King's Fund Inquiry

The King’s Fund Report on their inquiry into the quality of general practice “Improving the quality of care in general practice” is worth a read by anybody interested in UK healthcare. Even if it does manage to get the date of foundation of the RCGP wrong by 20 years (page 14) – it was 1952 and the context shows the error is not just a typo. However, I digress as what I want to pickup is just one statement from the reports “Key Messages”:

“Technology is available that could transform the way patients interact with general

practice. However, general practice has been slow to adopt it.”

I don’t believe this is really true and it is certainly not fair.

It is true that general practice has not adopted some of the available technology to the extent and on the scale that might have been possible in the leadership of the NHS and to a lesser extent the leadership of the profession had created an environment where such adoption was encouraged and enabled. However, general practice has pioneered many of the possible uses of technology, often with opposition from or at best indifference from the powers that be.

GP Computerisation leads the world and remains one of the few examples of widespread use of IT at the point of care. This have been the norm in nearly all practice for over 10 years with the majority operating paperlite (i.e. not pulling paper records in the consultation) this contrasts with most other care-settings and most other countries where the clinical use of computers at the point of care remains a minority sport. If we look at other areas GPs have led the way in so many. GP practices were the first NHS organisations to have web sites and GPs with support from systems suppliers, have pioneered online appointment booking, repeat script requesting, online consultations and online access to patient records.  While the rest of the NHS debated whether these things were either useful or practical pioneering GP just got on with it and proved that they were both. For the King’ Fund Inquiry to point the finger a GPs for the failure of these things being more widely implemented is unfair – The problem lies elsewhere;  where those petrified by the possible impact of disruptive technologies, those seeking evidence where not can exist, those tied up in arcane governance concerns and those hog-tied by inappropriate IT contracts.

GP lost control of their IT with the 2004 GP Contract and this has stifled the ability of GP and their supplier to innovate and then drive implementation of successful implementation. Lets hope that GP Consortia can put the control of GP IT back in GPs hands and that we see a resurgence of the grass-roots innovation that got GP IT to it current leading global position.

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