Thank you for allowing me the opportunity to respond to the criticism from Dr Morris and her colleagues. Having re-read the essay, I find it difficult to accept that there are any inaccuracies.
It is true that their consent model has been approved by the BMA, the Scottish government, the GMC, and lawyers; nevertheless, the essay points out that a doctor should only transfer information after patients have been informed of the disclosure. Many of our patients were unaware of the request to disclose the information to a central database. We therefore had to ensure that this had happened, and did so at considerable personal cost.
Many patients were unaware of the ECS project until we told them; I am glad that this, a central point of the essay, is not suggested to have been inaccurate. I have never challenged the idea that the intentions were to make this information widely available; nevertheless it failed, and we did what we could to put that right.
The comment about potential inaccuracy was directed towards records that contained ‘supposition and conjecture’; this does not apply to the ECS. I did not state that the information in the ECS may be inaccurate. However, handwritten prescriptions will be excluded (we have an average of two power cuts a week here). Only yesterday we had an example of a patient whose details had been wrongly extracted from the database as a result of human error. She was quite capable of giving a clear history.
I did suggest that ‘profligate information sharing’ might lead to people wishing to opt out of a public health care system. The ECS does not constitute such a level. Nevertheless it appears that this first small step on a great (and potentially very positive and exciting) journey was not well understood by the public.
I still believe that the most effective part of the audit trail is a GP knowing that primary care records have been accessed. I know there are other safeguards, and I make no suggestion that these will be anything other than assiduously adhered to. But the best bank in the world is not secure when thousands of people have the key!
While clinicians report that it reduces phone calls to GPs, I wonder if this is really a good thing? Perhaps if Dr Morris had phoned we would not have to slug this out in print. Many assertions about the benefits of ECS described are anecdotal, and I would be interested in a peer reviewed published evaluation that showed ‘that patient safety is considerably improved’. I would be able to recommend this much more positively to patients if that were the case.
- © British Journal of General Practice, 2008.
