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BTS meeting roundup

GPs attended the NPfIT stakeholder group inaugural meeting hoping their scepticism at its radical plans would prove unfounded ­ Ian Cameron was there

GPs have consistently accused the National Programme for IT of failing to consult them over its radical, and hugely expensive, plans.

So it was with anticipation and a high degree of scepticism that GP members of the national programme's 'stakeholder' group on the NHS Care Record arrived at its inaugural meeting earlier this month.

The Care Record is the centrepiece of the NPfITs plans. It is essentially a centrally-held national electronic patient record which is meant to enable more joined-up care in the NHS. It is supposed to be fully implemented by 2010.

But GPs are far from convinced that it will be secure and that patient confidentiality will be protected.

The stakeholder group ­ which also includes members of the public and other health professionals ­ will, NPfIT insists, be able to shape the development and implementation of the Care Record.

Richard Granger, director general of the national programme, stresses this at the start of proceedings. He does concede, however, that as he has been in his job for 800 days, it may seem as if this is a token exercise in consultation. 'The die is not cast,' he says. 'We have had significant input and leadership from clinicians, but not enough and I hope we are actively addressing that.'

Mr Granger went on to extoll the virtues of the national programme. Information had to move at the same speed as the patient, he said. Patients were treated in a 'sub-optimum' way because information was not available to those who needed it.

To those who questioned the security and confidentiality of the Care Record, he asked them to consider how secure paper records were. Patient safety, he concluded, 'is the talisman'.

Alan Hunt, the director responsible for implementating the Care Record, next detailed how the programme intended to consult with GPs and others through a pyramid system of communication with the stakeholder group near the top. Delegates then got the chance they had been waiting for ­ to put finally their concerns to the NPfIT's leaders. Some 195 questions flowed in from the room.

Would there be a 'sealed envelope' of personal information on the record? How would it work? And, crucially, what information would be sent to the shared record? It was at this point that GPs realised they would not be getting detailed answers during the meeting or for some time yet.

Dr Mike Bainbridge, chief clinical architect for NPfIT and a former GP, told delegates the vital issue of what would be put on the shared record was 'still under discussion'. But, he argued, the fact a decision had not been made was the whole point of having a stakeholder group and holding such meetings.

'It's a big area and one of the most important. We have to harness professional views and understand what it is we as patients feel about having data shared and how to arrange sealed envelopes for patients. We have set up a flexible service to allow whatever patients and the service want to give us.'

A snapshot poll of delegates revealed this message was not good enough ­ 88 per cent were dissatisfied at the lack of information they had been given so far on control over the data held on the Care Record. In the spirit of listening, Department of Health patients tsar Harry Cayton described this result as a 'fairly useful message'.

Very little detail emerged during the rest of the day. For instance, it was not made clear what role GPs will play in a major campaign being planned for next year to tell people what information will be held and shared about them and who may access it.

Marlene Winfield, head of public engagement for NPfIT, said she 'would hope and expect' that GPs would be 'one of the main conduits for making this information available. But she added that 'it's difficult to say' how this will be done, given the workload demands on GPs.

Such a paucity of detail about how things will work exasperated some GPs.

Dr Mary Hawking, a GP in Dunstable, Bedforshire, said the day had been exactly as she had feared. 'I've been trying very hard to find out what's going to be on it, how it's going to get there and be maintained,' she said. 'But they haven't decided that and everything depends on it.'

Dr Alan Adams, a GP in Northwich, Cheshire, said: 'I don't think I was much better informed at the end of the day than at the beginning. I got the impression we will be told what we're going to be doing.'

But the general mood of GPs was more optimistic. Most were reassured they would have a say in the detail of the programme when those decisions were made.

Dr Phil Koczan, medical adviser to Torex and a GP in Chingford, said he was more confident the programme would not ride roughshod over GPs' views.

'The message was that they are prepared to engage. I don't think the answers to our concerns exist yet and if the national programme had given the solutions I would have been angry.'

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