‘Manage, struggle, just try to survive.’ That’s how Gerard McHale, a ‘very disgruntled and very frustrated junior doctor’, describes his everyday interaction with IT in the NHS.
Dr McHale, who retrained as a doctor in London having been an auditor earlier in his career, compared NHS IT to technology at his previous place of work.
‘In 2006, we moved from paper audit notes to the digital audit file. This was amazing, a step forward,’ he said. ‘Yes, they were clunky. They were more Lotus Notes than smart phones and they definitely weren’t an all-singing all-dancing cloud system. But they worked.
‘Fast-forward 12 years and I started work as a junior doctor. I was shocked, bewildered. Not only do I have to write on paper files, to walk to the end of an often huge estate with a paper note to try and get a radiology department to do a simple X-ray, but I can’t then understand the note about the sick patient written in doctor scroll overnight.’
He said today’s reality was ‘computer hopping’ with: ‘Doctors coming in long before their shifts in the morning to prep notes, find the working computer on wheels, then find it stolen by a colleague just before their ward round starts.’
‘Is this common? Absolutely. Is this acceptable? Absolutely not.’
Even when doctors are given self-development time to learn new systems Dr McHale said they often end up having to set-up in the mess or a corridor. He questioned: ‘How are you going to discuss a confidential case? How are you going to debrief on a difficult clinical scenario?’
‘The IT infrastructure of the NHS is for the 19th century, not the 20th century, not the 21st century. It needs massive investment and massive improvement. We need fit-for-purpose IT.’
The motion he backed says ‘significant investment’ is needed in hardware, software and IT support to enable the NHS to build on the ‘successful aspects of remote working’ initiated during the pandemic - and calls on the BMA to campaign for this.
London GP Penelope Jarrett, who tabled the motion, talked through the jargon in a recent IT board agenda and recent IT update and how it left her ‘dizzy with acronyms’.
‘I spent many hours studying to be a doctor and I spend many more keeping clinically up-to-date,’ she said. ‘I do not have the time, nor the expertise, to get on top of all this too. I do not think I’m unusual.’
She stressed ‘we need support to get this right’ yet ‘no one wants to be in charge’ of updates or procurement of IT systems and software, be it for patients sending in photos or for remote appointments.
But Dr Jarrett described software as ‘clunky’ and ‘not ready’ for patients to have full access to their records with funding streams and lines of responsibility ‘unclear’ as CCGs move to ICSs.
She noted that remote working is not only for doctors working from home but patients at home speaking to doctors in clinical settings. ‘Either way, it is unfair and insecure that staff do not have private places to work in and are using their own devices,’ she argued.
Consultant Sarah Jones agreed with the need for significant investment but questioned the ‘problematic’ wording in the motion that recognises the ‘successful’ aspect of remote working since the pandemic.
‘Yes, there was some successful aspects, but there were a lot of unsuccessful aspects as well,’ she said. Dr Jarrett said the motion’s wording suggests there are also unsuccessful aspects and said it was ‘not a reason for stopping remoteness altogether’.
Dr Jones also called for clarity in the motion, which asks for remote working facilities to be within a short distance from a doctor’s place of work.
‘Is it the park and ride down the road, home, or within the building?’ she asked. ‘We should be asking for quiet places within our places of work.’ Dr Jarrett said distances could be defined at a later stage.
Kent GP Coral Jones, meanwhile, called for the wording to be adjusted to ensure the investment and benefits of the investment in IT are both publicly delivered and accountable as she warned of ‘data being sold off for unaccountable uses’.
She called on the BMA to ‘expose the risks of commercialisation and the propaganda of the private sector’ as she opposed the motion.
Short on staff
BMA council chair Chaand Nagpaul said the issue of data was ‘taken on board’ but said the motion was specifically about the technology, not data. Dr Jarrett added she also has concerns about private partners’ use of data but it was a separate point.
Dr Nagpaul broadened the debate to address workforce issues.
‘We are so desperately short of doctors,’ he said. ‘And remote working has enabled many doctors to remain in the workplace. We have doctors working in general practice who could not have done because of illness or other caring responsibilities.’
He added: ‘When we asked doctors what their priorities were after the pandemic, they wanted remote working. And it is also what the public wants. We need to stop this dichotomy between remote vs face-to-face. The public want both.’
The motion was voted for in three parts, each of which were carried.
Remote BMA meetings were discussed later in the day with the motion to continue with hybrid models tabled by Devon-based GP Lucy-Jane Davis, via video, who said she ‘wouldn’t be speaking’ at the ARM if logging in remotely – which 27% of delegates did – wasn’t an option.
She explained how her journey to London is ‘five hours and three modes of transport’ – a ‘massive’ commitment.
‘Three years ago, we kept having to ask if we could use the virtual kit so all our members could join, and it was a constant fight’ she said. ‘Six months later, suddenly we were able to have meetings with everyone there. And it was because of Covid. We could bring our membership together, even in a moment of massive crisis.’
Making the case for hybrid meetings, she said ‘we’re doing this stuff already’. And while accepting in-person networking ‘really matters’ said more can be done to improve remote networking, such as informal video calls and WhatsApp groups.
She argued facilitating hybrid BMA meetings would ‘engage our membership, promote a diversity of voices and ensure we really are a democratic organisation’.
Simon Minkoff, a GP based in Greater Manchester, argued hybrid meetings risk ‘dumbing down’ BMA activity.
Dr Minkoff insisted he was ‘not being a luddite’ and said remote working ‘makes economic sense’ - but believes his 3.5-hour journey to London is worth the effort.
‘I can’t be the only person to notice how flat and sterile online meetings are,’ he said. ‘We are missing an opportunity to genuinely network, like those of us been here’ [at ARM in Brighton]. We work so much better when we’re in the same room.’
Dr Davis responded that the motion is calling for hybrid meetings, not remote meetings. She said she would also ‘rather be in the room’ and has ‘so much FOMO [fear of missing out]’ but stressed she ‘wouldn’t be able to engage’ if meetings were in-person only.
BMA council chair Chaand Nagpaul said he was ‘very supportive’ of the motion, as remote meetings ‘improve access for many members who otherwise would not be able to be involved in the BMA at all’.
The motion was carried, with 89% of voters – from both the room and online – in favour.