What do NHS staff think of e-records?

Dr Chris Woods is concerned about possible security leaks

The long-awaited pilots of NHS e-records have begun in two PCTs in the North of England.

The government says it will be safer and more convenient for patients accessing care outside their GP surgery - for example over the Christmas holidays when normal services are shut.

The basic premise is that NHS staff anywhere in the country will be able to look up key details, such as medical conditions, current medications and allergies.

But do the potential benefits outweigh concerns over security and what do staff think?

Dr Julie McMillen, a GP in Bolton who was among the first to upload her patient's records to the NHS online database, said she believes it will be useful for out of hours doctors - for example, when they are dealing with elderly patients who appear confused.

"You don't have their records so you don't know if they are normally confused or if they have dementia.

When I heard it was just going to be information on medication and allergies and everyone was going to get a letter explaining they could opt-out I was happy with that. Dr Julie McMillen, GP E-records launches

"The last thing you want to do is admit a patient who has dementia.

"But equally, the confusion could be a sign of a serious illness, such as stroke."

She said it was also becoming increasingly common for patients to be on 10 different medications.

"The more information you have, it really does help treat people who have complicated medical conditions."

Opt-out

Dr McMillen was originally sceptical about NHS e-records but says she is now convinced of the benefits.

"Most GPs had concerns about patient confidentiality.

"But when I heard it was just going to be information on medication and allergies and everyone was going to get a letter explaining they could opt-out, I was happy with that.

"A huge number of mistakes happen because of medication errors so it will make things a lot safer, especially in terms of hospital - you won't be giving patients things that are contra-indicated."

She said so far about one in 200 of her patients had decided they didn't want their record to go up.

Dr Chris Woods, also a GP in Bolton, is not yet convinced of the benefits of the scheme and has chosen not to upload his patients' records.

"My main concerns are over confidentiality and security.

"I feel uneasy about uploading my patients very sensitive health records to a large central computer.

"Patients come to see me and talk about their problems in the knowledge that the information will stay on site."

He said there was the potential for a loss of confidence in the doctor-patient relationship.

Although sharing of information is useful, he said, a local system between hospitals and GPs in the area would be preferable to a national database.

"There is a healthy scepticism among some GPs and there needs to be a proper debate."

Unconscious

Dr Chris Molton is a consultant in accident and emergency at the Royal Bolton Hospital.

"The big change is we'll have information about people who aren't able to give that information themselves - for example people who are unconscious or too sick to speak or under the influence of drugs.

There's a balance between appropriate clinical access and inappropriate use Dr Richard Vautrey, British Medical Association

"Most patients think we already have this information - they assume we have some kind of NHS network."

However, he says he does not expect e-records to be as widely used as people might think.

"We won't be looking at it for most people.

"Around 80% walk in to A&E and we wouldn't need to look up details for them."

Ambulances are not part of the initial roll-out but eventually they will also have access to a patient's record at the point of care.

Dr Richard Vautrey, deputy chair of the British Medical Association, said although e-records could be useful for out of hours GPs who do not have patients' notes, it should not replace taking a full history.

"Often it's better to get the information first hand."

He added that patients needed to be reassured that not just anyone would be able to view their personal information.

"They would not expect any individual to access their records so there's a balance between appropriate clinical access and inappropriate use."