Politics pushing NHS scheme

An influential report into the Summary Care Records (SCR) component of the £12.4bn NHS National Programme for IT (NPfIT) suggests that political agendas are still affecting rollout of the scheme.

SCR will provide a centrally-stored electronic health summary from individual patient medical records, accessible to health professionals in different locations.

The University College London study, published last week, looked at four of the six early adopter sites for SCR, each consisting of health providers in particular districts.

Although the report was focused on SCR, the wider political context has been hard to ignore, according to report author Trisha Greenhalgh.

The study found that early adopters felt under pressure as Connecting for Health (CfH), the NHS agency responsible for rolling out NPfIT, pushed the project forward to meet targets.

“If you make unrealistic expectations, people just aren’t physically capable of finding the time to do the things you’re asking of them, and that means they will resent the project,” said Greenhalgh.

Scepticism in the clinical community means that CfH must consider the report findings carefully.

But political pressure to keep the already delayed project on time and on budget means CfH must exert a certain amount of pressure on all parties to keep the scheme moving, said Greenhalgh.

The same dilemma applies to another controversial part of the scheme ­ the consent model of the summary care records.

The current model means that those who do not opt out of the scheme implicitly agree to have their records shared with any clinician ­ but people in early adopter sites did not understand the implications, according to Greenhalgh.

“There is a need to simplify the consent model, and make it work on a case-by-case basis, rather than granting general access,” she said.

The case-by-case model is used in Wales and switching plans would require a degree of technical refitting by CfH.

But this is a workable and necessary solution, according to Chaand Nagpaul, of the British Medical Association’s GP prescribing committee.

“The model of implied consent is not fit for purpose. It is possible to modify the model and this is the line that should be taken,” he said.

NPfIT in a nutshell

• A broadband network connecting health sites ­ known as N3 ­ has been implemented. Savings have been made from decommissioning legacy systems.
• The choose-and-book system is an electronic service allowing patients to pick the place and time of their appointments ­ and is now used in 98 per cent of GP practices.
• Half of GP surgeries are on the GP2GP system which will allow the transfer of medical records between surgeries.
• The electronic prescriptions service is the most delayed, mainly because suppliers have been told to focus on other parts of the programme.

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