Calls for clarity in spirited BMA confidentiality debate

Doctors queued up to speak on the confidentiality issues raised by centralised electronic records in a lively open debate at the British Medical Association’s annual representatives meeting in Manchester.

The debating time was extended to allow more speakers to get their views across and passions on the subject ran high. Most contributors to the debate were sceptical about the government’s plan for centralised health records but others praised the developments, arguing the case for greater sharing of information across the NHS.

Dr Hamish Meldrum, chairman of the BMA’s general practitioners committee, said: “We, as GPs who have been most involved in IT, seem to be being accused of being rather conservative or Luddite, but I’d like to make two points. There is a lack of clarity about what is being proposed and there is a lack of awareness about what’s being proposed.”

He said the issue of clarity was beginning to improve, but far more awareness was needed among the public and professionals.

Dr Mary Hawking, a Bedfordshire GP with a special interest in IT, cited the case of Helen Wilkinson when she expressed concern over the arrangements for correcting errors in records. “We have no mechanism for ensuring that a record is accurate, contemporaneous and that errors have been corrected,” she said.

“Like everyone I am in favour of being able to access records where appropriate and necessary, but I do not feel at present we have a system that is going to be safe for the patient, doctor or anyone.”

Dr Richard Vautrey, a practising GP and negotiator on the General Practitioners Committee, said he was not surprised by the numbers lining up to speak because doctors had a fundamental duty to protect patient confidentiality. He argued the need for a fully informed public debate about the level of detail to be included in the care record and how patients could opt out without compromising their access to NHS services.

Developments such as the secure transfer of records from practice to practice were long overdue, he said, “but fundamental to all this is the need to maintain the high levels of trust patients have in their doctor.”

Katie Fletcher, a member of the BMA Students’ Committee, struck a different note, saying: “I’m excited that the NHS is finally moving into the 21st century.”

She said the National Programme for IT had the potential to revolutionise healthcare and congratulated the DH for having the guts to “go for it” despite the conspiracy theories.

Conspiracy theorists also had their say with warnings that information in the new system, which would include details such as ethnicity, could be used for reasons other than healthcare.

Grant Kelly, a GP and former chair of the BMA IT committee who said he was “wearing several anoraks” commented: “Confidentiality in this context is mixture of two things: access control and governance.”

He said he had seen the technological advances in access control and it was difficult to believe how specific they could be. “I’m content with access control, but it is fairly simple; the difficult thing is who makes the decision about who looks at which bit of data. That is the governance issue.”

He cautioned the association: “It is between us and the patient to decide how it [information] is shared and in the end it is the patient who has the final say. But it would not be good for us to be seen to restrict the sharing of data.”

Later, the ARM voted 92% in favour of a detailed motion that called for the government to urgently consult publically on electronic care records. The BMA asked that the consultation should cover issues around opting in or out, what information is held on the spine and who has control of the information, and all results should be publicised fully.

One part of the motion, to back the concept of a centralised health record system, was voted on separately and revealed a clearer split in opinion. However, it was passed with 56% of delegates agreeing with the statement.