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Thank you, Gerry Northam, for an outstanding report. I am eagerly awaiting the posting of the programme transcript to your website so that I can use it as a teaching tool for worst practice in IT systems design, implementation, and roll-out with my first-year class in Management Information Systems. Phil Bodrock, USA

Congratulations on an excellent review of the current situation. The system design based on a single centrally held record is fundamentally flawed. Very successful GP systems that have evolved over several years through the purchasing decisions of GPs in a competitive market are likely to be detrimentally affected.

Professionals will all be overloaded by irrelevant information and the proposed confidentiality safeguards are untested, probably unworkable and likely to be misused. In research undertaken jointly with the Consumers' Association a substantial proportion of patients advised that they would not want their information placed on the database, even after the system had been positively explained to the patients. Even so, it is proposed that information about all patients will be put on this system without first seeking patient consent.
Dr Paul Thornton, UK

I think there are big potential problems with loss of confidentiality with such a big medical record network. Also the failure to co-operate with existing functioning IT systems is very odd, and I don't think we are being told the truth about the reasons for that. Good opportunity for investigative journalism. I am a GP in North Lincs.
Ted Willis

An interesting programme but perhaps a bit off target. There is no requirement for GPs to type requests into the Choose & Book system, the expectation is that it will be support staff within the practice that carry out these tasks, the GP's role is to help the patient make an informed choice.

Doctors - who are without doubt crucial to the process are not the only clinical staff involved in the process - simply polling 500 out of 1.3 million employees does not appear to be an unbiased or representative sample. Some system suppliers have a vested interest in maintaining the status quo as they currently negotiate their contracts on a per practice/per hospital basis - possibly not achieving best value for money for the taxpayer, and perhaps a process that should be subject to some scrutiny.

Whilst the financial costs of the national programme should, quite rightly be vigorously monitored and challenged, we should not ignore the costs of the current situation in which the GP systems do not allow the exchange of electronic information between different practices.

It's currently almost impossible to transmit electronic information between different hospitals because there are about 300 different systems in use, a situation which would not be tolerated in any other sector. The untold human costs caused by clinicians not having access to the information they need and subsequently making the wrong decision.
Andrew Crookes, UK

The programme didn't really explore the NHS IT project as much as it illustrated the reluctant attitude of some doctors towards adopting national standards.
Sam Smith, London

As a hospital consultant I must congratulate BBC Radio 4 on an outstanding programme. Doctors and technical staff who have great expertise and have done the NHS a great service by ensuring that chosen products offer best value, in the past, are now being told that we have no choice in products that are selected. This programme is a scandal of certifiable proportions and the arrogance of those who are managing the project beggars belief.
Dr Gavin Newbond, UK

As a former NHS Trust chair and commentator on the NHS I find your survey of GPs, about the National Programme for IT, frankly 'silly'. NPfIT is the biggest IT roll-out anywhere in the world and the first stage, the spine, is highly technical and of course the GPs have not been involved.

The deputy chief medical officer has been appointed to lead consultation on the subsequent phases, which, along with the local service providers will involve end users. The users are hospitals, patients and GPs. Not just GPs. When at last the NHS invests in something really worthwhile I can't see why you want to fabricate criticism? So far the scheme is on target and on budget.
Roy Lilley, UK

I am chairman of Medix, which carried out the research for the BBC. Re Andrew Crookes's comment, we were asked to determine only doctors' views. We are satisfied that our methodology is sound and findings robust. For the full results, go to www.medix-uk.com and click on the link at the top of the page.
Robin Guenier

I find the earlier comments here by Roy Lilley ("the first stage, the spine, is highly technical and of course the GPs have not been involved") serve only to underscore the disturbing aspects of the NHS IT project explored in your programme. The methodology which appears to be being adopted is that of engaging a group of outside consultants, no doubt expert technicians but with no prior knowledge of current NHS computer systems, nor the manner in which these are used, to design and build the infrastructure which they fondly imagine will best provide necessary services to the NHS. Once this "spine" is substantially completed, and largely set in stone, another group of technicians (on past experience - a less able group) will be brought in to consult with end-users and attempt to mash their requirements on to the actual capabilities of the infrastructure.
Everybody, and I mean, everybody, with any experience in this field says that it is essential to involve end-users from the very beginning of any successful project. These users should be consulted before anyone involved even thinks of designing actual components. The philosophy espoused by Roy Lilley fits disturbingly well into a classic failure model:
1) Senior manager decides that what his organisation needs is IT. He is probably unaware that they are already using computers. 2) A clique of middle managers become very excited and enthusiastically involve external consultants to design their dream system. They have never used their current computer systems, and likely will never use the new ones. 3) As an afterthought, after the system has been developed, installed and paid for, the actual users of the IT system are asked what colour they would like their monitors to be.
This approach has all the hallmarks of a disaster waiting for space in a GP's surgery near you.
Karl Saville, U.K.

I fear for my patients, as their rights appear to being placed secondary to political considerations. Dr Tony Hall-Jones, UK

This situation will ever be so whilst IT professionals continue to regard organisations as they do the technology they design, ie as objective realities and functional entities that can be analysed and designed like computers. Unfortunatley, they must 'get their hands dirty' and engage with the culture, values and power structures that give organisations identity. We ignore them at our peril!
Mal Davenport, UK

It is not cost that is the issue here. Money may be a measure but what is not accounted for is the expertise and ability of the staff. It is recognised the average age of GPs is quite old, and as you get older the ability to learn slows down - especially if there is a sea change.
Chris Gidden, UK

It will be a fiasco. Frontline GPs are already overburdened and demoralised by dogma-driven change, seemingly endless, senseless regulation and the conflicting demands of patients, politicians and PCTs. Without the willing co-operation of those supposed to use the system, even if all the technical problems can be overcome, it will be a disaster. Consequently, patients should not tell their doctors anything they do not want 400,000 NHS employees to have access to.
Dr Vidhu Mayor, UK

NHS Computer System: great programme yet again!
Edward Wheatley, uk

It may sound odd, but despite widespread woeful failures, a small number of UK organisations consistently succeed in delivering benefits enabled by IT projects, through the implementation of a practice called Benefits Realisation Management, which was developed by Gerald Bradley in the 80s, and advocated by Cranfield University. This small number of organisations make the UK a world leader in this area (which doesn't say much for the also-rans). The keys are to recognise that IT is only an enabler. Top-down implementation of change, which does not recognise the importance of involving those affected, will never yield its full potential. I
Philip Sturtivant, UK

Thank you, Gerry Northam, for an outstanding report. I am eagerly awaiting the posting of the programme transcript to your website so that I can use it as a teaching tool for worst practice in IT systems design, implementation, and roll-out with my first-year class in Management Information Systems. On its own, the NHS case would be sufficient as an example of how not to create and implement a system, but the addition of other expensive failures and fiascos, especially the courts, makes your report compelling.
Phil Bodrock, USA

Isn't Roy Lilley a bit out of date? Aidan Halligan - appointed in March 2004 - has accepted a post in Ireland. Some people might consider this to be a wise career move. I would agree that this is a big project involving more sectors than general practice - but the consultants I have spoken to are equally concerned that their systems are under threat. I'm a GP. The point being made (which I think Roy Lilley may have missed) is that if you don't involve the end users in the design phase of any large IT project, it has been shown that the chanches of a large scale project to succeed is greatly diminished. My practice has been paperless since 1997. We couldn't function with any LSP system I have seen so far - and the pressure is on the PCTs to finance the NPfIT/LSP offerings and not allow free choice for GPs.
Mary Hawking, England

I have been astonished by the extent to which those associated with the NPfIT project have rushed to condemn this broadcast. I have discussed issues raised with figures who can be considered pivotal to this project in our region, and all without exception feel that this broadcast was sensational journalism with unfair criticism. Yet they fail to reassure GPs like myself, when we ask, "Why isn't the funding for this huge project not ring fenced in PCT budgets?", and "Why must the Choice and Book option be performed by GPs?" Most crucially, the anxiety that many of us have about data transfer losses, and who is allowed to correct inaccuracies held upon this spine, are not being met with any sensible strategy. Key figures concede that the Choice and Book option is being used politically as its development is way out of step with the rest of the network developmental progress. Requests that Accenture or the DOH release the risk assessment of this grand project are met with a stoney silence. I fear for my patients, as their rights appear to being placed secondary to political considerations.
Dr Tony Hall-Jones, UK

The government has missed a golden opportunity to exploit free and open source systems and reap the benefits in terms of cost, reliability and ownership which the public sectors of many other countries (Germany, Spain, Brazil, China) are doing. Instead they are pumping billions of tax payers' money into IT suppliers with egregious track records which represents a stealth privatisation of NHS IT. Regardless of any supplier penalties for failure to deliver, it is patient service that is really at risk and clinicians and IT support staff who must make up the shortfall in service. Compare the price tag with the supposed benefits to patients, do they add up?
Leon Stringer, UK