GPs vote to halt Care Record Service development

16 Jun 2008

GP representatives overwhelmingly backed a motion to call a halt to development of the NHS Care Records Service at the BMA’s annual Local Medical Committees conference on Friday.

LMC representatives backed a motion expressing no confidence in the government’s ability to store electronic patient records safely.

They also backed calls to support patients who wish to opt-out of the Summary Care Record (SCR), and a motion calling for a halt on any further development of plans to develop Care Records Service plans.

Proposing the motion was Dr Mike Ingrams of Hertfordshire LMC, who told the representatives: “In view of the government’s unparalleled reputation for not being able to store records safely, the GPC must put a halt on any further development of a centrally-held patient record and promote locally held interconnected storage instead.”

Sections of the audience agreed with Dr Ingram’s calls with many shouting ‘Hear, Hear’. Other LMC members also backed the proposals, calling for the BMA to stop working with the government on development of patient systems until security promises were fulfilled.

A call for the BMA’s General Practitioner Committee (GPC) to boycott working with the government until all concerns about consent and confidentiality are addressed was rejected.

A representative from Avon LMC said: “We have no confidence in the government’s integrity, and therefore its ability to keep patient records safe. The BMA General Practitioner’s Committee should desist from working with the government until all early adopter site glitches have been ironed out and cast-iron guarantees are in place.”

However, these calls were resisted by the BMA and the vote to pass the motion to desist from with working with the government was narrowly defeated by audience voters.

Instead, proposals to promote a national publicity campaign to warn patients of the risks of having data held on the Spine, will be looked into.

The audience also voted to continue to follow BMA policy that no patient medical data should be added to the national database without patient consent and pledged to continue to encourage GPs to support patients should they wish to have their details withheld from the Spine.

One member of North Yorkshire LMC, who wished to stay anonymous, told E-Health Insider the motion was the right thing for the BMA: “The government has demonstrated time and time again that it cannot be trusted to maintain securely, confidential patient health records. It’s only right that the BMA along with all NHS personnel re-iterate again and again that trust is essential for this to succeed.

“We don’t want to see the National Programme fail by any means, but we don’t want to be reassuring patients over issues we too have fears about. It’s disappointing to me calls for desisting work with CfH were rejected, but calling a halt is simply the first step in ensuring both we, and our patients, get the best system possible.”

Reader's Comments

Well done!

16 Jun 08 10:35

Great news for the many GPs encouraging and supporting patients who wish to opt out.

The forthcoming BMA motion (July ARM):

A - 524 Motion by NORTH YORKSHIRE LMC: That this Meeting is aware that as government has demonstrated that it cannot be trusted to maintain secure confidential patient health records, there should be a national publicity campaign to warn patients of the dangers of consenting to their records being held on a national database.

(The Agenda Committee may prefix with the letter “A” any motion which the chairman of the committee or body concerned has recommended to it as likely to be non-controversial and acceptable without debate. The chairman shall formally move that each such motion be accepted without debate.)

credibility gap

16 Jun 08 11:28

of course the BMA might have a greater chance of persuading the public if it hadn't deployed exactly the same set of arguments over NHSnet, NHSmail, PMIP, Choose and Book, and just about every other technological development over the past decade

Proxy wars

16 Jun 08 12:36

Isn't this just another broadside in the increasingly nasty little tiff between the Government and the BMA? It has very little to do with patient confidentiality or the security of public sector data. It's just a handy stick to beat the Government with.

Most of the data loss has been the result of the kind of archaic practices that NCRS is designed to tackle - the kind of thing that 'locally held, connected storage' would perpetuate. Doctors are using the general lack of awareness of the facts to fabricate 'gut reaction' opposition to NCRS.

As a method of putting a spanner into the DH / Government's works, it's likely to have some effect. And whilst the Government may have provoked doctors into this kind of behaviour, but it's not big, it's not clever, and it's not likely to benefit patients.

Greenhalgh report forgotten already?

16 Jun 08 13:41

The BMA, the author of the EHI article and posters 2 and 3 above all seem to have overlooked the measured recommendations of the independent report by Professor Greenhalgh et al.

http://tinyurl.com/3gmn75

>>Executive Summary 1.50. At a more strategic level, we suggest that the NPfIT National Programme Board consider carefully the finding of this evaluation (which confirms previous observations by academics and policy analysts) that ‘technology push’ is being prioritised at the expense of attention to wider socio-technical change and that this is, in the opinion of the evaluation team, a major risk to the success of the NPfIT. Should the Board seek to address this, it follows that fundamental changes are needed to the structure, culture and preferred change model of the NPfIT.<< http://www.ucl.ac.uk/openlearning/documents/scrie2008.pdf

The BMA's argument is superficial and hung up on security which is but one of the issues around the SCR.

We can only hope that CfH does not forget the Greenhalgh report as well..

Double Standards

16 Jun 08 22:15

Interesting how the LMC representatives backed a call for patients to be able to opt out of the Summary Care Record. Was such attention paid to pet GP projects to share records between practices without Patients Consent never mind opting out.

Its already there!

17 Jun 08 10:30

There seems to be a widespread ignorance of the fact that there is already a central database of all patients in England held on the Spine. The Personal Demographics Service (PDS) stores all names, addresses, Dates of Birth and additional personal information.

This information is accessible by NHS users holding a Smartcard and the relevant security access control (potentially hundreds of thousands of people both clinicians and administration staff). PDS is in place to enable the linking of patient records across the NHS and also in the process of paying GPs.

There is a distinct lack of understanding over the components of the Spine and how it is already used to support business as usual in the NHS.

I fear for GP’s not knowing about the Spine, what it already stores and how it is used, as this could compromise their positioning on the issue. I don’t remember my GP being concerned to tell me that all my personal demographic data was being stored on a central government controlled database when it was initially created.

I wonder if the GPs inform their patients that their personal demographic data is already on a shared centralised database when they talk about additional medical information being stored…….and wonder if the vast majority of patients are particularly bothered about storing all their data at all.

GP Guide

17 Jun 08 12:53

A guide to the PDS for GPs is available at http://tinyurl.com/36b8ba.

It's been there for a while - NSTS

17 Jun 08 15:53

I'd like to add to the note above; the concept of PDS and storing patient records centrally is nothing new.

NSTS - NHS Strategic Tracing Service has been storing patient information such as name, address, date of birth, GP etc. centrally for some time now which most people seem to have overlooked.

Its been there for much longer - PDS/NHAIS/Exeter!

17 Jun 08 20:42

Funny how it was OK for all this patient data to be stored on Exeter when it was used as a basis for paying GPs!

Correct me if I'm wrong but wasn't the Exeter system used to collect details of all patients registered with GPs in England and wasn't this information used for call and recall for Cancer screening appointments?

Didn't Exeter develop into NHSIA and weren't almost identical dataflows used to populate and update PDS - albeit under a different contract?

(Post edited by EHI)

Leave it to the professionals

19 Jun 08 10:16

"LMC representatives backed a motion expressing no confidence in the government’s ability to store electronic patient records safely."

Absolutely right - let's leave it to the professionals to manage our clinical and demographic information.

Six laptops stolen from hospital: http://news.bbc.co.uk/1/hi/england/london/7461619.stm

Laptop stolen from doctor's home: http://news.bbc.co.uk/1/hi/england/west_midlands/7461607.stm

What a surprise

19 Jun 08 12:03

What is the greatest threat to GPs presently? The opening up of primary care provision to the market, poly clinics etc. Unlock the data in GP systems - unlock the primary care market. Frankly I am fed up with this paternalistic and self interested extremism. GPs quite happiliy share data with privatised out of hours primary care services - a market in which they are heavily involved - but the threat of summary care records brings about a totally contradictory but predictable response.

The vast majority of patients would prefer their data to be shared and available to others involved in their care - and frankly why should a patient trust a GP practice with their data anymore than any other part of the NHS? At least the rest of the NHS isn't driven by the same profit drivers of GPs - so can perhaps be trusted more.

(Post edited by EHI)

NSTS and PDS are not the same..

maryhawking@tigers.demon.co.uk

23 Jun 08 08:49

It's true that before PDS there was NSTS - but the fundamental difference is the accessability! NSTS was only accessible to a small number of authorised users - and even they might get their requests refused. Anyone else remember the fury when a paper claimed that the NHS had been used to trace survivors of a Lithuanian death squad in 2002? PDS, on the other hand, is available to everyone who has a possible need to locate a patient - including all GP practices, administrative staff in hospitals and I'm not sure who else. This change in access leads to a totally different security risk model. In addition there is still - AFAIAA - a tension between personal security and use of other Spine services. Suppose, for good personal reasons, you are bent on concealing your home address and phone number (work for a company associated with animal laboratories, have a violent ex-partner, any other reason which seems good to you) it can be done if you know how - but no-one was informed when the system of holding personal demographic information was introduced - and I don't think GPs have been told how to do it yet! The problem is that you then cannot use other spine functions such as C&B, ETP and GP2GP - which could limit your choices considerably ..

Does anyone know how it would affect SCR - another spine function - or any SSEPR?