BMA statement on Connecting for Health
June 2006 - Updated November 2006
The BMA supports greater sharing of healthcare information and recognises that increased investment in IT has the potential to improve the working practices of doctors, the service delivered to patients and patient safety. The current hybrid system of paper and electronic records is far from perfect, therefore we have been working with Connecting for Health to help ensure that new systems meet the needs of clinicians and improve current practices. In some areas of the programme this has been a success; for example, clinicians have been successfully engaged with the GP2GP transfer project and the Electronic Transfer of Prescriptions Programme. There has also been commitment from clinicians at a local level to influence the development of systems.
The BMA recognises that doctors are concerned about the scale of the project and the reports of overspending in the current financial climate. The BMA shares these concerns. Lord Warner has confirmed that the National Programme for IT is likely to cost around £20 billion. Connecting for Health maintains that the programme is running to budget because the £20 billion includes existing local spend on IT of around £1 billion a year, over the 10 year life of the programme, as well as the £6.2 billion core contract costs.
The Health Minister also announced that the NHS Care Records Service, which will deliver an individual health record for each NHS patient, has been delayed by at least two years. Whilst we welcome an incremental approach in delivering systems and support the thorough piloting of systems we are concerned that the delays could result in an increased number of interim solutions which could increase the costs of the programme. Doctors are understandably becoming disillusioned as they use increasingly out of date equipment whilst waiting for Connecting for Health to deliver. These delays also mean that the BMA has not seen the systems working and therefore cannot at this stage give assurances that systems are fit for purpose.
The BMA is concerned that NHS CRS pilots, which are now scheduled for Spring 2007, will be based on an implied consent model requiring patients to explicitly opt out. It is the BMA view that patients should be asked for consent explicitly before any clinical information is shared onto a central system. Doctors feel that some patients may be unhappy about having their 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. Their view is that uploading clinical data without explicitly asking the patient could jeopardise the trust and relationship between doctors and patients, as well as violating a patient’s right to confidentiality.
A more gradual approach to information sharing would also ensure that each individual record is properly checked to make sure that it is meaningful when shared, before it is uploaded. This should increase patient safety. It is also felt that a gradual approach will generate greater confidence in the system from both a clinician and patient perspective. We are aware that there are some concerns about the practicalities of seeking explicit consent from every patient. The BMA is producing some practical guidance on the process of opting in.
Despite continual negative reports in the press about the programme, the BMA has tried to take a balanced view on the benefits and difficulties. The BMA is aware that many doctors are sceptical or negative about the programme. However the BMA believes that better sharing of clinical information between doctors will improve patient care and we can see the benefits of an integrated electronic system provided our concerns are met.
The BMA remains committed to providing clinical input into the programme so that these concerns can be addressed. Guidance on many aspects of the Connecting for Health programme is being drafted and will be available shortly.