This site is intended for health professionals only

Paper-free practice

30 May 2013

Share this article


At the start of the year, health secretary Jeremy Hunt announced that the NHS would be paperless by 2018 in an attempt to save around £5billion a year.

The Government’s vision is that patients will be able to see their medical details online and digital records that will be shared at the touch of a few buttons between all parts of the health and social care services, from ambulance workers to hospital consultants to care homes for elderly people.

Setting out his proposals, Hunt said that the NHS must not be the “last man standing as the rest of the economy embraces the technology revolution.”

“It is crazy that paramedics cannot access a full medical history of someone they are picking up in an emergency – and that GPs and hospitals still struggle to share digital records.

“Previous attempts to crack this became a top-down project akin to building an aircraft carrier. We need to learn those lessons – and in particular avoid the pitfalls of a hugely complex, centrally specified approach,” he said.

Mr Hunt has already pledged that one region in England will have a fully portable electronic health record in place across health and social care by the time of the next election.

He has said that every trust has a duty to make savings through quality innovation productivity and prevention (QIPP) and that to ignore the potential of technology to offer a better service at a lower cost is “a mad thing to do”.

The Government’s announcement was timed to coincide with the publication of two reports which demonstrate the potential benefits to the NHS of making better use of technology.

The first, a Price Waterhouse Coopers study, found that measures such as greater use of text messages for negative test results, electronic prescribing and electronic patient records could improve care, allow health professionals to spend more time with patients and save just under £5 billion a year.

The second, the National Mobile Health Worker report, published by the Department of Health (DH’s) mobile health worker project team looked at introducing laptops for staff at 11 NHS sites and found that cost savings could be made.

However, the DH’s multibillion-pound scheme has already raised concern in some quarters about a repeat of the fiasco over the NHS database, set up by the previous Labour government and scrapped by the coalition in 2011 after more than £6 billion of public money had been spent.

It has also sparked fears about how patients’ records are kept private, an issue that has dogged all major public service infomation technology (IT) projects, especially after details of 25 million people claiming child benefit were lost by HM Revenue & Customs in 2007.

The health secretary has attempted to reassure critics by stressing that the Government’s plan, first flagged up in the NHS mandate last year, is significantly different to the junked Labour scheme, Connecting for Health, which was originally announced in 2001.

Unlike the Labour scheme, under which the DH in Whitehall attempted to design a national database and ask five different organisations to build it, the current government will set out national standards for different IT systems to “talk to each other”, but allow clinical commissioning groups (CCGs) to design and purchase their own programmes.

Last May the DH published an impact assessment on early plans for digital records, which estimated that at a basic level, over 10 years, they would cost £1.2 billion to implement and save more than £6.3 billion, including savings to patients’ time and improved quality of life from earlier diagnosis and treatment of problems – a net saving of just over £5 billion. But how possible, in practical terms, is it for the NHS to go paper-free? Many general practices are now rather ambitiously termed “paper light” which means they have gone as far as they can to eliminate the need to use paper for things that can be done electronically.

Jayne Tabor, a practice manager for two general practices in Hampshire, says that in her practices all results are now processed electronically and will come directly from the laboratory to the practice via a data warehouse. 

However, she says the main barrier to becoming paperless is secondary care. “We do get some referral letters by email [from hospital consultants] but it would be great if they all came through that way,” she says.

“When paper letters are sent to us from the hospital we scan them, enter the relevant codes and shred them – it is a total waste of paper.

“It is a big frustration that we can’t get this all sorted if big global organisations and companies can manage to do so,” she admits, and says that she believes general practices have been “way ahead of the curve” compared to secondary care on the IT revolution.

Dr Simon Carvell, a GP partner in a Birmingham practice, agrees. “Doing things electronically will be safer and more secure but I think that hospitals will need extra funding to do this. When they have the money this has to be the future.”

Dr Paul Cundy, General Practice Council IT lead, says that the problem with many hospital-based IT systems and the reason why they are underused is that they are of no real benefit to the doctors and nurses who are expected to use them. He says that what is needed are clinical IT systems which clock both clinical signs and discharge dates and which can join up with general practices.

One of the Government’s first mandates to is to push forward the paperless agenda and NHS England (formerly the NHS Commissioning Board) director of patients and information Tim Kelsey has gone further than the DH, saying that he is pushing for the end of 2015 to “eradicate paper from the NHS”.

Speaking at the Healthcare Efficiency Through Technology Expo earlier this year, he said that a paperless NHS would mean the end of referral letters and lost records. When asked whether he thought 2015 was a realistic timeframe, he admitted that the focus in the first phase will be on re-procuring Choose and Book as many hospitals are still using paper referrals.

Bradford GP Dr Shahid Ali has already introduced technical innovations in his practice. These include online tools which help his patients manage their own conditions, by identifying the health problems they have which can be reduced through lifestyle changes, and supporting them through those changes.

He says that all the electronic systems in the NHS need to be joined up in a way that everybody can see all the information they need electronically.

“The system suppliers need to sit down together to make sure that their systems fit together…it is important to have everything connected up.”

“A ‘world class solution’ means a wholly integrated system where general practices and hospitals are connected horizontally and vertically and where patients also know what is going on…it does not matter who has which system as long as they are connected and information can be shared.”

So will it be possible for the Government to realise its paperless NHS dream in the next five years? This is likely to depend on whether suppliers can make sure all the different IT systems the NHS currently uses from GPs to secondary care can communicate effectively with each other.

However, one of the key determining factors will be the motivation and involvement of the end users of the systems – doctors, nurses, patients and managers. As with many things in the NHS, only time will tell.