NPfIT still failing to engage doctors

Haven't we been here before?

Yet another study of the UK Health Service's National Programme for IT has found that frontline staff, GPs, feel they have been left out of the planning and decision making processes. The study warns that the failure to engage with GPs has put the entire project at risk.

The report, published in the British Medical Journal (BMJ), found that staff felt demoralised and cut off from the planners at the project's headquarters. They also complained that communication with project managers has been extremely poor - both in terms of information shared, and local advice heeded.

The study quotes an IT manager at one of the trusts: "The communication has been appalling, absolutely appalling. They've done some wonderful events, and I've met some people who are great, NPfIT, who are very facilitative and very enabling, and the next week you're told you're not allowed to talk to them."

The chief executive of another trust said that there had been a real lack of engagement. The un-named chief exec went on: "I think we've been involved and been asked to promote something... - we say it's a bit like trying to go and sell, probably in IT terms, vapourware."

The researchers spoke to 23 senior staff in various departments within four acute health trusts. The trusts were chosen to reflect typical conditions - in terms of size, financial health etc - within the NHS.

Overall, they concluded that despite pumping extra cash into the project, the government has been unable to allay fears about the impact of centralising the NHS' IT systems. The researchers found uncertainty among staff about when NPfIT systems would be implemented in hospitals, and what funding would be provided locally.

The researchers also found cases where the project is actually hindering the improvement of the NHS service. They found that some existing IT systems, such as those in radiology and pathology, are in urgent need of updating. But because the NPfIT is being implemented in phases, those upgrades have been delayed, waiting for the NPfIT to catch up.

"Such delay may mean a risk of system failure, but buying a temporary solution is seen as costly", the researchers write.

But factors other than the technical come into play, and it is the socio-cultural side of things that the BMJ report found had been most neglected. The report describes these oft-called softer challenges as being "as daunting as the technical and logistical ones" and recommends that programme managers make dealing with this side of the project a priority.

This is not news to anyone who has been following the saga of the NPfIT, or Connecting for Health as it sometimes prefers to be known.

Back in January the National Audit Office warned that unless the NPfIT managed to engage frontline staff, the project was in danger of missing its deadlines, and going further over budget. Another survey, conducted by Medix in February found falling levels of support for the programme among GPs and consultants.

Doctors have been particularly concerned about the security of confidential patient information in the new system. Just two per cent of GPs think electronic records will be more secure than the current system.

At the time, the NPfIT said it had begun to address the lack of involvement of frontline staff, but that the Medix survey had taken place before this "has had the chance to penetrate at grass roots level". The same claim, surely, cannot still be made.

You can read the BMJ study here.

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