09.04.11
Keep NPfIT
Dr Simon Eccles, a consultant in Emergency Medicine at the Homerton Hospital in Hackney, East London and a national clinical director for NHS Connecting for Health, describes the benefits the programme is bringing for patient care right across the health service
The National Programme for IT is introducing electronic records for NHS patients right across the country, thereby completely transforming healthcare as we know it. We face a huge array of challenges, including patient expectations, demographic changes that are seeing more people live longer, and the constant march of technological and medical advances. And NHS Connecting for Health, the agency set up in 2005 to oversee the delivery of the programme, has made great strides in ensuring we meet these challenges. While the actual electronic patient records themselves are late, they are still rolling out this year and the infrastructure is mostly in place. More than 50 per cent of patient referrals are now made via our Choose and Book system, which allows patients to electronically book appointments at a time and place convenient to them, and over 3,000 GP practices are using the GP2GP system to transfer records securely between sites. As the programme continues, NHS CFH is committed to continuing to listen to and work closely with health practitioners to ensure the system is of maximum benefit to those who will most use it.
It is true to say that things do not always run smoothly, with one supplier giving up their main contract since the inception of the programme, but the contracts were purposely constructed with built-in flexibility, so that teething problems could be overcome without any extra cost to the taxpayer. We have always recognised that the programme is a business change, not an IT project. The Wanless Report, published in April 2002, recommended that four per cent of the NHS budget should be spent on IT. In fact, the overall cost of the IT for the National Programme is around one per cent, with savings of around 3.7 billion being made by procuring suppliers centrally rather than locally. This has freed up extra budget for personalising systems at a local level, ensuring that both patients and healthcare practitioners are getting a service which is of real benefit to them.
Indeed, local, professional ownership is crucial, which is why NHS chief executive David Nicholson commissioned the NPfIT Local Ownership Plan. The plan, which is fully in line with recommendations from the National Audit Office, enables strategic health authorities to define their own priorities and the IT support they require, helping them to deliver improved services to patients. NHS CFH involved clinicians throughout the country from the early stages of the programme with a range of practitioners advising on all of our systems. This advisory role was formalised in 2006, with the establishment of the Office of the Chief Clinical Officer. Within this team, a whole range of clinicians’ voices are represented from GPs and nurses to midwives and allied healthcare professionals. These representatives, known as national clinical leads, help to co-ordinate local input, ensuring that the views of those working most closely with the programme are properly represented. In this way, OCCO has ensured appropriate clinical input to every aspect of the national programme, aiming to secure increasing professional engagement and support.
Engaging with healthcare professionals and patients through clinician representatives provides regular, coherent feedback on the programme and its usability, but we also look forward to the outcome of the NHS Informatics Review, which is being carried out as part of the wider review of the health service led by Lord Darzi. The review, commissioned by David Nicholson and Hugh Taylor, the Department of Health’s permanent secretary, is examining how the NHS collects and uses data, and will look at the NHS Care Records Service as well as partnership working with the Department of Health. Recommendations from this review will be invaluable in ensuring that information is being used and shared effectively right across the NHS. As this is review is being carried out, we are continuing to ensure that programmes are still being delivered on time. With medical errors due to lack of information sharing still incurring enormous costs, surely the utmost priority is to get programmes underway as soon as possible. Picture and Archiving Communications System (PACS) - which allows digital storing and viewing of on screen X rays and scans – has brought savings of up to £300,000 in some primary care trusts after only 12 months of operation and has saved countless hours of medical time previously spent looking for lost films.
From my personal experience, I have already seen the time savings that the programme has brought in my hospital, particularly the accident and emergency department. Use of both electronic patient records and PACS has created a workable, efficient system which is shared and understood by all of its users. Doctors, nurses and other healthcare professionals can access vital information when we need it which, ultimately, leads to smoother inter-professional working and better patient care. Substantial achievements have already been made as part of the programme, with the NHS now an international leader in delivering universal coverage of digital X-rays, and it is vital that we build on these successes to deliver systems which further support an already thriving health service and give our patients the care they deserve.
Dr Masood Nazir is a GP at Hall Green Health Centre in Birmingham, which has more than 24,000 patients. He is also the clinical engagement lead for the Summary Care Records system for South Birmingham Primary Care Trust. The trust is one of the first in the country to adopt the SCR system, which makes an electronic record of patient information such as medication and allergies available, enabling it to be shared between practices and hospitals as needed to care for the patient. As a doctor who works out-of-hours and on a weekly basis in an accident and emergency department, he is firmly convinced of the benefits of the programme, particularly for non-local and unscheduled care patients. He says: “I think initiatives such as hand-held units, which allow district nurses to remotely access records of patients with long term conditions and sharing of patient information between practices and hospitals, are going to be of enormous benefit for absolutely everyone. I regularly have to treat patients who have no idea what medication they’re on, who have come from another area, and who are quite difficult to treat effectively because of the risk of medication clashes or allergies. The sharing of information means patients can be treated more quickly, safely and accurately.” Dr Nazir is now responsible for talking to doctors, nurses and other healthcare practitioners in south Birmingham about their specific requirements from the programme.
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