The government's handling of NHS IT reform has taken another battering this week with the release of a survey that shows growing concern about initiatives such as electronic records and Choose and Book.
Over 1,000 doctors, including more than 400 GPs, took part in the annual survey compiled for GP by healthcare research specialists Medix.
Among the key themes to emerge were poor consultation, confusion about key initiatives and concern over the cost and confidentiality.
The findings show that attempts by Connecting for Health to engage with GPs and promote early successes, such as the recent uploading of care records data in pilot areas have had little impact, with more and more growing disillusioned with IT reform.
While a majority - 55 per cent - are still supportive of the IT reform agenda and believe it will improve long-term clinical care the figure was far higher in 2006, when 65 per cent gave the same answer.
Looking at a longer period of time, this decline in support is even more pronounced. Only 30 per cent of GPs believe IT reform is an important priority for the NHS, compared with 67 per cent five years ago.
Four years ago, 56 per cent of GPs described themselves as enthusiastic about the National Programme for IT (NPfIT), but that figure has more then halved to just 23 per cent.
A lack of information from government was a key gripe, with just 6 per cent of respondents saying they had a lot of information about NPfIT and 74 per cent saying that they did not feel 'engaged' with the project.
Among initiatives to be criticised is the electronic transfer of patient records, which 76 per cent of GPs believe will lessen patient confidentiality. The majority of GPs (59 per cent) say that they are unlikely to upload patient details without specific consent.
A total of 57 per cent of GPs were concerned about access to patient records by public officials outside health or social care, 53 per cent were worried about hackers and 26 per cent feared bribery or blackmail of people with access to the records.
Effect on clinical care
Overall, just 48 per cent of GPs now believe NPfIT's initiatives will improve clinical care in the long term (see chart, below, right).
Robin Guenier, Medix non-executive chairman, said that over the past five years Connecting for Health and NPfIT had failed to properly engage health professionals, which has fuelled resentment and cynicism.
'I remember as far back as 2004 we had a meeting with NPfIT to discuss how to engage with GPs and other professionals surrounding IT and it said it was in hand. Nothing happened then and not much has happened since,' he said.
'With any project you need three things: clinical leadership, engagement with users and a proper business plan with costs clearly laid out. What has happened here is that there has been little effective engagement so little is known about how it is being run and how much it is costing.'
Chairman of the GPs' joint IT committee Dr Paul Cundy is more optimistic, saying that once many of the schemes are fully operational then this decline in support should be halted.
'A lot is made of engagement, but part of the frustration among GPs is that the products are not actually delivering as they are not up and running,' he said.
'Once they do start delivering then I believe support will grow. Delivery is what many GPs want above all else.'
He also believed that it was too simplistic to label all NPfIT projects as a concern for GPs.
'In some areas such as GP-to-GP transfer and electronic prescribing there is considerable support and I hope that can be mirrored in other areas such as Choose and Book,' he said.
While the Medix survey paints a bleak picture overall in terms of GP opinion of Connecting for Health's efforts it does support Dr Cundy's view that some initiatives are more popular than others, for example 47 per cent of GPs rating electronic prescribing as 'important', but only 20 per cent were prepared to describe Choose and Book in the same way.
Choose and Book came under fire in the survey, with 90 per cent of GPs saying the referral system increased the time it takes to make a referral, in the main by at least five minutes.
A further 69 per cent believed it made no difference or was actually detrimental to patient outcomes.
Some 30 per cent of GPs thought the care records service was either unimportant or not at all important.
The same figure for electronic transmission of prescriptions was 25 per cent, for the picture archiving and communications system it was 24 per cent, for the quality management and analysis system it was 10 per cent and for the email and directory service it was 16 per cent.
This survey is just the latest damning report into how implementation of NHS IT has been handled.
Lack of clarity
A report published in September by the Health Select Committee into the electronic patient records initiative found 'a lack of clarity' in the way the initiative was communicated to patients and clinicians.
MPs also raised concerns about delays in implementation and a lack of transparency regarding security testing.
A Connecting for Health spokesman said: 'We take the views of the public, patients and front-line staff very seriously. We would view these results in the light of what patients tell us.
'The results of the survey do not appear to reflect the general picture on the ground or chime with recent comprehensive surveys.'