GP says clinical consultation not delivering

A GP involved in advising Connecting for Health has claimed the programme is being mismanaged with professional input ignored and that the Choose and Book software is potentially dangerous.

Dr Nigel de Kare Silver, a GP in Neasden, north London, and IT lead for Brent Primary Care Trust, has outlined his concerns in an article in the British Medical Journal this week.

Dr de Kare Silver was an IT representative for his strategic health authority at National Programme for IT workshops last summer and has since been involved in more meetings and correspondence with the NPfIT London programme as part of its consultation process.

He writes in the BMJ that despite meetings being continually cancelled, rescheduled and relocated the initial workshops involved people passionate about getting the best possible outcome and that the workshops had resulted in “vibrant discussions with clear conclusions”.

He adds: “We were clearly told by the session leaders from British Telecom and IDX, the companies involved, that their contract was to design and supply clinical software to be used universally across the NHS.

“What did we get when we were presented with the draft version? We were shown screens of a third-rate computer program lifted from the existing system of US hospital administrators. Its screens of nursing notes were cumbersome and displayed none of the features we had asked for. Promised that this early version was only for demonstration purposes, we departed disappointed.”

Dr de Kare Silver wrote that later in the year he attended a meeting held at BT headquarters at which there were “lame presentations by various strategic health authority IT leaders. Afterwards a senior team member privately disclosed considerable embarrassment at the software demonstration, which had moved backwards from the versions shown months earlier.”

Dr de Kare Silver told EHI Primary Care that none of the work that he and many others had put into the programme had seemed to be reflected in what was being produced.

He added: “My overall concerns are that it’s a massive programme with the right objectives but it’s costing a fortune and it’s being totally mismanaged. For all the millions that are being spent on this it’s a complete waste of public money as far as I can see.”

Dr de Kare Silver is also critical of the Choose and Book software, which he describes in the BMJ article as the “really frightening module.” He says that the software is intended to be the preferred pathway for GPs to seek advice, without referral, from consultants.

The article states: “Here there is a big problem. The advice cannot be filed, by either the consultant or the GP. Once the replies have been sent, the advice is deleted from the Choose and book screens, and no mechanism exists to integrate it with clinical results. There is no file note for the GP or the consultant. This is a major clinical governance issue.”

Dr de Kare Silver told EHI Primary Care that it was crucial that the advice was able to be integrated into patients’ records.

He said: “At the moment it’s the equivalent of being at the bottom of a 10ft-high filing cabinet. It needs to be retrievable both at our end and the hospital end. Programme managers know this but their inability to deliver it is really frightening. The clinical governance implications are huge.”

Dr de Kare Silver said there was also confusion locally both at practice and hospital end about what sort of machines would be needed to allow the Choose and Book system to work. His practice is involving in piloting Choose and Book. He said: “I will use it on a trial basis but I will not use it if its too complex or it I feel it puts my patients’ health or clinicians into a vulnerable situation.”

In the BMJ article Dr de Kare Silver describes how he attended a meeting at which the Choose and Book software was demonstrated.

He writes: “The module’s blurb says that it will take GPs 20-30 seconds to progress through the screens. Who says? And on what evidence? We sat through about half an hour of frustration while three trainers struggled with their computers to demonstrate the module. The application screens are slow, and the computers often fail to pick up the programs.”

The article adds: “When we got really frustrated we were told that this was a period of change that would have to be managed across the health service. We politely pointed out that the phrase "change management" applied to progressive developments, not a reversal to Neanderthal processes. The conversation was moved on.”

Despite all the problems Dr de Kare Silver told EHI Primary Care that he would be prepared to continue to give his advice on IT plans for the NHS in London.

But he added: “Every so often you need to stop banging your head against a brick wall and have a break. If I am going to go out of my way and give up time that I could be spending with my patients its got to be justified and what is the point if you go to a meeting and then they just carry on in the same way as before?”

E-Health Insider approached NHS Connecting for Health and IDX for a comment on Dr de Kare Silver’s concerns but they declined to respond by deadline.