GPs vote against NHS Connecting for Health

Despite improved relationships with the leadership of the BMA, last week’s Local Medical Committees’ (LMC) conference revealed just how far Connecting for Health still has to go to win the confidence and support of grass-roots GPs.

NHS Connecting for Health’s (CfH) GP clinical leads last week failed to win over delegates at the BMA’s main family doctor conference, despite setting out a new ‘incremental’ approach to developing Care Records and stating that the current version of Choose and Book is not yet fit for purpose.

In debates covering several IT motions, delegates at the BMA’s LMC conference in London last week rejected a proposal saying that patient care will “benefit from the safe sharing of electronic information across the NHS”.

In contrast, they passed a number of motions declaring a lack of confidence in NHS CfH, NHS management and the Choose and Book electronic patient booking service.

The only endorsement of IT came with a motion on the quality and outcomes framework when LMC representatives – in effect the local branch structure of the BMA in general practice – declared its data to be a success.

Dr Chaand Nagpul, a GP in Harrow, said: “We now have a public health database of primary care morbidity unrivalled anywhere in the world.

“We know how many people have diabetes, high blood pressure, epilepsy and so on. We know the quality of their management and their risk factors. This is something that was inconceivably only a year ago.”

The first attempt to win over the conference came from Professor Mike Pringle, professor of general practice at Nottingham University and a GP clinical lead for NHS CfH.

He outlined a new incremental approach to the shared care record now being developed by the clinical leads and due out for consultation later this year.

In a move that would mark a significant U-turn if adopted, he said the national programme should abandon the ‘monolithic’ care record.

Instead Professor Pringle argued, it should start small and build up as it wins over patients’ and doctors’ trust. “It must be built around patient protection, patient safety, patient care and patient outcomes,” he said.

He envisaged starting with a very basic level of information such as demographic data but then expanding with patients able eventually to contribute to their own record. “When we have made the system robust that will allow us then to take the record forward,” he said.

Acknowledging GPs’ increasing concern over Choose and Book he declared that it is not yet fit for purpose. Although it was good for patients, he said: “I acknowledge it’s not good enough for you or me or fit for the roll out we will need.” He urged delegates to wait until September when version two will be unveiled.

But delegates were not convinced and questioned him closely about the safeguards of the system. Christine Heseler, a GP from Gloucestershire, said: “We do not accept what you have said.”

Paul Cundy, a member of the BMA’s general practitioner committee, questioned the whole notion of sharing patient information, calling it a “WMD – word of mass deception.”

He said: “My patients tell me that they want their GP to hold their record and control where their data goes, when and for how long. How can CfH argue for holding records in perpetuity?”

He added: “It is GPC policy for data not to go on the spine before our anxieties have been answered. I am not sure that they have.”

The conference debated several motions previewed by EHI Primary Care earlier this month.  With barely a speaker in defence of NHS management or the national programme, each motion was passed overwhelmingly.

Tellingly, the GPC – the BMA’s negotiating committee – did not ask GPs to vote against any critical motions. However, Richard Vautrey, a member of the committee told the conference: “I have a feeling that our concerns [about Choose and Book] are being heard by many in CfH and the Department of Health. We are starting to make meaningful engagements.”

Delegates also rejected a motion put forward by Dr Gillian Braunold, joint GP clinical lead for NHS CfH. In addition to arguing that patient care will benefit from safe sharing of electronic records she argued for CfH to seek endorsement from patients and professionals for the safeguards.

She said GPs should not set the hurdles too high. “We need to balance pragmatic solutions with the search for the ideal,” she told the conference.

Dr Braunold told E-Health Insider that she was not surprised or disappointed by the outcome of the debates. GPs are in the vanguard of IT development and perceive they have a lot to lose through the national programme, she said. “This is the most vociferous anti market and I could not hope to persuade them with one three minute speech.”

Along with Professor Pringle she confirmed that the “incremental” approach hinted at during the conference would be out for consultation, possibly as early as July.

Dr Braunold told EHI such an incremental approach has been agreed by the CfH Care Record Board and has support of senior people in the programme: “It has been accepted as a way forward that they have to go. It does not damage the architecture of what they want to put in place.”