Doctors critical of NPfIT costs, survey finds

Doctors believe the National Programme for IT (NPfIT) could provide valuable benefits to clinical care in the long term, but they are increasingly critical of its costs and the way it is being implemented, according to a survey released today.

The independent survey, commissioned by E-Health Insider, bjhc&im, Computer Weekly, Financial Times, Guardian, GP and Hospital Doctor, is the latest in a series by Medix UK tracking GP and hospital doctors’ opinions of the £6.2bn NHS IT modernisation programme.

A total of 1329 doctors – 604 GPs and 725 other doctors – answered the survey. Medix says respondents covered a wide, well-balanced range of specialties and grades. The survey is available in the EHI document library. 

Headline findings suggest that high numbers (40% GPs, 59% other doctors) believe that NPfIT will improve clinical care in the long term though fewer think there will be a positive effect over the next year or two (19% GPs, 31% other doctors).

Asked to rate progress on the programme so far, just 1% said it was good or excellent and a worrying 68% judged it to be poor or unacceptable.

The profession has growing doubts, too, about whether NPfIT represents a good use of NHS resources with only 17% of respondents believing this was the case. This contrasts with previous findings in February 2003 when 47% said the programme was a good use of resources and 31% who answered the same question positively in February 2004.

Dr Simon Eccles, NHS Connecting for Health’s clinical lead for hospital doctors, said: "Doctors think it’s going to improve clinical care and that’s great."

Asked about the hospital colleagues who had shown support for the ideas behind the national programme but expressed considerable concern about its implementation, he replied: "I would be slightly nervous that we’d brainwashed them [respondents] if they all said ‘Great. Fantastic’.  People are not going to believe the programme is capable of what is promised until they start seeing it.  That’s fair enough.

"But if you take things like PACS [picture archiving and communication systems], we are starting to deliver it and they love it.  This is a long slog.  But having said that it’s the fastest anyone has ever taken to implement these things."

Choose and Book particularly unpopular

Choose and Book came in for particular criticism in both the questionnaire and in comments added by respondents. Over half (58%) of GPs said the electronic choice and referral system was “unimportant” and 52% did not expect to use it before December 2006 – the new target for achieving widespread national implementation. A small minority (9%) say they will never use it.

One GP commented: “Big white elephant. Choose and Book is to please the middle classes only. It has no impact on patient satisfaction.”

Technical problems were raised by some: “I was an early user but have found the system very time consuming and not really a choice for the patient,” wrote one GP. Another said: “Choose and Book started here but all the information was incomplete and access to appointment systems impossible so it has collapsed as far as I am aware and we are no longer able to use it…”

Some distinguished between the two elements of Choose and Book. “Choose and Book is crazy. Electronic booking is an excellent idea,” commented one GP.

More support for other NPfIT services

In broad terms, there was more support for other NPfIT offerings, though the NHS Care Records Service (CRS) is seen as being less important than it was two years ago. Then 58% of GPs and 66% of other doctors said it was very important. In the latest survey only 18% and 27% thought the CRS was important.

Most were unaware of when they were likely to start recording patients’ clinical details electronically as part of the CRS. Confusingly, 16% of GPs and 3% of other doctors thought they were already recording details as part of the CRS which is due to start pilots in late summer 2006.

One GP summed up his thoughts: “Some good (ETP, GP2GP); some acceptable (care record spine); some ghastly (C&B).”

Knowledge of the programme has grown steadily since the first survey in February 2003 recorded 94% of the profession saying they had received little or no information about NPfIT. That said, the latest figure for those who have received little or no information still stands at 56% with 6% saying they had never heard of the programme.

Consultation remains an issue

Lack of consultation remains a sore point. Asked to respond to the statement: “There has been adequate consultation with me about NPfIT”, 84% of respondents either disagreed or strongly disagreed. Equally, 89% of respondents thought consultation was important.

One respondent wrote: “I am enthusiastic about the concept of NPfIT and the aims are generally very laudable. However, the strategies implemented have largely ignored the concerns and advice of those who will be using it…”

Another gave chapter and verse: “When I have been consulted about NPfIT by attending two day workshops, the views and concerns expressed by myself and other GPs were NOT taken into account.

“For example, we expressed concerns that the Choose and Book service was too slow and had too many steps. We piloted Choose and Book a year later and sure enough it took 20 minutes to refer – this is an unacceptable amount of time just to simply request an appointment.”

‘Language’ difficulties presented difficulties for one respondent who said: “If the people trying to introduce this spoke the same English as the rest of us we may get somewhere. Nothing is more off-putting than incomprehensible jargon.”

Respondents were generally pessimistic about their NHS organisation’s capacity to implement NPfIT with 69% indicating they doubted whether sufficient funds were availably locally.

One said: “At present we do not even have computers on our desks in clinic. The IT budget for my whole trust this year is only £30,000. It appears there will never be sufficient funding to implement NPfIT.”

Dr Eccles said the national programme was "cracking value for money" with huge savings made by the central procurement of software. Referring again to the example of PACS, he said 13 trusts had dug in their pockets to fund the hardware costs and 51 had signed off business cases.

Documents

Medix-UK survey, 10.1.06