‘In this practice we have a disproportionate number of nuns,’ explains Dr Paul Cundy, in answer to a question about concerns over data requests from the new General Practice Extraction Service (GPES), set up by the Government to make patient records more accessible to NHS managers, researchers and private companies.
‘We have concerns that some queries might not be appropriate for those patients.’
It is a typically clear-headed and patient-focused response to a question about the use of IT, for which he has been a GPC spokesperson for nearly 12 years.
Sitting in his – surprisingly low-tech – practice in Wimbledon, south-west London, Dr Cundy appears relaxed, despite the continual stream of new-technology projects clogging up his in-tray as they float downstream from the Department of Health.
A member of the GPC for 18 years and a GP since 1982, Dr Cundy has seen his fair share of politicians promise whizz-bang technology solutions that turn out to be duds. And this Government, he says, is no different.
The GPC will point out the evidence; it’s up to the Government to decide whether to listen.’
‘It’s a continuing disappointment that successive Governments have introduced policy that is not based on evidence,’ he says with an air of weariness.
‘That’s the political world, it’s not the scientific world we live in. The GPC will point out the evidence; it’s up to the Government to decide whether to listen.’
Dr Cundy is leading the GPC’s subcommittee at a time when big decisions are being made about the future of NHS IT. Health secretary Jeremy Hunt has made technology a top priority for the NHS, with the Government’s information strategy aiming to enable patients to book GP appointments, access their records and contact their GP online by 2015.
Mr Hunt has also promised a ‘paperless NHS’ by 2018.
Dr Cundy says the proposals are ‘self-evidently very sensible’ but need to be carefully managed: ‘The net effect will lower the threshold at which patients will communicate with health services; that will inevitably result in an increase in workload.
‘If general practice suffers what has happened in the States, where there’s a 25% across-the-board increase in work, primary care will fall apart because it cannot sustain that level of increase.’
Summary care records
He is even more strident on the long-running Summary Care Record (SCR)programme. According to the latest
NHS Connecting for Health bulletin, almost 23 million people in England – more than one in three – now have an SCR, and their records have been accessed a combined total of 242,341 times since their creation.
But Dr Cundy is unimpressed by the stats, and offers some calculations of his own: ‘If you look at that in terms of utilisation rate, it means that each time an SCR has been accessed for a patient, it has cost £1,200 for that access.
‘The system is an absolute disgrace and the plug should be pulled as soon as possible,’ he adds, though he later stresses that he is speaking in a personal capacity on this issue and that BMA policy remains that the SCR programme should ‘stand on its merits’.
Dr Cundy supports LMC leaders who have called for patient information campaigns to be restarted on the SCR, as most patients are blissfully unaware any record has been created in their name. The information programme was run several years ago. These records are now being created and patients are not aware of what’s going on.’
CV: Dr Paul Cundy
• Chair of the GPC IT subcommittee since 1999 (bar two years)
• GP in Wimbledon, south-west London, since 1982
• Ran a GP out-of-hours commissioning group for 10 years
• Ran an IT company for 15 years
• Lists motor racing, flying planes and anything mechanical as his hobbies
Dr Cundy is also highly critical of the DH programme to make data from GP records more accessible to NHS managers and private companies through the new GPES system.
The Government is keen to stamp on any suggestion that it is creating a ‘super-database’, but Dr Cundy says it marks a sea-change in attitudes to the use of patient data.
He says: ‘There’s a great move at the moment to say that patient data in the NHS is there for use by the NHS, but that’s not the way data has been used for the past 60 years. That’s a fundamental change and patients need to understand that.’
The GPES system enables data – both patient-identifiable and anonymous – to be extracted from GP systems and sent to the Health and Social Care Information Centre, which can send it on to customers in the NHS and private companies.
The GPC negotiated some important protections: that GPs must agree to the extract being taken and requests for data must go before the GPES Independent Advisory Group, which will conduct an information governance assessment.
The NHS Commissioning Board recently announced it planned regular extractions of anonymised data on demographics, diseases, events and referrals from GP systems.
Dr Cundy says: ‘Most patients do not understand that their information may be used to police CCGs, trusts and GPs. If we’re going to be moving to an area where it’s being used to routinely manage what’s going on in the NHS – which is a legitimate aspiration – then patients need to understand that.’
He advocates a public information campaign on the GPES to inform patients ‘when you go to see your GP or go to A&E or hospital, the information that’s been taken will not be used just for your personal care but for other things too’.
Dr Cundy is also critical of another of the Government’s big ideas for the NHS, questioning whether GPs can cope with leading the drive on telehealth.
We have to be careful not to do things just because they can be done.
‘There’s no doubt there are a few niche areas where the use of telehealth can be very valuable.
‘But for the average patient who lives half a mile from their practice, and who has conditions that are not terribly urgent and is mobile, telehealth is of no value whatsoever.
‘You go from a situation where you take someone’s blood pressure once every six months to 24 every day. That overwhelms systems.’
He concludes with an observation that might apply not just to telehealth but to the wider NHS IT strategy: ‘We have to be careful not to do things just because they can be done.’
Dr Cundy on…
…online access to GPs
If general practice suffers what has happened in the States, primary care will fall apart
…Choose and Book
The patient and GP can only choose from the appointments offered by the trust. There’s no choice there – you are given what you’re given
…the SCR programme
The system is a disgrace; the plug should be pulled as soon as possible
We’re on the verge of a public information campaign saying: ‘When you go to see your GP, the information that’s been taken will not be used just for your personal care’