Mixed feelings from GPs in new survey on NPfIT

A new survey of GPs shows a widespread dislike of Choose and Book, but optimism that the National Programme for IT (NPfIT) will bring improvements in clinical care in the longer term.

There were concerns, too, about patient privacy with 71% of GP respondents saying that the NHS Care Records Service would mean the confidentiality of records would be a little (24%) or much less (47%) secure than it is today.

The independent survey, commissioned by E-Health Insider Primary Care, bjhc&im, Computer Weekly, Financial Times, Guardian, GP and Hospital Doctor, is the latest in a series by Medix UK tracking GP and hospital doctors’ opinions of the £6.2bn NHS IT modernisation programme.

A total of 1329 doctors – 604 GPs and 725 other doctors – answered the survey. Medix says respondents covered a wide, well-balanced range of specialties and grades. The full text is available in EHI Primary Care’s Document Library.

A majority of GPs (59%) thought NPfIT would bring significant or slight improvements in the longer term. Only a small minority (10%) thought there would be a slight or significant worsening in clinical care.

Choose and Book, though was rated as “unimportant” or “not at all important” by 58% of GPs. Free text comments suggested significant animosity towards Choose and Book focused both on the system and on the political moves behind the Patient Choice agenda.

A small minority of GPs (9%) said they would never use the system; though they were counterbalanced by another minority of 8% who said they were already making most of their referrals through Choose and Book. In between GPs predicted various start dates for switching most referrals from the early part of 2006 to ‘later than December 2007’.

One GP wrote: “Choose and Book is crazy. Electronic booking is an excellent idea. ‘Choice’ is a misguided concept created by politicians in order to try to woo the population into some sort of feeling that the NHS is managed well! The ‘Choice’ agenda is doomed to failure…”

Another said: “Choose and Book started here but information was incomplete and access to appointment systems impossible, so it collapsed and as far as I am aware we are not longer able to use it.”

“Chaotic, slow and confused implementation. Unnecessary for personal care, more a political football,” said another.

NHS Connecting for Health GP clinical lead, Dr Gillian Braunold was unsurprised by the response. “I don’t think there’s anybody in the programme who doesn’t feel there have been political imperatives pushing Choose and Book and it has skewed the priorities.”

But Dr Braunold said she was pleased to see colleagues recognised the programme would benefit patients.

GPs were more positive about other elements of the national programme’s services. High ratings of importance were given for electronic transmission of prescriptions (55% important/very important); the NHS Care Record Service (58%); PACS (43%); QMAS (75%) and email and directory services (58%).

One GP summed up his thoughts as: “Some good (ETP, GP2GP); some acceptable (care record spine); some ghastly (C&B).”

Another commented: “I am involved with local projects which have been of much greater value to GPs than most of what has been done by NPfIT (electronic discharge summaries from hospitals, submitting ultrasound requests and OPD referrals by e-mail). These are easily achievable, cheap and of value to GPs.”

Though GPs were optimistic about the benefits for patients only 37% of GPs saw modernised IT systems as improving their working lives and 32% thought it would lead to a slight or significant worsening.

Dr Braunold predicted that the new direct enhanced service (DES) payments for IM&T and Choose and Book, announced in December would result in GPs knowing a lot more about NPfIT and would increase understanding.

Asked to NPfIT’s rate ‘progress so far’, only 1% said ‘good’, 8% judged progress to be satisfactory and nearly half (49%) said ‘poor’. A further 26% rated the programme’s progress as ‘unacceptable’ and a further 15% said they were unsure or had too little information to comment.

Respondents were generally pessimistic about their NHS organisation’s capacity to implement NPfIT with 72% of GPs indicating they doubted whether sufficient funds were availably locally.

One GP wrote: “The principles of NPfIT are fine but I remain sceptical that there is sufficient resource and expertise to realise the objective, maintain confidentiality and producing [sic] user friendliness.”

Dr Braunold said she understood worries about spend on IT when there were so many other priorities. “That’s why it’s increasingly important to ensure any resources put out to PCTs are ring-fenced.”

Dr Braunold, who completed the poll herself, was critical of its approach. “I was really disappointed with the quality of it. I thought it was a lost opportunity. It led me in certain directions and did not give me enough information to make an informed choice about the options in front of me.”

Some of the questions were ambiguous, she said, and as a respondent she was left feeling she didn’t know how to answer them.

Chairman of Medix UK, Robin Guenier said: “We lean over backwards to avoid ambiguity and to give every opportunity for doctors to comment. We believe our surveys are as good as any other equivalent survey and are professionally carried out.”

Certain questions have been included in all the Medix NPfIT surveys since 2003 to provide fair comparators, he said, pointing out that NPfIT had sponsored one of the past surveys.

He added: “Several doctors commented on the survey. Everyone was in favour of it, except one. We had a lot of praise for a good survey and a useful survey.”

As sponsor of the survey, E-Health Insider Primary Care was invited to contribute ideas for questions but Medix UK retained independent control of the survey’s contents and its management.

Documents

Medix-UK survey, 10.1.06 [Word, 900K]