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BMA working party on NHS IT - Summer newsletter

June 2007

• Introduction
• The NHS Care Record
• NPfIT Local Ownership Programme
• Choose and Book
• Electronic staff record
• Electronic Prescription Service
• GP2GP
• Records standards
• Parliamentary Work
• Progress in Scotland
• Progress in Wales
• Progress in Northern Ireland

Introduction
This is the fourth Newsletter giving an update of the work and discussions of the BMA Working Party on NHS IT. You can see the other newsletters on the IT pages of the BMA website.

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
Summary Record Early Adopters
The first practices in Bolton began their information campaign on the NHS Care Record Service (CRS) as part of the Early Adopters Programme on 15 March 2007. Until 2008 when the option of sealed envelopes will be available, patients have a choice of three options of how their information should be stored and shared. Once informed, they can decide whether or not to have a summary care record and, if they decide to have one, whether or not it is shared. They can change their mind at any stage and their decision can only be overridden by statute, court order or in the public interest. (An NHS CfH stand with demonstrator will be available for those members attending the BMA Annual Representative Meeting to answer any queries). By July, eight weeks after the end of the consultation phase, Bolton's out-of-hours provider and A&E department should be able to view the summary record. More than 20 GP practices from Bury Primary Care Trust (PCT) have become the second early adopter site.

BMA staff have visited a first wave Early Adopter practice to discuss the affect of the pilot on clinicians and patients. NHS Connecting for Health (NHS CfH) seem to be taking a slow implementation approach and experimenting with any issues that arise. In the first wave practices it was informally reported that to date there has been a low opt out and few patients requesting further discussion. We await more detailed analysis.

University College London (UCL) has been awarded the contract to undertake the independent evaluation of the Early Adopters. An External Advisory Group, with lay chair, will be set up by the independent evaluation team and will provide the main vehicle of governance for the project. The Advisory Group will have academic, clinical and patient representation. A representative from the BMA has been invited onto the Advisory Group. The final report is due to be published in May 2008 but interim reports are expected.

Further information on the Early Adopters evaluation is available on the NHS Connecting for Health website.

HealthSpace
Since its launch in December 2003, Healthspace has developed and now integrates with other major NHS internet services, such as acting as a gateway to booking appointments online with Choose and Book. Healthspace is due to be available for patients in the Early Adopter Sites to check their Summary Record in July. This will mean that even those patients that have dissented from sharing will be able to view their Summary Care Record online. A complex registration process, including completing a standard application form and a personal meeting with a ‘Registration Agent’ may deter patients from checking their Summary Care Records. This registration process will be tested in the Early Adopter Phase and can be amended if necessary. Patients will be able to save information such as their preferred language or any transport requirements etc to allow clinicians to be more responsive to patient’s individual needs. This basic Healthspace access will not require the complex registration process.

You can see more about Healthspace’s functionality for the Early Adopters on the NHS Connecting for Health website.

BMA Policy supports the development of HealthSpace as a tool for patients to monitor their records and stay informed about their health. There are, however, a number of issues relating to Healthspace for example, ensuring that Healthspace is secure without making the process to register too cumbersome. There are also issues around children’s records and managing the changeover from parents to children having control of their Healthspace. These issues are currently under discussion.

Caldicott Guardians
The BMA Working Party on NHS IT has raised the issue of funding and resourcing for Caldicott Guardians and privacy officers on several occasions. 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 are concerned that there have been no realistic estimates of the numbers involved, necessary additional resources, and budget. Without such an exercise the BMA is 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. It is reported that NHS CfH is 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 more information is available. Most recently the BMA wrote to Martin Marshall, Chair of the Summary Care Record Advisory Group to highlight the concerns. His response made clear that this was still under discussion but also suggested that the UK Council of Caldicott Guardians may be making a national recommendation in the near future.

NPfIT Local Ownership Programme (NLOP)
The National Local Ownership Programme will provide a new governance structure for NHS CfH. Responsibility for meeting key local and national objectives for the National Programme for IT (NPfIT) will devolve to more than 150 senior responsible owners (SRO) at local and regional health service sites. Accountability was intended to transfer to three groups of SHAs; South, London and the North, Midlands and East (NME), in April with the transition completed by July but there have been delays in some areas. It is unclear how much freedom local senior responsible owners will have to operate, and whether they would be held responsible for any failure of the NPfIT. NHS CfH will continue to be responsible for NPfIT commercial strategy, contract negotiations, specialist technical functions and overall finance.

Choose and Book
Choose and Book has had a mixed picture of success. Some areas have found it helpful but there have also been many problems. The Directed Enhanced Service (DES) in place to pay GPs for using Choose and Book was stopped for two months and its future seemed doubtful but it was announced in mid-May that it would be rolled over for the 2007/08 year. Figures provided by NHS CfH from May show that since it started there have been over 3.7 million total bookings through Choose and Book and at present around 39% of referrals are made via Choose and Book. Pulse Magazine has recently announced a campaign calling for an end to Choose and Book. However, in a recent meeting with the Choose and Book Clinical Lead and the National Implementation Director it was made clear that the Choose and Book Team is planning to continue roll out and they hope to have every service bookable by 2008 as well as 90% takeup.

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 the BMA Working Party on NHS IT with any concerns or comments that you would like raised with these groups.

Electronic Staff Record (ESR)
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. You can see more about the ESR here. The Working Party has been in discussion with the ESR team with regard to the Charter but has failed to reach agreement on two remaining issues: (i) the audit trail and (ii) disciplining staff in the event of unauthorised access. The BMA is seeking the support of the other Unions via the Social Partnership Forum. We have also written to Clare Chapman, Director General Workforce at the DH to express our concerns.

Electronic Prescription Service
Progress with the Electronic Prescription Service (EPS) has been steady and there are now over 4500 users registered as pharmacists and over 50% of GP practices have installed the software. There have been over 23 million prescription messages transmitted using EPS. The Chancellor and Prime Minister in waiting, Gordon Brown has given the project his backing and called for more electronic prescriptions to be issued in the NHS. An invitation has been issued to PCTs to become an initial implementer site for EPS Release 2.

GP2GP
The popular GP2GP system which enables the transfer of records between practices continues to rollout with 650 practices now enabled to use GP2GP record transfer between practices using the same clinical system. The challenge is to make transfers between different clinical systems, which is being piloted by INPS and EMIS.

Record standards
The BMA has been working with the RCP Health Informatics Unit to support the development of standards for clinical records. The Unit has been asked by NHS CfH to broaden the standards to all specialties. This started with an extensive consultation period on draft headings of the acute medical admission clerking record and is now being followed with a similar project to develop handover and discharge summary headings. The BMA will have input to this consultation which will be eventually signed of by the Academy of Medical Royal Colleges (AOMRC). As the NHS Care record Service grows the use of consistent standards will become more pertinent. We hope that members will feed their input into the development of these standards.

Parliamentary Work
The Public Accounts Committee (PAC) report into NPfIT was published in mid-April. (The full report is available here). The report came to mixed conclusions but the press tended to focus on the lack of progress on implementing electronic patient records. Improved communication with clinicians was identified as a priority area, with the report being blunt about the current position. The report also called for an urgent independent review but concluded that, despite problems encountered so far, if successfully delivered, the programme still offered huge benefits in the long term.

The Health Select Committee Inquiry in an electronic patient record and its uses closed to submissions in March. The BMA submission is available on the website. Dr Paul Cundy was invited to give evidence at the oral evidence session on behalf of the Joint GP IT Committee (JGPITC) of the BMA and RCGP. Dr Cundy blamed delays on NHS CfH’s failure to consult at the initial stages.

The Home Affairs Committee Inquiry into a ‘Surveillance Society’ closed for evidence submissions at the end of April. The BMA submission is available on the website. The BMA response concentrated on access to NHS databases by public agencies and Government Departments, strongly arguing that there should be no access to health records outside the healthcare setting and urging stronger audit and abuse monitoring safeguards.

Devolved nations
The issue of IT links between the home countries is still a concern for the BMA Working Party on NHS IT. We are glad to see that there have been some cross border discussions but will continue to raise the issue until there is a clear solution for patients.

Progress in Scotland
Information Governance
In Scotland a similar Information Governance Board is being set up that will attempt to remain aligned with England. The BMA supports this development and hopes to have sufficient clinical representation.

Emergency Care Record
The Scottish NHS ‘emergency care record’ project seems to be making good progress. However, GP representatives have recently agreed that GP practices must remain the data controller for GP records even if databases are held within a hosted environment. In a special debate on information sharing and confidentiality at the Scottish Local Medical Committees’ (LMCs) conference GPs also insisted that Scotland’s explicit consent model should remain for all information held by practices.

Suppliers
The Scottish LMCs’ conference welcomed the Deloitte Report published late last year which recommended that Scotland move to at most two system suppliers, neither of which is likely to be GPASS. GP representatives called on Scottish GPC to negotiate a smooth transition for GPASS users and to ensure that GPASS users are protected from financial loss as a result of any transition. Representatives also claimed that some NHS boards were preventing practices from having real IT system choice and insisted that the Scottish Executive take urgent action to force NHS boards to comply with the commitment to system choice in the nGMS contract.

The Scottish Executive Health Department, now under new SNP health secretary, Nicola Sturgeon after the recent elections has released the Business Case for moving to an Integrated Primary and Community Care (IPACC) system rather than the current GP only system. Scottish GPC had considerable input into the drafting and the BMA wrote to outline their general support of the proposals for Integrated Primary and Community Care IT solutions for Scotland whilst raising some specific concerns.

Progress in Wales
Information Governance
Wales currently has a permanent representative on the Care Records Development Board and has been asked whether they want the suggested National Information Governance Board to cover Wales as well as England. At present a decision has not been made, but it may be that they will prefer to be covered on a voluntary basis.

Cross border issues
As the NHAIS (Exeter) system is very slowly turned off there seems to have been some progress in Wales. The NHAIS Functionality Verification Project has now completed all its objectives and clarified the issues facing Wales with the decommissioning of the NHAIS (Exeter) system. The Welsh Assembly Government is negotiating with NHS CfH to use the personal demographic service from England via a Welsh gateway with its own security system. CfH has encouraged Wales to take on the whole English system but this has been declined by WAG.

Choose and Book
The Informing Healthcare team have recently met Dr Tony Calland, (Chairman of Welsh Council IT Subcommittee) and it was reported that patients on the border may soon be able to have their appointments booked through Choose and Book. This would be an advantage for a small number of patients in the Chester and Shrewsbury areas. However Wales are considering implementing a different electronic referral system in Wales which will speed up the referral system (that assumes that Local Health Boards will allow electronic referrals). This is using the Scottish system called the Scottish Care Information (SCI) Gateway which has been successfully deployed in Scotland since 2001.

GP2GP
The system has been shown to work and will be slowly progressed in Wales as in England.

OOH electronic access to the health record
The pilot for electronic access to health records in Gwent has reportedly been a great success. There have been very few dissenters on explicit consent (under 40 out of 400,000). Patients seem happy to have the data kept in the local health economy rather than transferred to a warehouse. Informing Healthcare is looking to have two more rollouts, North Wales and West Wales. They are still keen to keep the data in the hands of medics only so no extension is planned at present or likely to ambulance control etc. They have confirmed that there will be no extension of users without negotiation.

Progress in Northern Ireland
Cross Border Issues
The BMA in Northern Ireland share the concerns regarding cross border issues and the fragmentation of the once UK wide systems which underpinned the NHS. They have urged caution, while striving to reflect local needs, not to allow the national framework against which health and social care is delivered to disintegrate.

Information Governance
This is an area of concern to BMA in Northern Ireland. Discussions are being held with the Department of Health, Social Services and Public Safety (DHSSPS) to take this forward but as yet no decision has been taken.

GP ICT Modernisation Project
The GP ICT Modernisation Project has now formally completed its remit and the responsibility has passed to a new Primary Care ICT Strategy Board. The remit of the new Board will be to look at all aspects of the provision of ICT to the wider primary care teams including independent contractors and a number of sub-groups of this Board have now been formed. One of the initial products of this has been a draft ICT strategy for GMS which has just been released to the service for further comment.

Electronic Referral Management System (ERMS)
This 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 (MDS) for referrals has been agreed and the GP system providers have completed the necessary changes to allow letters with this MDS to be produced automatically. The additional function of being able to send referrals electronically will be the next phase of this project and this is expected in the next twelve months.

Emergency Care Record (NIECR)
A project Board has just been formed to develop an emergency care record for use in Out of Hours centres and in due course Accident and Emergency centres. It is proposed that Northern Ireland adopt a similar approach to Scotland and Wales and learn lessons from projects in the other three countries.

GMSIS
This project has been launched by the DHSSPS and discussions are taking place regarding the possible use of the information held on GP systems. This will seek to use anonymised information from GP systems to provide better support for commissioning and public health.