsider involvement in ‘any work which is government-driven, inefficient and of no real benefit to patients’. A letter from the GPC Chairman was circulated recently to all GPs in which Choose and Book is specifically mentioned as an example from the portfolio for England as one of the suggested policies with which GPs could cease to cooperate although GPC voted against a national boycott.

Choose and Book Release 3.4 was released on 25 February. Its main functionality improvements were in the patient printouts, changes to support 2 Week Wait (2WW) referrals, returning services now grouped by organisation and referrer details now available on appointment search screens. If you have any comments on this latest release we would be very interested to hear them (by emailing the Working Party). The next release (R3.5) is due in May and is being hailed as the largest ever “minor” release. The BMA are pleased to see improvements in each release and have been working with Choose and Book in suggesting improvements and priorities for future releases.

The BMA’s biggest concern over Choose and Book has been over reports that both primary care and hospital trusts are manipulating the Choose and Book system by not allowing patients to be referred to particular clinics so that they can meet waiting list targets. For Choose and Book to work as intended it is important that primary care trusts and hospitals work with it rather than blocking its proper use. These are challenges that NHS Connecting for Health and the Department of Health must overcome if Choose and Book is to be successful.

Another issue that has been highlighted in recent feedback is that some hospital trusts are making it impossible to refer to named consultants. This is of great concern to doctors and is destroying the relationship between GPs and Consultants. The software is in place to allow this and it is only hospital management that is blocking such usage.

Recent reports have also been received of increasing numbers of PCTs obliging GPs to use Choose and Book, the BMA are strongly opposed to this compulsion. Although electronic booking has the potential to be a useful tool for clinicians, Choose and Book is not yet ready to be the sole referral method. Not all practices can yet use it even if they want to, and most importantly there is a patient safety risk if paper referrals are not dealt with appropriately by the receiving hospital.

These issues have all been raised with the NHS CfH Choose and Book team and we hope to see steps to overcome these difficulties in the near future. The BMA is also working on some guidance for clinicians to sign post you to the wealth of information already available on Choose and Book.

NHS CfH has recently secured funding to support a network of Local Clinical Advocates for Choose and Book. The need is to build a network of 'local' clinical users and the BMA has put forward names from both primary and secondary care, to become members of this. We are pleased to see this step to further involve clinicians in the project.

The BMA has representation from both primary and secondary care on the Choose and Book Design Steering Group and National Clinical Reference Panel and we are happy to receive local feedback from users so that this can be fed into the discussions. Please email us with any concerns or comments that you would like raised with these groups.

NHSmail
NHS mail currently has over 230,000 registered users. The BMA has endorsed NHSmail for the exchange of clinical information between NHSmail users. However, there are still some information governance issues, which need addressing. The BMA is working with NHSmail on producing guidance for clinicians and some changes to the service have been made following suggestions from the Working Party.

Electronic Staff Record (ESR)
The Electronic Staff Record (ESR) has increasing uptake among clinicians. The next wave (wave 7) is due to go live in April. You can see more about the ESR here.

Following a resolution at the Consultants Conference 2006, a Staff charter has been drafted which provides standards which will determine the data security and access rights in relation to the ESR. There are a few unresolved issues, which are being negotiated with the ESR team. We will continue to monitor this area in light of the recommendation in the Regulation of Health Professionals white paper (‘Trust, Assurance and Safety – The Regulation of Health Professionals in the 21st Century’ which is available here), published in February, about using the ESR to store essential regulatory data such as details about registration and qualifications.

Electronic prescribing
The Electronic Prescribing (ePrescribing) programme ran a series of workshops in the summer (2006). The BMA sent several representatives to these and sent a detailed response to the consultation on the ePrescribing Functional Specification. Version 1.0 of the ePrescribing Functional Specification has now been published and CfH will now be discussing the functional specification with Local Service Providers. To see more about the Functional Specification please click here. We continue to monitor the development of ePrescribing solutions.

GP2GP
NHS Connecting for Health has exceeded its target of implementing GP2GP at 500 practices before 31 March 2007. The roll-out is now continuing and it is expected that the number of PCTs and practices involved in the roll-out will increase rapidly. The next release of the GP2GP software, v1.1, will enable transfers between practices using different systems (e.g. EMIS to InPS and vice versa). This interoperable version of GP2GP is in the early stages of being trialled in Croydon. The BMA Working Party are pleased to see such good progress on this project. The number of transfers that has taken place is encouraging and early feedback from practice staff and clinicians in Croydon is that they are delighted with the results.

PACS
Seventy three Picture Archiving and Communications Systems (PACS) are now live across England (21 March 2007). This equates to 55% of the planned deployments. Reports from members on PACS have been overwhelmingly positive.

Record standards
The Royal College of Physicians’ (RCP) Health Informatics Unit (HIU) is developing standards for clinical records that are written and used by physicians in hospital practice. Research evidence demonstrates that structured records improve the outcome of medical care. A comparison of currently used admission clerking forms carried out by the HIU found there was broad similarity of structure and content but diversity in the detail. This work is important as the development of the Electronic Health Record (EHR) risks being technology rather than clinically driven, which may well have adverse consequences for patient care. As a first step therefore the RCP have developed content standards which could be applied to paper records, but are primarily intended to be the basis of the hospital EHR. The goal is a standard approach to the structure of medical records that has an inherent flexibility to accommodate specialty specific content. They are currently consulting with clinicians to define the headings of the acute medical admission clerking record and a questionnaire was devised regarding headings and their definitions. This work will improve patient safety, clinician performance and the quality of data extracted for secondary purposes, which is likely to include revalidation. As the BMA Working Party on NHS IT is supportive of this work and hope to use the data to aid in drafting standards for the summary record the survey was also emailed to BMA members. 3082 replies were received and the HIU are currently analysing both the quantitative and qualitative data before it is shared with us.

Telehealth
The BMA Chairman spoke at an International Conference on Telehealth at the DTI Conference Centre on the 24 January – ‘Building a Global Healthcare Network – London Telehealth Symposium’. You can see more about this, including copies of all the presentations here. In his presentation he highlighted the drivers for change (an ageing population with increasing dependency and increasing numbers of long term conditions) and suggested a need to shift resources into prevention, to transfer care from hospital to home and join up services at a local level whilst also encouraging innovation.

At their meeting the following day, Working Party members considered a presentation on telehealth from Dr Mike Bainbridge, the clinical architect for NHS Connecting for Health. Members heard that:
  • In response to emerging to the demographic challenges, the Government has signalled a shift towards improved preventative care services, particularly for those with long term conditions and the frail elderly.
  • Based on evidence, largely from overseas, telehealth appears to offer a viable option.
  • The Government intends to launch large-scale “whole system demonstration” in June 2007 involving people with complex health and social care needs and a powerful commitment to new, assistive technologies to demonstrate the feasibility of delivering major improvements in care.
  • The prospect of large scale implementation of telehealth services raises a number of challenges for the Medical profession.
It was noted that the NHS had signed up to the Continua Health Alliance and the BMA Working Party agreed that interoperability was key. Working Party members stressed the importance of sifting and managing the data from telecare as it has the potential to swamp the system. It was agreed that the BMA could have an important role in considering the questions which would need to be asked in the evaluation of the pilots. It was agreed that a representative from the BMA should attend a DH/CfH meeting to consider the issue further. NHS CfH is contributing to the debate by exploring how assistive technology might be provided on a bigger scale but in a sustainable way for the longer term.

Devolved nations
The issue of IT links between the home countries is still a concern for the BMA Working Party on NHS IT. The particular issue concerns patients who live close to borders and ensuring that they are not disadvantaged by the non compatibility of IT systems. The Chairman of the BMA NHS IT Working Party wrote to Richard Granger (Director General of IT for the NHS) as well as IT leads in Scotland and Wales to seek clarification on the issue in November but has not yet received a response. Working Party Members continue to raise the issue at several forums.

Progress in Scotland
Only 174 patients have so far (Dec’06) opted out of the Scottish NHS ‘emergency care record’ project. At the Scottish Clinical Information conference in December, Scottish clinicians raised several specific concerns and criticisms, but seemed generally content with the overall direction of travel.

The BMA has seen the GPASS draft report which bears out the concerns that Scotland’s GPs have been expressing about GPASS for a number of years – that it is not fit for purpose and is hindering GPs’ ability to deliver on the new GP contract and consequently on the [Scottish] executive’s Delivering for Health strategy.

The BMA is now keen to work with the Scottish Executive not just to identify appropriate commercial suppliers but also to develop an exit strategy for GPASS that will ensure continued support for those doctors still using the system until such a time when they can transfer to an alternative.

More than 300 GPs in Scotland are to send information about benefits claims electronically as part of a pilot scheme designed to speed up benefit payments and reduce paperwork. A total of 344 GPs from 94 practices in Glasgow, Lanarkshire, Lothian and the Forth Valley will send information electronically on disability living allowance and attendance allowance claimants to benefits staff. The pilot, launched on 15 January, is the first of its kind in the UK and if successful will be extended across Scotland and to other benefits.

Progress in Wales
In recent meetings the IM&T Subcommittee in Wales have continued discussions on border connection issues. There is a Department of Health board overseeing the changes to the NHAIS system and the GPC have a representative on it. The DH will be asked to report on what actions they are taking on this issue. Jim Johnson has written to IT leads from the Department of Health and the Welsh Assembly Government to seek clarification. There have been no official responses as yet.

A number of practices in Wales are already enabling their patients to order repeat prescriptions over the internet. Welsh Assembly Government hopes to be able to roll out the successful sample bar coding pilot to all practices later this year.

Informing Healthcare is working with Gwent Healthcare NHS Trust and Gwent Out-of-Hours Service on a project to develop an Emergency Health Record (EHR). The project allows key patient information from GP practices to be shared with Gwent Out-of-Hours and Emergency Services medical staff after having obtained explicit consent to access the records form the patient over the phone. The Emergency Health Record contains contact details, information about current medication and allergies as well as any current problems or diagnosis. The project was introduced in November after a period of planning and procurement. BMA Wales have been involved in the setting up and support of this project. Eighty practices are now joined to the Gwent Trust Out-of-Hours Service, making over 400,000 records available. There are reportedly very few glitches and the service has been generally well received. There is also connection by practices to the Gwent Trust internal computer system so that primary care can track the progress of a patient through the hospital part of the incremental rollout system in Wales. It is hoped that access to the EHR will be extended, subject to evaluation, to the rest of Wales. Informing Healthcare aims to build on the success of the electronic EHR in other unscheduled care settings and will use the experience to inform the development of an Individual Health Record, which will allow health information to be shared and viewed by clinical staff providing care as well as by the patient.

Progress in Northern Ireland
There are a number of topics on the NI IT agenda which are progressing.

At their recent meeting on 7 February, the BMA Northern Ireland Council had a discussion about making a medical summary available more widely to out-of hours providers and A/E units. This has been taken up by the Programme Board and there is now some discussion as to how this can best be achieved. The Board is mindful of the difficulties that NHS Connecting for Health have experienced and the proposals are that an initial upload would contain a modest amount of information with this being built on as the problems are met and solved.

The NI GP IT Committee met on 31 January and noted the progress in the various projects that are ongoing in particular the Electronic Prescribing Eligibility System (EPES) which is still in its initial start-up phase. Design, testing and piloting should be completed within a year, with full roll-out to all Community Pharmacists achieved a year later. A NI ICT Strategy Board was set up by the Department of Health and is in place to oversee development of various ICT projects. A number of workshops have been held with stakeholders to develop this strategy with an initial emphasis on GMS and a draft should be available shortly.

The NI GP Committee also met with representatives from the DHSSPS to discuss proposals to run a data extraction project which would allow anonymised information to be extracted from GP systems on a voluntary basis. This would then be analysed for public health purposes and fed back to practices to improve data recording and allow practice to compare their recording with other anonymised practices.

The GP ICT Modernisation Project has now completed its remit and has involved connecting all GP surgeries to the HPSS network and making available secure internet access and secure email on the HPSS system. An end-project questionnaire is being developed to examine the use of these services.

The Health and Care Number Project has been undertaken together with its sister project above. This is replacing the old Chi number and numerous hospital numbers with a new unique patient identifier to be used across the HPSS. All GP systems have now been populated with the new numbers and rollout to the various Trust PAS systems should be completed by April 2007. The rollout of electronic Registration Links is ahead of target, having passed the halfway mark with more than 190 of the 363 GP Practices completed. In parallel with this the introduction of electronic patient registration at GP surgeries has been undertaken and this is also moving ahead according to plan on a rolling basis.

The Person Centred Community Information System (PCIS) Project aims to establish a single integrated community health and social care record for all patients and clients in respect of community based services. Fujitsu Services Limited has been appointed the PCIS Preferred Bidder, with the expectation that a contract will be agreed by the end of the financial year. With the co-operation of all stakeholders, early preparation will mean that all Trusts could commence implementation during 2007 – an important target as PCIS will be a key enabler of improved performance management of community based services.

An Electronic Referral Management System (ERMS) is being developed to support the ICATS project announced in January 2006 by the Minister for Health as part of a reform of outpatient services and designed to reduce waiting times for treatment. The Minimum Data Set for referrals has been agreed and the GP system providers have completed the necessary changes. The system-generated referral template has been rolled out to practices. Renovations for the new centre are underway and recruitment for service and centre staff has begun.

Northern Ireland health minister, Paul Goggins, recently announced a £1m investment in telehealth and telemedicine initiatives across the country. Telehealth is now expected to feature in the Department of Health, Social Services and Public Safety’s programme of reform.

Membership of the BMA Working Party on NHS IT 2006/07
Chair:
Mr James Johnson - BMA Chairman of Council

Members:
Dr Paul Miller - Central Consultants and Specialist Committee
Dr John Powell - BMA Health and Information Management Committee, former Chair
Dr Peter Tiplady - Committee for Public Health Medicine and Community Health
Dr Richard Vautrey - General Practitioners Committee, Negotiator
Dr Paul Cundy - Joint GP IT Committee, Chair
Dr Jo Hilborne - Junior Doctors Committee, Chair
Prof. Michael Rees - Medical Academic Staff Committee, Chair
Mr Michael Livingston - Medical Students Committee
Dr Michael Wilks - Ex-Chair Medical Ethics Committee and CRDB member
Dr John May - Patient Liaison Group
Mr Derek Machin - Private Practice Committee, Chair
Dr Greg Dilliway - Staff and Associate Specialists Committee
Dr Tony Calland - Medical Ethics Committee, Chair and Representative from Wales
Dr Stuart Scott - Representative from Scotland
Dr Jimmy Courtney - Representative from Northern Ireland
Dr Gillian Braunold - Connecting for Health National Clinical Lead – GP
Mr Simon Eccles - Connecting for Health National Clinical Lead – Hospital Doctor
Prof. Vivienne Nathanson - Director of Professional Activities
Mr Tony Bourne -BMA Secretary and Chief Executive

© British Medical Association 2008

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