From patient records to NHS SBS: the challenges ahead for GP IT

At a time when NHS unions and doctors' associations are presenting an increasingly united front to oppose the government's health and social care bill, it comes as no surprise to hear Dr Chaand Nagpaul, the GP IT lead on the British Medical Association's (BMA) IT committee, describe the changes as "hugely detrimental". According to Nagpaul, while health secretary Andrew Lansley originally proposed stripping out a tier of NHS administration by abolishing primary care trusts (PCTs) and strategic health authorities (SHAs), the new-look NHS will have more bureaucracy. "What we have now on the table is more structure than we have had before," he says, citing 241 clinical commissioning groups (CCGs) at the last count, and about 50 commissioning support organisations. In addition there will be about 50 NHS commissioning board regional outposts, outnumbering the SHAs they replaced. Another significant change to the way the NHS operates will come from plans to allow patients to have online access to their health records by 2015 . The risks, benefits and logistics of such a plan have not been considered, according to Nagpaul. Patients already have the right to access their medical records at a GP surgery, he points out, given safeguards such as the removal of reference to third parties or information likely to cause patients psychological harm. The system also ensures that it is only the patient who views their record. In contrast, Nagpaul believes that giving patients remote access to their records creates a possibility that someone other than the patient could access their data, such as where a record is accidentally left open, for example. Employers could pressurise staff into providing access to their records to prove they have visited their doctor, or in place of getting a medical opinion, while insurance companies could bypass objective medical opinion by having patients provide extracts from their records, Nagpaul says. "There are a myriad of examples of how it could be so easy to put pressure on a patient in a way that would not currently be possible and would not necessarily be in the patient's interest." There's also the logistical issue that medical records have historically been recorded in a format designed for healthcare professionals, and remote access could see large numbers of patients seeking explanations from staff around the data held in the records. "It's like giving me my accounts without meeting my accountant," he says. "We're absolutely in favour of patients being empowered through access to information about their health, but what the government is proposing seems to be an end point without having thought through the issues," he adds. Meanwhile, GP commissioning of ICT is suffering from a lack of preparation, he believes. ICT management was "completely absent" from the government's white paper on NHS reforms and there is nothing in its guidance about where it will "statutorily sit". One solution could be to source services from NHS Shared Business Services (SBS), but Nagpaul has doubts around such a strategy. "I am not saying this is the case in all areas, but we certainly have considerable feedback from many GPs in many areas that outsourcing to SBS has resulted in a range of problems, from the fact that the service is remote and is not responsive to the end user, who is the GP." Nagpaul is, however, sanguine about the national approach to GP ICT, and enthuses about "fantastic developments", including N3, which he describes as a huge achievement, and GP to GP record transfer which is "unheard of in secondary care". Electronic prescribing, and the infrastructure at GP surgeries where all consultations are recorded electronically, are also a step forward. "That is a huge advance," he says. "In fact, internationally you won't find primary care anywhere developed in this way. I have spoken to doctors from Canada and America, where there's a large reliance on paper records in addition to IT." After the National Programme In the near future the BMA's IT committee will be focusing its attention on ensuring that "what has worked is not thrown away". Nagpaul is positive about the GP Systems of Choice framework, which includes iSoft, EMIS and System One on its supplier list. The framework is very clear about the responsibilities of PCTs, the choice of systems and the ways in which they will be supported, he says. "Our problem has been that it has not been implemented to the letter in the way we would have liked, so there have been some problems along the way, but as a framework it has been of benefit." The issue has been that "in some PCTs the resources weren't adequate to be as responsive as the framework was phrased", he adds. But Nagpaul says the BMA wants the positive elements of the framework to continue, and to ensure that GPs continue to have a choice, free of political pressure to conform to a particular system, and that there is good ICT support. "This is also part of a wider debate about where the government wants to see NHS IT, and it stems into the debate about what the government wishes to see in place of the National Programme for IT," he says. This article is published by Guardian Professional. 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