Doctor's support of NHS National Programme for IT declines, says new survey

For example, whereas a year ago 70% of GPs thought it was an important NHS priority and 56% were enthusiastic about it, those figures are now down to 41% and 21% respectively. But one aspect of previous surveys' findings is unchanged: nearly all doctors have little information about NPfIT – despite 86% saying that consultation with individual doctors is important, only 5% say they have had adequate consultation. 71% have had none – essentially no improvement on the position two years ago.

In addition to the main survey, respondents were invited to write-in their comments about the Programme: these were 191 replies of which 93% are critical.

Previous surveys indicated that doctors were reasonably positive about NPfIT. That is no longer true. Two examples (re GPs): (Q4) only 41% now say that NPfIT is an important priority for the NHS compared to 58% six months ago, 70% a year ago and 67% two years ago; and (Q13) only 21% say they are fairly or very enthusiastic about NPfIT – a big drop from the 45% reported six months ago and 56% a year ago. Even support for the NHS Care Records Service (NCRS) has fallen off: a year ago, 58% said it was very important – now the figure is down to 20%. Findings re non GPs are not quite so bad but, even so, are not encouraging. For example, re NCRS, a year ago, 66% said it was very important – now that's down to 34%.

Earlier findings of poor consultation, however, have continued despite (Q7) a continuing strong view (86%) that consultation is important (for 54% it's very important): only 5% (Q6) say they have had adequate consultation and 71% that they have had none – little better than the 75% recorded two years ago. A new finding is that 89% of doctors say that early consultation is more effective than the deferral of engagement until there are working systems available – which appears to be current NPfIT policy. Only 3% (1% of non GPs) disagree.

Most doctors know little about NPfIT: (Q1) 31% have no information about it (including an extraordinary 5% for whom the survey was the first they had heard of it) and only 4% claim to have had a lot (compared to 1% two years ago).

A possibly related finding is that, when asked (Q12) if they agreed with delegates at a GP conference at the BMA last year that GPs should not engage with the Care Records Service until concerns about confidentiality and how the system will work are met, 79% of GPs agreed. But NPfIT insists that confidentiality will be much improved by the new systems, so the finding may be a consequence of widespread lack of consultation and therefore of understanding. Another example may be Q11 which asked doctors if they thought that the advent of the NHS Care Records Service was likely to mean that the confidentiality of patients' records will be more or less secure than it is today. 70% of GPs thought it would be less secure and only 6% more secure – for non GPs, the figures were 42% and 18%.

Q5 (Is NPfIT focused on the right projects?) confirmed earlier findings that doctors are much more enthusiastic about the NHS Care Records Service than they are about Choose and Book: 59% of GPs and 73% of non GPs consider the former to be important or very important but only 11% (GPs) and 28% (non GPs) think so about Choose and Book – which 61% of GPs now consider to be unimportant or not at all important. A year ago that figure was 47%.

As in earlier surveys, most respondents (81%) believe that the alignment of local working practices with NPfIT is important before it is introduced locally — only 4% think it unimportant.

A comparison of GPs' and non GPs' views

Previous surveys found that GPs had a rather more negative view of NPfIT than did non GPs (largely hospital doctors). As noted above, this survey indicates that GPs now have a significantly more negative view – for example:

> Regarding NPfIT's likely effect on clinical care in the longer term, 36% of non GPs expect significant improvement – but only 13% of GPs agree.

> Likewise, regarding the likely effect on a doctor's working life in the longer term, 28% of non GPs expect significant improvement – yet only 9% of GPs do so. Moreover, 13% of GPs expect a significant worsening compared with only 4% of non GPs.

> 68% of non GPs think that NPfIT is an important or very important priority for the NHS – only 41% of GPs agree.

> Whereas only 28% of non GPs think Choose and Book is important, a mere 11% of GPs (who mainly will be expected to operate the system) agree – hugely outnumbered by the 61% who think it's unimportant.

> When asked if the Care Records Service would be likely to mean that the confidentiality of patients' records would be more secure, only 18% of non GPs thought it would. That may be bad enough – but far worse is the finding that only 6% of GPs think so.

> This question asked respondents if they agreed that GPs should not engage with the Care Records Service until specified concerns were met. 59% of non GPs do so agree, compared with GPs at 79%.

> When asked about their likely level of support for NPfIT, a rather unimpressive 42% of non GPs say they are fairly enthusiastic and 9% very enthusiastic – but, for GPs, the figures are far worse with only 19% fairly enthusiastic and a mere 2% very enthusiastic. A year ago the equivalent figures for GPs were 36% and 9%.

Whereas the findings of past Medix surveys contained much to encourage NPfIT, that is no longer true. Doctors' responses throughout this survey indicate a decline in support over the past year.

That is particularly true of GPs. The many problems recorded in this survey seem to spring from continuing poor levels of consultation. It may be that, as new services become available and can be seen and used, that decline will be reversed and enthusiasm reignited.

However, the responses to Q7 (re the importance of individual consultation) and Q8b (re the need for early consultation) suggest that it would be dangerous to rely on that approach. It seems likely that, if levels of understanding of the advantages of NPfIT amongst individual front-line doctors, especially GPs, were massively increased by rigorous, interactive, detailed and widespread communication, support and enthusiasm for NPfIT would strengthen.

And that should have a knock-on effect to other clinical staff and a consequential blossoming of the Programme's prospects for success. But, after more than two years of delay, it will be a major challenge to overcome the distrust and cynicism that seems to be replacing enthusiasm in the minds of many doctors. That challenge must surely be addressed urgently.

Related links to this article:

Medix

NHS National Programme for IT

Background information to this article:

Medix survey Q647 was commissioned by bjhc&im, Computer Weekly, the Guardian and E-Health Insider to investigate the views of doctors in England about the National Programme for IT (NPfIT). It was carried out at the end of January 2005 and is the fifth survey Medix has carried out on this subject, starting from February 2003. There were 900 respondents, about 1% of relevant doctors, representing a balanced range of specialties.

The survey ran for five days at the end of January 2005. Respondents were invited to the Medix website (www.medix-uk.com) where they completed the survey on line. Completion took about 4 minutes. Medix has strict procedures to ensure that responding doctors are eligible and that a doctor who has completed the survey cannot do so again. 900 doctors responded, all of whom practice in England.

Respondents are about 1% of the 85,000 or so doctors who practice in England and will, therefore, be affected by NPfIT. Respondents cover a wide and well-balanced range of specialties and, in terms of grade, commitment and decade of qualification are a good representation of practising doctors on the GMC register, with some bias towards general practice. That and the large sample achieved are strong indicators that respondents represent the views of the wider population of doctors affected by NPfIT. One factor that might be thought to count against this is that doctors responding to a Medix survey (via the Internet) might be rather more favourable to IT systems than is the wider population. Various Medix studies suggest, however, that this is of little significance.

The objective was to investigate the views about NPfIT of doctors practising in England and to consider how those views had changed over the past two years, Medix having completed five surveys during that period.

The questionnaire was essentially unchanged from the questionnaires used in February 2003 (Q265), July 2003 (Q354), February 2004 (Q476) and July 2004 (Q558). However, three questions from Q558 were dropped and three new questions (Qs 8, 9 and 11) were added.

e-Government National Awards 2004: Winners were announced on 19th January

The e-Government National Awards (www.e-GovernmentAwards.org.uk) recognise and praise the best strategies, achievements, teams and individuals in UK e-Government. The guest of honour at the 2004 Awards dinner was Ian Watmore, head of e-Government at the Cabinet Office e-Government Unit.

Full details on winners can be found at this link.

A gallery of photos of Awards winners and the dinner can be found at this link.

Organiser for the awards was PublicTechnology.net, the leading online news provider for those in UK e-Government and public sector IT, with 29,300+ readers per month. The Awards were supported by the Cabinet Office e-Government Unit and Socitm. Platinum sponsor was Intel and also a sponsor was Jobsgopublic.