Volume 3

The Electronic patient record : sixth report of session 2006-07 / House of Commons, Health Committee.

  • Great Britain. Parliament. House of Commons. Health Committee.
Date:
2007
Catalogue details

Licence: Open Government Licence

Credit: The Electronic patient record : sixth report of session 2006-07 / House of Commons, Health Committee. Source: Wellcome Collection.

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    Q51 Sandra Gidley: You are “the fourth attempt”. What does that mean? Dr Braunold: 1 will explain that. There were other clinical engagement efforts that happened before the National Clinical Lead’s appointment, three previous ones, and the National Clinical Lead’s appointment was praised in the report from the Public Accounts Committee and the National Audit Office in terms of starting to make real efforts and quality improvements in the clinical engagement with the community. We were sponsored by the BMA and the Royal Colleges as jointly owned individuals who were accountable back to those bodies and as named individuals that they would be prepared to work with who were sponsored into the programme. Q52 Sandra Gidley; How long have you been involved? Dr Braunold: Two and a half years. I was nominated by the BMA. I was nominated by the General Practitioners Committee. My job-share, Professor Mike Pringle, was nominated by the Royal College of GPs, and we two together work as clinical champions from the general practitioner community with a track record with GPs, who are accountable back to the profession, for making sure that systems are built that are fit for purpose from a GP perspective, and it is our responsibility to do an ambassadorial role for the National Programme from a General Practice perspective. There are equivalent roles. We have hospital doctor colleagues, Dr Simon Eccles and Mr Ian Scott, and we have Jan Laidlow from the Allied Health Professionals and we have our nursing colleagues. We have done quite a lot—I think it is an enormous amount—in terms of setting up advisory groups and interfaces with our colleagues and making sure that they are involved at every stage in every important programme. There is a National Clinical Reference Panel for the Summary Care Record for which every one of those colleges has been asked to nominate people who are able to make sure that the Summary Care Record has the right advice about what should be in it and what should be not in it and that it fulfils the criteria for the Care Record Guarantee, and that has all been slowing things down, frankly, from the original intention because we wanted to make sure that it had proper clinical sign off, and that tension is evident. Q53 Sandra Gidley: But that is only the last two and a half years. What engagement was there in the first three years? Mr Cayton: Could I come in here. The Care Record Development Board took over from two committees, one of which was called the National Clinical Advisory Board, on which every single one of those bodies was represented, and that existed well before I became involved in the programme. So, if that group, which consisted of the Royal Colleges and their colleagues, was not delivering four years ago, that is actually the responsibility of the clinicians who lead those colleges. I have had innumerable meetings with Royal Colleges and with the Pharmaceutical Society, and so on, over the last three years. I have had very positive relationships with them. I have actually found them extremely constructive in practice, and I think we are just in one of those situations where what people say in public (because it is a posture to take), “We have not been adequately consulted”, is not the same as what is happening in practice. We have had patient organisations involved throughout. Only last week we had an open session in which we had over 30 patient organisations taking part, the Care Record Development Board has an annual conference which is open to the public, and to the press, and to clinicians, and we have had over 100 patient organisations and certainly over 350 people attending those conferences every year. We have actually done a great deal to try and engage with clinicians at all levels, and certainly, since my involvement, I have been personally entirely committed to that process. Q54 Sandra Gidley: How long have you been involved? Mr Cayton: The Care Record Development Board was set up three years ago. Mr Granger: It is undoubtedly the case that we could always do more in this space. It is undoubtedly the case that the concept of professional consensus about some of these issues is challenging. Generally, when you put disparate professionals together on some of these issues, you do not get agreement, you get at least one opinion per person. QS55 Sandra Gidley: That is within a profession? Mr Granger: Yes, a medical consensus is undoubtedly oxymoronic, but if you look, for example, at your profession, would you like us to wait until the pharmacists and the GPs agree on how much data would be visible in dispensaries, or would you like us to get on and roll out electronic prescriptions with the benefit that that delivers? We have those challenges across the whole programme because the tribal nature of clinical practice means that these different groups all take different positions and different postures, and we have tried to strike a balance around achieving progress rather than just wait for everybody to agree. I suspect we would be waiting an awful long time. Q56 Sandra Gidley: I gather the prescriptions are problematic as well, but we are not here to discuss that. We can probe this further with those groups themselves. My final question at the moment: why has so much effort been diverted into Choose and Book rather than into the detailed clinical systems that actually support patient choice? Mr Granger: 1 will ask Gillian to come in in a moment on this. If you look at the strategy document from 2002, you will see Choose and Book did not exist. What you will see is electronic booking. One of the many areas where we got additional work was the delivery of choice, and electronic booking was quite a straightforward proposition which had been extensively piloted, which was about packaging up a referral and