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Independents' Day

How are the Government's IT plans progressing?

By Steve Nowottny gives a progress report on the Government’s IT plans. After a bumpy start to say the least, there are pockets of progress being made.

By Steve Nowottny

By Steve Nowottny gives a progress report on the Government's IT plans. After a bumpy start to say the least, there are pockets of progress being made.

The National Programme for IT is nothing if not ambitious. Established in 2002 to oversee a complete modernisation of NHS IT, it's been widely billed as the largest civilian IT project in the world – not least because of its £12.7bn budget. It's also been hugely controversial, hampered by repeated delays and battered by critics.

A damning National Audit Office report earlier this year concluded the programme's targets had been unachievable and unrealistic – and warned it could be 2015 before every NHS trust in England fully deployed care record systems – four years later than planned.

Opposition politicians last month renewed calls for a review of the programme, citing fresh delays in the rollout of patient administration systems in hospitals as proof the ‘hugely expensive' programme was ‘desperately behind schedule'.

On the primary care side, the picture is somewhat different, with signs that Connecting for Health is getting back on track. Most notably, after pushing ahead with its Summary Care Record ‘implied consent' model for more than a year in the face of widespread GP opposition, the agency announced in September it would switch instead to asking for explicit consent each time a patient's record is accessed.

But as Pulse's survey of 314 GPs this week reveals, GPs still have real concerns. One in three say they have become more supportive of care records since the switch in consent – but almost half are opposed, and many also remain sceptical of other NPfIT projects such as Choose and Book.

Summary Care Record

The Summary Care Record is the programme's flagship project – and the one most likely to revolutionise patient care. Initially listing only current medications, adverse reactions and allergies, but with potential for more to be added, it will allow authorised NHS staff working across a range of care environments to access a patient's basic health information.

A simple enough requirement, perhaps – and GPs in early adopter areas frequently report patients are surprised that the NHS does not do this already. But the care record is the lynchpin of the new model of healthcare delivery the NHS is moving towards. Out-of-hours providers, polyclinics, medical researchers – all depend on secure, reliable and up-to-date shared patient data.

Over the past year, GPs in six early adopter areas have been piloting the care record, with mixed success. Fears of large-scale security breaches or a massive increase in workload have – so far – failed to materialise. But in April, Pulse revealed the first early adopter area, Bolton, had been hit by delays, technical glitches and practices pulling out.

The independent University College London evaluation of the early adopter areas, published a month later, found implied consent had caused widespread confusion. After a summer spent contemplating the report, Connecting for Health backtracked. Care records would still be uploaded under implied consent, but under the ‘consent to view' model, patients would be asked for explicit consent each time a record was accessed.

Dr Gillian Braunold, clinical director for the Summary Care Record, says the change has been well received by grassroots GPs, but she advises caution. ‘We've got an enormous number of areas in the country that are quite keen to take up the Summary Care Record but I want to make sure the software's ready before we ask people to take it on,' she says.

Rollout beyond the early adopter areas has been postponed until next April and is expected to take two to three years. But some early adopter practices have moved on to the next stage, uploading ‘enhanced' Summary Care Records for patients with chronic illnesses, containing far more information than just drugs and allergies.

Work also continues on Healthspace, a ‘secure online personal health organiser' now run by NHS Choices. So far just 717 patients in the early adopter areas have signed up for advanced accounts allowing them to view records online, but more than 50,000 users across the country have basic accounts.

Healthspace is eventually likely to offer patients functions including appointment booking, personalised health advice and access to test results. Pilots of the Communicator function, which will allow patients to contact their GP by email – if the GP is willing – start next April.

Secondary uses of records

Patient records are already accessed for ‘secondary uses' such as research, audits, service planning and public health. It emerged last month that 500 million records have already been shared with academics at the Dr Foster Unit at Imperial College London. But with the advent of the care records, the information potentially available will increase enormously.

How that data is used is the subject of a 12-week public consultation, and Pulse's survey reveals it is a controversial topic among GPs. Just over half of respondents did not support the secondary use of electronic records for research and more than a quarter shared the concerns of some religious groups over their use for research on abortion or stem cells.

But Dr Mark Davies, the Information Centre's medical director and a GP in Hebden Bridge, West Yorkshire, insists the benefits from secondary use of records will make it an exciting development. ‘We are sitting on a wealth of really valuable patient information and we have an obligation to ensure it is used,' he says.

To facilitate secondary use of data, plans are under way for improved extraction, with the General Practice Extraction Service going out to tender and expected to be up and running next year.

Choose and Book

Once the part of the national programme most hated by GPs, Choose and Book is getting a more favourable reception. Pulse's survey found just over half of GPs still opposed to it, but that compares with 69% who a year ago said the system made no difference or was detrimental to patient care. More than a third of GPs told Pulse's survey their use of the service had increased since April, even though national incentives ended then.

Use of Choose and Book for first outpatient referrals is now running at around 50% – although it has remained there for most of this year. And although many of the software glitches that first irritated GPs have now been ironed out, the way in which hospitals use Choose and Book has thrown up a whole new set of problems.

Pulse revealed in February that nine in 10 hospital trusts had cut appointment availability to help meet the Government's 18-week target, and our survey finds 85% of GPs still face this problem in their area. The inability to refer to named consultants is also cited as a major issue.

Dr Alex Bayes, a GP in Manchester, says: ‘Choose and Book has become a joke. Hospital abuse and blocking of appointments is widespread. It's ridiculous and patients find it very frustrating.'

Dr Stephen Miller, medical director of Choose and Book, acknowledges the problems and says Connecting for Health is working with hospitals to ensure ‘Choose and Book is seen as an important first step in the 18-week pathway, rather than a competing priority'.

GP use may be boosted by an improved version of the software due next year, with increased functionality such as SNOMED searching. And the NHS constitution will enshrine the right to choice in law.

Other projects

Three other less high-profile projects have been progressing – and each will have a real impact on the way GPs work.

Release 1 of the Electronic Prescription Service has been widely deployed and is now used for around 35% of prescriptions each day. The real benefits for GPs will come with release 2, which will remove the need for paper prescriptions – 17 implementer PCTs will pilot it from the turn of the year.

Developed with the BMA, GP Systems of Choice (GPSoC) gives GPs the option of any of eight approved software suppliers. More than 6,000 practices now receive services under GPSoC, although there have been repeated reports of PCTs bullying GPs into switching to preferred local suppliers.

Dr Grant Ingrams, chair of the GPC IT subcommittee, says the initiative has been ‘hugely successful'. ‘GPSoC should take us back to where we were before 2001, to having systems where there's competition, not monopolies within areas.'

GPs have long been frustrated by delays in accessing records for newly registered patients, so the almost instant transfer offered by GP2GP has made it a popular element of the national programme. GP2GP is now used in 4,803 practices and has made more than 350,000 transfers. But there are some questions over data quality and transfers can so far be made only between practices operating EMIS and INPS systems.

Dr Manpreet Pujara, national clinical lead for Connecting for Health and a GP in Rochester, Kent, says: ‘We're working with iSoft and TPP to extend the service to more practices. We'd like all systems to do it – but one has to be pragmatic. If we could get the four main suppliers it would be a breakthrough.'

As with the national programme as a whole, there remain glitches, but pockets of progress too.

Just over half of GPs in Pulse's survey were opposed to Choose and Book Just over half of GPs in Pulse's survey were opposed to Choose and Book GPs have a limited choice of named consultants through Choose and Book Choose and book Change to the consent model has improved GPs' view of the Care Record Change to the consent model has improved GPs' view of the Care Record Round up GPs are wary of pharmacists and receptionists having access to the Care Record GPs are wary of pharmacists and receptionists having access to the Care Record

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