Dear NPfIT…

“Rubbish”, “white elephant”, “waste of money” – quotes from the comments written by respondents to the recent Medix survey of doctors’ opinions of the National Programme for IT were not encouraging.

In fact, the 16 unwieldy pages of despair, complaints and grumbles, mixed with the odd outburst of abuse, made such depressing reading that it was tempting to send the print-out firmly in the direction of the recycling bin.

But doctors’ views and perceptions of healthcare IT developments are important and a closer analysis of the comments submitted as free text by respondents to the structured survey provided some interesting insights.

Over a fifth (227) of the 1025 doctors who responded to the survey took time to add a comment. To identify common threads of concern, the comments were analysed by E-Health Insider into seven subject areas: technology in general; money; management of healthcare IT; information governance and security; specific comments about Choose and Book; a category labelled “good idea but…” and compliments or supportive comments.

Some contributions covered more than one subject, so comments in the subject areas totalled more than the number of respondents. This was the breakdown:

Management

Many comments were critical of a perceived lack of consultation and engagement with doctors. Typical of this group was Dr John Lockley, a GP at Amptill, Bedfordshire, who wrote: “NPfIT [the National Programme for IT] should have involved ordinary doctors – and in particular doctors’ users group – from the start. These groups correctly identified (very early on) some of the subject areas that have subsequently caused problems.”

The effect on local development of a national programme was also a cause for concern. An anonymous GP wrote: “I have always been frustrated by the planning blight caused by the promise of a fir-for-purpose national system. This has failed to materialise and the NHS hospital trusts have been left hamstrung by their legacy systems or, worse, crippled by their new ones…”

Lack of training and poor implementations were also mentioned frequently.

Money and resources

TWOTAM (Total Waste of Time and Money) was the verdict of one respondent. Others felt that too much had been paid for systems that were useful but could have been delivered more cheaply. One respondent wrote: “There are benefits to be had, but at huge expense.”

Some respondents felt that money spent on IM&T could be better spent on patient care and saw no advantages for patients flowing from work in this area. “Just think how much clinical benefit could have been gained for patients with the billions squandered on NPfIT,” wrote one respondent.

“£12 billion could have been used to improve clinical outcomes immeasurably. NPfIT is unlikely to make any difference to clinical outcomes and will just become another bean counting tool.”

Technology

Clearly some respondents were struggling to make systems work well locally. “The system is often so slow as to be unusable,” one GP said. Another expressed concern about how services would cope in the event of a Spine failure. Poor support from the local PCT was another source of complaint.

Other respondents queried the entire basis of current technology strategy. “Why does the NHS have to think that it has to reinvent the wheel and then decide the wheels ought to be square? I suggest that we pull the plug on the entire project and start again, basing solutions on interoperability standards…”

Several respondents compared NHS systems unfavourably with their experience of using computers for other purposes. “If it’s not as fast as Google I don’t want to know,” wrote one.

There was substantial praise for PACS. “PACS has been a great success…”, “Contact and PACS are excellent…”, “It can be done well, eg PACS…” but the comments were, in many instances, coupled with an adverse comment about Choose and Book.

Choose and Book

“Rubbish, rubbish, rubbish” screamed one respondent. “It looks like it has been written by a bunch of school children. I can watch screen/applets being loaded, it is so slow.”

Several respondents said that there were few practical choices in their district. Dr Mark Popple, a GP from Tamworth, Staffordshire, commented: “Patients rarely want to choose away from [the] local provider, slow systems adds a lot of time to consultation, patient phone lines are inadequately manned.”

Other GPs felt the system was cutting off their line of communication with consultants. “I do not know to whom I am referring.”

“Choose and Book has given GPs responsibility they don’t want and taken control away from consultants (who need it).”

Good idea but…

The fund of support for change remained high; few respondents displayed any Luddite tendencies. “Basic electronic links across the NHS is a brilliant idea if it works,” said one commentator. “A huge project, extremely difficult to undertake, but worth the effort because of the payoff eventually. Problems with implementation are to be expected, but NHS staff are used to dealing with such issues and will rise to the challenge,” said another. “Great in theory but the implementation seems excessively expensive and to date imperfect…”

Dr Hamish Towler, an ophthalmologist at Whipps Cross Hospital, is waiting in hope for the national programme to make some impact on his work. “I will be delighted when NPfIT can catch up and replace my software!” he said.

Information governance and security

A significant level of concern and distrust was expressed about security and confidentiality. “Care record security overwhelmingly important and suspect under present system,” said one respondent in a comment fairly typical of this group.

Dr Simon Hayhoe expressed concern not only about the security of a government-controlled database containing medical records but also about the validity of the exercise. He wrote: “I am not convinced (from emergency experience in both general practice and hospital) that information on the database and not available from current sources (eg by asking the patient) would influence treatment for the vast majority of patients.”

Another respondent wrote: “I have never heard of the Care Record Guarantee and suspect it will be about as much use as a chocolate fireguard.”

Others believed the new system would destroy medical confidentiality; would allow prying which would be swept under the carpet and would eventually lead to another big news story about unsecured data. “I can’t wait for Channel 4 News to download the first tranche of unsecured confidential data,” said a respondent.

Compliments and supportive comments

Amid the welter of criticism, there were positive comments, and not only about PACS. “As a potential patient I look [forward] to the system being made to work and being in my interests,” said an occupational health doctor.

“NPfIT is the future for the healthcare sector,” wrote one respondent. “The benefits to patient care far outweigh any risks,” said another.

Dr Simon Eccles, national clinical director of NHS Connecting for Health, rather predictably, made a supportive comment: “The National Programme for IT is potentially the biggest advance in the way we deliver the health of the nation since the founding of the NHS. Sadly this is not appreciated,” he wrote. His sign-off was unexpected: “The programme is being actively obstructed by a minority of GPs for essentially selfish reasons.”

Linda Davidson