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The NHS IT revolution soldiers on

Despite flaws with SCRs and Choose and Book, the National Progamme for IT will grow. There is little doubt that information technology is destined to play an even bigger role in the reformed NHS. By Fiona Barr

Dr Collins: improved access to SCRs helps GPs working out-of-hours  (Photograph: Phil Weedon)
Dr Collins: improved access to SCRs helps GPs working out-of-hours (Photograph: Phil Weedon)

Except for snippets such as elective patients being able to opt for a named consultant on Choose and Book, last month's NHS White Paper did not include much detail on this.

However a paper about the future of the National Programme for IT (NPfIT) was due to be published as GP went to press.

This £12.5 billion NHS IT project for England, which celebrated its eighth birthday in June, does not have universal support. But at this year's BMA annual conference, when a hospital doctor suggested cancelling the scheme, a string of GPs spoke in its defence.

Summary care record
Popular projects include GP2GP record transfer and the potential of programmes like the Electronic Prescription Service, while the subject of most GP concern has been the creation of summary care records (SCRs).

This has culminated in the last few weeks in calls from the BMA to suspend access to existing SCRs after it emerged some were not being updated by practices as well as suspending further uploads.

Former GPC IT chairman Dr Paul Cundy has controversially gone further and suggested GPs apply the 93C3 Read code to all patients, effectively applying a blanket opt-out.

The independent evaluation of the SCR published in July found that the SCR has yet to deliver significant benefits. It said the SCR suffered from a number of 'wicked problems'

including the difficulty of gaining consent from 50 million people, the quality of GP data and the definition of data to be included in the SCR.

The researchers from University College London did find evidence of improved quality in some consultations, and said the SCR could potentially make a 'significant impact' in secondary care.

Dr Neil Bhatia, a GP in Hampshire, is a critic of the implied consent model and has pledged not to upload patients' records without explicit consent.

After a five-year campaign, he has logged opt-outs from 20 per cent of his patients. He argues that the government-run Public Information Programmes (PIPs), which have generated an opt-out rate of below 1 per cent, are ineffective.

'Many patients still have no idea about the SCR,' he says.

GPs' concerns about PIPs' effectiveness led to the roll-out of the SCR being halted soon after the coalition government took office although, subject to agreement from practices, records can now be uploaded.

Dr Chaand Nagpaul, the GPC negotiator who leads on IT issues says: 'We need to pause and reflect on the whole issue around the SCR, which is quite complex, and consider what would be the best way forward. It would be a total injustice if we did not reflect on the independent evaluation.'

Support for the SCR comes from doctors working in out-of-hours services where software from IT company Adastra enables them to check the SCR. Over 20,000 SCRs have been accessed out-of-hours.

Kent GP Dr Simon Collins, clinical lead for Medway on Call Care believes that access to SCRs is a great improvement.

He says: 'If we are expected to look after GPs' patients out-of-hours then we need the information to do it safely.'

GP clinical systems
Sharing GP information across the wider NHS is not restricted to the SCR project and some believe that the development of GP clinical systems like EMIS Web, Vision 360 and SystmOne will make the SCR redundant.

Meanwhiile NHS IT projects in Scotland, Wales and Northern Ireland have also pursued an emergency summary. In the devolved nations the plans have generated much less controversy. In Scotland the whole population minus opt-outs now has an Emergency Care Summary; Northern Ireland hopes to follow suit and in Wales the national rollout of its Individual Health Record is underway.

Bedfordshire GP Dr John Lockley who chairs the iSoft User Group, argues that the NPfIT is worth keeping despite its problems. However the user group believes that the government should build on primary care's world-leading position in medical IT rather than ride roughshod over it - a common criticism of the NPfIT.

'I am pleased that the government seems to be thinking carefully about what it does rather than going in for dictatorial statements,' Dr Lockley says.

Dr Neil Paul, a GP in Cheshire, also argues that, while not all big projects are bad, NPfIT managers have not listened enough to what frontline clinicians want or need: 'There has been an over-emphasis on one size fits all when what we need is more joined up systems that talk to each other.'

He predicts GP commissioners will also want a radical overhaul of performance data with the right information presented in the right way. 'Overall we need continued investment in IT as money gets tight. IT is a productivity enhancer when done right, and is an excellent way of enhancing governance,' Dr Paul adds.

Past and future
  • Summary Care Record (SCR) Almost 30 million patients contacted, 2 million SCRs created, under review.
  • HealthSpace Online portal for patient access to SCRs: low take up so far, plans for further functionality in pipeline or government could leave this to commercial sector.
  • Electronic Prescription Service Release 1 rolled out with bar coded prescriptions but offers little benefit to GPs. Release 2, enabling digital prescription signing, at pilot stage.
  • GP2GP Record transfers between EMIS LV and Vision 3 enabled; transfers between other system suppliers to follow.
  • Choose and Book About 50 per cent of referrals are sent through the system. Choice of named consultant for elective care is to be mandatory by April 2011.
  • Contracts with local service providers (LSPs) Over 1,000 GP systems installed by TPP in northern clusters as part of the local service provider contract. Elsewhere GP systems are funded by GP Systems of Choice, a scheme due for renegotiation next year.

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