The National Programme for IT (NPfIT) for health and social services in England has an anticipated cost of around £30 billion. The world's largest ever IT project aims to provide ‘Better information for health, where and when it's needed’. The core strategy is ‘to take greater central control over the specification, procurement, resource management, performance management and delivery of the information and IT agenda’.1 Its top priorities are listed in Box 1.1 Few would question the programme's high-level intentions. Virtually every general practice in the UK is now computerised. A rapidly increasing proportion of all practice team members, not just GPs, use computers face to face with patients every day. Arguably, UK general practice leads the way in the use of computers to support patient care. Yet, as evidenced by the medical tabloids, this key stakeholder group has become alienated and marginalised.
Box 1. National Programme for IT – top priorities.1
▸ A centrally managed email and directory service: free to all NHS organisations
▸ NHS Care Records Service: where every patient's medical record will be held electronically. To become available securely and safely online and to be easily accessible to healthcare professionals and patients, whenever and wherever it is needed
▸ Choose and Book: to facilitate booking of appointments ‘without sending referral letters to hospitals and waiting for a reply’
▸ Electronic transmission of prescriptions
▸ New National Network: ‘with sufficient connectivity and broadband capacity to meet current and future NHS needs’
▸ Quality Management and Analysis System: to support the quality and outcomes framework of the new contract for GPs
▸ Picture Archiving and Communications Systems: ‘to capture, store, distribute and display static or moving digital medical images’
The explanation for this lies in part with ownership and control. The NHS struggles to throw off its image as a ‘command-economy state organisation’2 but …