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Dr Gillian Braunold visited the Pentagon to hear how US military officials faced near mutiny when they brought in electronic patient records. By Ian Cameron

Dr Gillian Braunold recently met senior US military officials. During the talks at the Pentagon, they told her she would have to 'take the first bullet' in her role as a clinical lead with the UK Government's controversial Connecting for Health NHS IT

programme.

It is the kind of guidance that could put conspiracy theorists in a spin. But Dr Braunold was not being tipped off about a plot against her from GPs opposed to Choose and Book or the NHS Care Record.

The officials were telling Dr Braunold and other senior Connecting for Health representatives how they had faced huge opposition from the US military's doctors to a plan to set up an electronic patient record for Armed Forces personnel. She, they said, should expect the same flak from doctors in the UK.

Dr Braunold says her counterpart at the Pentagon told her the success of the electronic patient record and Connecting for Health's other plans

required that they accept short-term pain.

'They had faced similar issues that our teams were facing in terms of clinical engagement as well as technical ones. He told me someone has to take the first bullet,' she says. 'That if you believe the national asset is worth that bit of pain you have to go with it.'

The Pentagon's electronic record covers 9.1 million people across the globe and is deemed 'comparable and scalable' to the UK programme.

The US military eventually won its medical staff round.

But Dr Braunold, a former GPC member who still works as a GP in north London, accepts Connecting for Health has not yet won over GPs.

The reaction of LMC representatives to a presentation by her fellow clinical lead, Professor Mike Pringle, at the recent annual conference certainly left no doubt about that.

But she says she continues to be surprised by the strength of their opposition, particularly over the NHS Care Record.

Some of GPs' claims about security and confidentiality, she says, are 'frankly outrageous'.

GPs must overcome an 'I'm all right Jack' attitude born out of the maturity of primary care electronic re-cords compared with secondary care, Dr Braunold adds. 'It will be a quantum leap when they have access to information to look after patients properly ­ and patients have a right to dictate that, not GPs.'

She admits that clearer information about what will go on the records will help ease GPs' minds. Internal Connecting for Health papers are on their ninth draft, she says, and wider consultation will begin later this month.

One certainty, though, is that the national care records will contain some historical data from GP systems, rather than, as had been mooted,

only data recorded after its launch.

'That would have been a terrible missed opportunity,' she says. 'Otherwise you would not find out about an allergy, for example, until you get a reaction. It will be non-sensitive quality and outcomes-type data ­ for example conditions such as diabetes but excluding mental health ­ as well as allergies and maybe repeat medications.'

With both the Care Record and Choose and Book GPs

argue there will be huge amounts of extra work and, therefore, that they should get extra money.

Dr Braunold says Connecting for Health has accepted this argument. 'Giving patients information and deciding what goes on the spine, that's in-depth stuff and asks people to take a professional view,' she says.

'People in the programme understand you have to spend a considerable amount preparing for new ways of working together but we have to make the case to ministers.'

An event is being planned to enable grassroots GPs ­ not their LMCs ­ to suggest technical improvements to the software.

And on the issue of ensuring GPs have choice over the clinical software they use, Dr Braunold said this would be a reality by the end of July.

In Washington, Dr Brau-nold was given a stark example of the consequences if she fails to engage clinicians with Connecting for Health.

Managers from the huge Cedars-Sinai Medical Center in Los Angeles recounted how its 1,800 doctors went on strike two years ago in protest at a lack of consultation over the implementation of a new computer system.

The hospital is now hailed as example of how to take advantage of technology to improve health care. But it took a lot of pain to get there.

Where are we now?

Choose and Book

·1,000 bookings so far made

·53 practices using the system

·£6,000 per practice paid to PCTs which got 30 per cent of GPs to register interest by June 30

·GPs registering interest under no obligation to take on Choose and Book

·Connecting for Health says it is lobbying ministers for GPs to be paid for Choose and Book

·Version 2 of the software due for release shortly

·Government adamant all GPs offer choice by end of 2005

Care records/spine

·GPs continue to question security and confidentiality

·Wider public and professional consultation on content of the spine due to start this month

·Debate to centre on 'sealed envelope' of confidential data

·Records on the spine will contain some historical, non-sensitive, data

·Patients told they cannot opt out of having their record on the spine

IT choice

·Ministers promised in March that all GPs in England could choose from any accredited software, including EMIS

·Connecting for Health promises this will be in place by end of July after delays due to contract changes

Electronic transfer of prescriptions

·Being trialled in a limited number of practices

·Connecting for Health estimates this could eventually save GPs an hour a day processing repeat prescriptions

·Wider roll-out scheduled for later this year

GP-to-GP transfer of patient records

·Pilots using dummy records began in April in Leeds, Croydon and Isle of Wight

·Following demonstrations, GPC says system could save GPs hours of administration

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