Health Bill [Lords]

I bow to my hon. Friend's great judgment on the issue. He is a real expert on IT, particularly in the public sector, and I defer to him. I sometimes wish that there was some more snake oil poured into my computer; it might then work a bit faster. As things are, it cranks along. Things are not always straightforward, and I shall give some examples. Only about half of all services in my area are available on choose and book, and not all of the services that are supposed to be bookable can be booked. A couple of months ago I had a patient with a wrist problem, so I went on to choose and book. We found a hand and wrist service—ideal for the job—just down the road from my surgery. "Perfect," one would think. However, the next day when the patient came back to see me I found out that the hand and wrist service did not do hands or wrists. I am not making that up; it actually happened. I had to start again from the beginning. It meant another wasted appointment, a baffled patient, and bemused staff. Eventually, we sorted the matter out with a different hospital. Also, the choose-and-book server has the interesting habit of throwing the user out at 5 o'clock on a Friday evening. That is not even outside core hours, let alone compatible with the concept of extended hours, which most GP practices across the country are now embracing. When, at 10 minutes past 5 o'clock, one says to a patient, "I'll just book you a choose-and-book appointment," only to find that the server has gone off and will not come back on again until Monday morning, it is, to say the least, irritating. I have never understood why it happens, but it happens very frequently—far too often to be just coincidence. Even more seriously, it is apparent to me that some acute trusts have tried to get around the 18-week service target simply by saying to the patient, "There are no appointments available." It is a great irritation when one has given the patient a print-out and told them to phone up for the appointment of their choice, for them to be told that there are no appointments whatever. The patient then comes back to see me the following day, which means another wasted appointment. It transpires that hospitals can manipulate the 18-week target if they simply stop offering any appointments. If they do not offer appointments, they cannot miss the target. That might be wonderful from the hospital accountants' point of view, but it is pretty miserable from the point of view of the GP and the patient. In some areas, however, choose and book has been a runaway success. In Barnsley, for example, about 75 per cent. of all GP referrals are made through choose and book. The key to Barnsley's success is strong leadership from the local primary care trust, which has ironed out the technical glitches and professional resistance and persuaded the secondary care trust to get behind the service and make it patient-friendly. There is no reason why that should not be replicated across the country. There is no shortage of innovative care models involving communications technology that work at local level. In Sheffield, for example, trials are running of a virtual desktop that enables clinicians to access patient records using interactive bedside systems. That reduces the need for staff to keep logging in and out of computers, and cuts down on the endless administrative paper trail. It is when we try to create IT systems that are capable of being used in more than one place by more than one type of health care professional that we run into problems. As chair of the all-party pharmacy group, one of my biggest frustrations—I am sure that it is shared by the hon. Member for Romsey (Sandra Gidley), who is also an officer of the group—is that pharmacists are not being given the IT resources that they need to allow them to make full use of the new responsibilities laid out in the new pharmacy White Paper. If they are not connected and integrated, they simply cannot maximise the use of their skills. That is a potentially dangerous problem. If we are to expect pharmacists to prescribe as well as to provide front-line clinical services, as they should, it is absolute nonsense for them not to have read-write access to the patient clinical record. I shall give an example, because the problem is serious. This morning I did a surgery. I saw a patient with an infection and I wanted to prescribe her an antibiotic. I asked her if she had any allergies—"No, doc, I can take anything." So I typed in the first antibiotic of my choice. A message popped up on the computer saying, "Warning. Patient allergic to this drug." So I said to her, "It says on the computer that you're allergic to this drug." "Oh, yes," she said. "That's right." I asked her if there were any other drugs that she was allergic to—penicillin, for example. "Oh, no, doctor, definitely not." So I typed in "Penicillin", and the message on the computer came up to tell me that she was allergic to penicillin. I said to her, "It says here that you're allergic to penicillin." "Am I, doc? Goodness me. Actually, come to think of it, there are quite a few drugs I can't take," which she had completely forgotten to tell me about a few minutes before. Woe betide the hapless pharmacist who came across this lady and who might decide to prescribe antibiotics for her, having been told by her that she did not have any allergies, only to find out the hard way that she did. That is a mistake that should not happen. Had the pharmacist had access to the patient record, that would be easily dealt with. It is no longer credible to say that pharmacists cannot have access to the patient care record. Pharmacists are doing medication use reviews in huge numbers. At present the reviews come back to the practice in paper form. Most of them are no longer handwritten. At least they are now computer-generated, but a piece of paper in the GP's surgery is as much use as a chocolate Easter egg in hell. It is no use whatsoever, because the information on it has to be scanned, taken off that printed record and entered into the patient record, and in many cases that is not going to happen. So the usefulness of the MUR is severely hampered by the fact that if it is not in electronic form, it does not integrate into the patient record. It needs to do so. I move on to the commissioning of services. Progress in commissioning of new providers has also been very mixed. Many PCTs have a great record when it comes to stimulating the market and commissioning services from community-based providers, such as pharmacists. I am therefore pleased that the Department of Health has taken steps to address this by encouraging PCTs to ensure that there is appropriate pharmacy input in PCT decisions. I hope that this will improve awareness within the PCT. However, it is also clear that the introduction of practice-based commissioning has helped to make more effective use of resources, and is bringing care closer to home for patients. My patients, for example, are now able to take advantage of community cardiology services. This means that I, as a GP, can book a patient into a community cardiology service for a 24-hour ECG or an echocardiogram within a few days, which in the past would have taken several months. Now it can be done much more easily and quickly, with the patient travelling far less distance to receive that service. It has also reduced the cost by about 30 to 50 per cent. Similarly, those with muscular-skeletal conditions are now able to use a local access clinic, where the patient with a back, hip or knee problem can be triaged within a week or two and passed on to the appropriate consultant specialist without the need for extensive waiting and with a much more efficient service than we ever had before. MRI scans are available to open access by general practitioners. This is a huge advantage. Not only can I now get an MRI scan for a patient within about two weeks of referral, but there are several other benefits. First, the patient does not have to travel, because it is a local service. The machine is mobile and can be moved from surgery to surgery. Secondly, the waiting time is extremely short—only a couple of weeks. Thirdly, GPs can maximise their own clinical skills by making much more use of investigations themselves, and fourthly and possibly more importantly for the NHS, that reduces the need to refer patients to a consultant. This means that there is less pressure on hospitals and gives them more opportunity to maximise the skills that hospitals can provide, which others cannot. It takes the pressure off them and allows them to get on with their job. The challenge now is to ensure that these examples of best practice are replicated right across the country. I believe we can do that. I have provided many examples this evening to show that that can be done. I visited one of my pharmacy colleagues today, Bipin Patel, who runs a pharmacy in the middle of Bexleyheath, where my practice is based. I was talking to him about how we can reduce prescribing and dispensing errors, particularly in the light of an inquiry that the all-party pharmacy group is to carry out in the near future on dispensing errors. He read out to me a prescription with a very ambiguous message on it. Because he did not have access to the patient's record, he would have to phone the GP and double check what the GP meant, causing delay and problems for the patient. That is another example in which access to the patient record would be a good thing. In conclusion, I put a question to my right hon. Friend the Secretary of State. The NHS constitution, which I thoroughly support, allows a review only after a 10-year period. However, it provides for the handbook to be considered every three years and the effects on patients and staff every three years. Perhaps my right hon. Friend will consider the matter in the course of his deliberations, or perhaps it could be discussed in Committee and on Report. Can we ensure that the NHS constitution is reviewed rather sooner than 10 years? That is too long a time. I would advocate that it be reviewed after three years, at the same time as the NHS constitution handbook and the effect on staff. Will my right hon. Friend address that point?