Power plays

The strategy makes much of its ‘vision’ for moving the NHS towards a ‘digital first’ service, and giving researchers, commissioners, clinicians and patients the information they need to make informed choices about health and care.

But it sets out little by way of targets or milestones and is virtually silent on what organisations will be put in place to support the vision – or where the money will come from.

Reaction to the strategy has been muted in the GP community, with doctors and suppliers welcoming the commitment to more transactional services for patients, but raising practical questions about giving patients online access to their GP records by 2015.

Commenters have also raised concerns that the strategy is silent on such pressing issues as what will happen to GP IT support and systems as primary care trusts are abolished and GPSoC comes to an end in 2013.

BMA and RCGP joint IT committee chair – Dr Paul Cundy

“[The strategy] is largely fairly sensible. [It talks about] online booking of appointments and prescription requests; but a lot of us are doing that already, so it’s a non-issue.

“There’s no problem with [patients] having access to their records, but there are issues which will have to be sorted out first, not the least of which is knowing it is the patient who is accessing the record.

“Also, it has long been my personal view that the records I hold on my computer systems are not the patient’s records. They are my records, and the patient element is a component of them.

“There’s an enormous danger in letting patients believe that they can edit the tools I use to treat them. Yet the message from politicians is that ‘it’s your record and you can write it’.”

BCS Primary Healthcare Specialist Group chair – Roz Foad

“The call for a reduction in face to face consultations as a means of saving money is something that should only be introduced with patients involved in the implementation.

“Some will welcome the idea of telephone and, no doubt later, video consultations as a way of saving time. But the heaviest users of the NHS – the elderly with chronic conditions – will most likely see this as another reduction in service.

“What GPs have been crying out for since before the National Programme for IT in the NHS is the introduction of an electronic discharge summary direct into their records, in a form which provides the right, relevant, correctly coded information – where is that an actual target in the new strategy? It is flagged up as a good pilot scheme example, but it should be a priority target, not just an ‘encouragement’.

“What I have not found in the strategy generally is the specifics; such as who is responsible for GP IT system commissioning and support after March 2013, which is less than a year away. What is the replacement for the National Information Governance Board? Information governance will be ever more critical, and I see no independent, credible, replacement.

“Indeed, I very concerned about the consent issues around sharing confidential medical records with outside bodies. Obviously, there are great benefits to research organisations, to public health and so on in doing this, but patients must be fully informed about where their data is going, and have the opportunity to opt out if they so wish.”

Chairman of the BMA’s GPs Committee – Dr Laurence Buckman

“There are GP surgeries which have been pioneering online booking and repeat prescriptions for a while now, so we would support the wider implementation of this, as long as it doesn’t impact on patients without IT access who [will need to be able to] continue to book appointments in the usual way.

“However, we would caution against the potential use of email for consultations, because compared to a telephone or face-to-face consultation, it is difficult for GPs to assess someone quickly and safely this way.

“When it comes to patients being able to view their records online, we believe patients should have access to their health records but we’d want to be satisfied that their records would remain secure before this was implemented.”

GP and EHI Primary Care columnist – Dr Neil Paul

“My reaction is: records access by 2015 – do we need that long? The government should be more ambitious. Most of what is in the strategy is doable now.

“And I don’t think it goes far enough. We need better, secure communications with patients rather than email. We need something like the banks have, so we can send messages to patients safely and confidentially.

“We need to be publishing more performance data. For example, hospitals often take months or weeks to let patients know what their CT scan results are, when I know they are reported on the same day. Publishing some of this data would force secondary care to invest in IT more.

“We need to do more than just share data. We need better tools to analyse data and we need open access to clinical systems to allow custom built modules that don’t rely on big monopolies to dictate what we can and can’t do with it.”

Dr Foster co-founder – Roger Taylor

“My overall impression is that the objectives are absolutely right, in particular the objective of giving patients much more direct control over their information and the idea of the centre being an enabler for local innovation.

“The problem is that these are both quite challenging. And while the objectives have been set out, the detail on how we are going to achieve them is not there yet.

“I certainly think, for this strategy to work, it’s going to have to rely on the centre working effectively with local NHS organisations; and they have to be able to work with the private sector.

“To encourage investment and innovation in this space we are going to need more clarity on the detail on how to work this out. If they don’t realise that, the strategy won’t work.”

Chief executive of Patient Opinion – Dr Paul Hodgkin

“Overall, we welcome the strategy and the idea of patient feedback, but we feel it doesn’t take advantage of the potential for social media, and that’s very important.

“Throughout the consultation period, we have fed in comments around social media and it’s somewhat disappointing that it doesn’t feature more strongly.

“The strategy doesn’t prepare the NHS for what may be about to happen when there are cuts and people start feeding back en masse.”

INPS medical director – Dr Mike Robinson

“Patients have had the ability to book and cancel appointments and manage their repeat prescriptions online for some time. If the NHS information strategy creates a national standard for this, it could be good news for patients because every person in the UK will get the same level of service, regardless of the clinical system that is used at their registered practice.

“Patient access to their records online requires careful thought. We need to consider why this service is being provided: what problem does it solve?

“While many GPs may encourage patients to get more involved with their own healthcare provision, it is important to consider how well patients will understand the information their GP has recorded about them. [Will] having sight of the records cause anxiety and create additional workload for GPs, who could have to spend additional time explaining what has been written in patient notes?

“Online access to test results should be encouraged, as long as what the patient sees is an interpreted explanation, such as a traffic light system (green – results ok, amber – no problem but requires monitoring, red – contact GP). This is because the raw data will not mean anything to the majority of patients.”

EMIS chief executive – Sean Riddell

“We support the government’s transparency agenda, underpinned by consent, confidentiality, underlying standards and common terminology, which EMIS has long promoted.

“We also welcome the move to local decision making and innovation. This can only be good for the healthcare technology industry as it continues to support clinicians in delivering high standards of patient care.

“[The strategy] dovetails extremely well with our existing strategy for software development, sharing our emphasis on integrated care systems based on the principles of connectivity (interoperability), and the support of clinical and patient portals that give a more joined-up view of the patient record.

“Our patient portal patient.co.uk already receives more than 5m visitors a month, and last year over 2m repeat prescriptions were requested through its patient access portal.”

Managing director TPP – Frank Hester

“The framework aligns perfectly with the direction TPP is already heading in.The sharing of information, across primary, secondary and social care has consistently been a key goal for TPP.

“We are already engaging with clinicians to promote cultural change and encourage the sharing of essential patient information to facilitate the ethos of ‘no decision about me, without me’.

“We will continue to work with patients, and care professionals, on the extensive development and improvement of SystmOne.”