Access targets

The one healthcare IT project certain to get mainstream press attention is a pledge to give patients access to their records.

No matter how often it is hauled out of the cupboard marked ‘whizzy ideas for making the NHS sound more modern, brighter and shiner’, the idea is certain to get papers excited.

All that changes is the technology for doing it. So, right back in 2001, the Labour Party promised in its election manifesto of that year that: “We will give every citizen a personal smartcard containing key medical data, giving access to their medical records.”

This, it added, would give “older people, people with disabilities and their carers” more control over their information and so over “the services they want.”

Over the next decade, enthusiasm for smartcards evaporated but patients were still promised access to their GP records and to the new Summary Care Record, via the HealthSpace website.

Its clinical director, Gillian Braunold, said she was sure there was unmet demand for the service, because “there are frequent flyers to the health service who we think are frustrated by their lack of access to 21st century health service IT.”

HealthSpace is dead

The present government killed off HealthSpace, but still made access to records its flagship healthcare IT promise in the heady days in which it first took power.

It pledged that patients would have access to their GP records by 2015 in its May 2012 NHS information strategy and in its July mandate to what was then the NHS Commissioning Board.

The strategy promised that by 2015 all general practices would be expected to provide not just access to records but the “electronic booking and cancelling of appointments, ordering of repeat prescriptions and electronic communication with the practice.”

The BBC reported former health secretary Andrew Lansley saying that this would “take the hassle out of healthcare” while The Telegraph reported that it would give patients more “power.”

The present health secretary, Jeremy Hunt, went further in his Policy Exchange speech in January that called for a ‘paperless’ NHS by 2018.

On the way to this target, he said what is now NHS England would develop electronic health records spanning health and care by 2015, and that it would run a consultation on giving patients access to these records this summer.

So it’s noticeable that news about this big idea has dried up of late. NHS England’s recent focus has been on hospitals adopting traditional electronic patient record systems, and funding extensions to them such as e-prescribing and scheduling.

So has the government put its ambitious plans on the backburner, or are we soon to be dazzled with an influx of money, energy and enthusiasm to make patient records access a reality?

Long live the ICSP

The government’s big pledge on patient records access not only repeats some of Labour’s initiatives, but is actually less ambitious (or possibly more realistic).

The documentation for the new directed enhanced service that gives GPs financial incentives to give patients access to records estimates that once 100% of GP practices are able to do this, about 5% of patients will take it up.

That’s about 2.6m people by 2015. By contrast, NHS Connecting for Health aimed to sign up 4m people to HealthSpace by March 2014.

By this date, if the Treasury had agreed its plans, the site should have been giving people access to test results and letters, appointment booking and repeat prescriptions, and a “Facebook-style communicator” to contact clinicians.

HealthSpace never got close to the level of take-up that it would have needed to make this a reality. In 2011, EHI Primary Care established that just 60 patients a month were viewing their SCR via the portal.

This was out of the 3,000 patients who had set up the ‘advanced account’ necessary to get access; and achieving that much had cost £18m over the previous 12 months.

So it was hardly a surprise that it was quietly killed off last year. Yet, like so many NHS IT projects, it now seems to have risen from the dead in a slightly different form.

At EHI Live 2012, Bob Gann, NHS England’s director of partnership and strategy, said an Integrated Customer Service Platform was being planned as the “digital front door to the NHS”.

Almost inevitably, he said this otherwise exciting initiative would enable patients to access their records, book appointments and communicate with their GP online.

“We know there is demand to do things differently and to do things better,” he told his audience. “There is a significant wish [among the public] to transact and do things online and in a digital environment.”

EHI PC reported this month that the team in charge of the ICSP is predicting that it will save the NHS a tidy £1 billion by encouraging patients to get involved in self-booking and self-care.

The beta launch of the platform is due this November, from which time EHI PC and its readers will be waiting with bated breath for the savings to start rolling in.

Go GP access?

Despite the development of the “daughter of NHS Choices”, general practices are still expected to offer their own access to records and other online services.

NHS England’s business plan, ‘Putting Patients First’ says all practices must have the “technical capability” to give people access to their records by April next year.

Data collected by the Health and Social Care Information Centre and published through its Indicator Portal suggests that around a fifth of practices do not have the functionality to do this at the moment.

Although the bigger GP system suppliers offer the functionality, those practices using INPS, Microtest, iSoft and Informatica systems were listed as not having it.

At the same time, the HSCIC’s figures suggest that of the practices that had the functionality, fewer than 1% (61 out of 6,200 practices) have switched it on.

This suggests that while there are a number of notable, passionate advocates of the idea of giving patients access to their records, there is a distinct lack of urgency among most of England’s GP population.

So what will persuade the practices that still need to flick the switch to do so? Some money might help; and a new DES of up to £985 is payable to practices that can show they have at least 5% of their patient list signed up for records access by March next year.

A further £0.14 is available for every patient registered for booking appointments or ordering repeat prescriptions online.

However, NHS England is only aiming for half of practices to be offering these transactional services by next April, when around 40% are offering them already.

A big, well supported campaign is another option. And, at the beginning of this year, it appeared that the Royal College of GPs was going to get a contract to get ‘Patient Online’ moving.

But recent attempts by EHI PC have failed to find even a flicker of life in the project.

Meantime, those plans to consult the public on access to new, cross health and social care records seem to have vanished.

Projects on track

A slightly different target that does seem to be charging ahead of expectations is that, again by 2015, all NHS patients will be able to leave feedback in real time on any service.

Care Connect allows patients to go online, ring a telephone number, text or use social media to log concerns that need resolving, ask a question or provide feedback on their experiences.

It is being piloted in 18 trusts this month. However, the new service, which is being delivered via the MySociety platform, has raised eyebrows, because other independent providers, such as Patient Opinion, have been working away at feedback (and NHS response) for many years.

Other patient facing initiatives on the cards include the Code4Health project to teach patients to code their own apps, due to go-live this ‘autumn’, and the Health Online programme to give 100,000 patients digital skills by next April.

NHS England recently put out a £2m tender for the patient training service, which got a mixed reception on EHI PC.

Some commenters despaired that it amounted to teaching people to use the internet, while others hoped it would be a big step forward in terms of helping those with long term conditions to help themselves.

A lot will depend on the content of the new programme; but the clock will be ticking loudly to get 100,000 patients registered and through it within six months.

Out of the Mail, out of mind

The clock is also ticking on those big, early government pledges to give patients access to records and transactional services via the ICSP and their own practice websites.

But it’s ticking less loudly than it was; perhaps because the government doesn’t expect to get called on missing the targets it has set. Nobody – except, perhaps, EHI and its readers – remembers that 2001 smartcard pledge, or laments the passing of HealthSpace.

The sad fact seems to be that while giving patients access to records and new digital services really could help them and modernise the NHS, policy wonks and hacks find it much more exciting to announce new initiatives than to plug away at old ones.

EHI will run ‘target watch’ as an occasional services in its weekly newsletter, with the next instalment this Friday. You can read the first target watch feature, looking at the acute sector here, and you can sign up for our newsletters here.