About 50% of family doctors are threatening to defy government instructions to automatically put patient records on a new national database because of fears that they will not be safe, a Guardian poll reveals today. It shows that GPs are expressing grave doubts about access to the "Spine" - an electronic warehouse being built to store information on about 50 million patients - and how information on it could be vulnerable to hackers, bribery and blackmail.
The survey reveals that four out of five doctors think the confidentiality of their patients' medical records will be at risk if the government proceeds with plans to load them on to the new database.
More than 60% of family doctors in England also said they feared records would be vulnerable to hackers and unauthorised access by public officials from outside the NHS and social care.
Ministers have committed a large slice of the NHS's £12bn IT upgrade to developing the Spine. They acted on the assumption that doctors would provide the information without asking their patients' permission first.
The new system has been constructed to upload information from GPs' computer systems automatically, without giving patients a say. But the poll found 51% of GPs are unwilling to allow this uploading without getting each patient's specific consent. Only 13% say they are willing to proceed without consent and the rest are unsure or lack enough information to comment.
The poll was conducted by Medix, a healthcare online research organisation that has been used previously by the government to test medical opinion. It found most doctors think a national electronic record will bring clinical benefits for patients. About 51% of GPs and 65% of hospital doctors said it would enable doctors and nurses "to make better decisions by having easy access to a complete up-to-date record of clinical information". But the doctors were not convinced about the security of the records.
They saw a big threat to patient confidentiality, with 79% of GPs and 55% of hospital doctors disagreeing with the claim of Richard Granger, the NHS IT chief, that the new system will be more secure than current arrangements.
Asked to identify the three most important concerns about confidentiality, 62% of GPs and 56% of hospital doctors said they were worried about "outsiders hacking into the system"; 62% of GPs and 51% of hospital doctors similarly feared "access by public officials outside health or social care". Other big fears included "bribery or blackmail of people with access to the records" and concern about "clinicians not adhering to the rules".
Nearly half the doctors who saw clinical benefits from a national record thought the confidentiality risks worth taking. But only 11% of GPs and 18% of hospital doctors were prepared to upload details without the patient's consent.
The British Medical Association said: "We share the concerns of the GPs responding to the poll. We are worried patients are not going to have all the information they need to know what is going on with their records. That is why we are in favour of a system that seeks their explicit consent."
Connecting for Health, the agency responsible for the NHS's £12bn IT investment, said the poll showed most doctors recognised the benefits to patients of the national programme for IT and agreed that introducing electronic care records would help clinicians make better decisions.
A spokesman said: "The law constrains how a national database must operate, but it does not prevent the creation of such a database, nor does it prevent the merger of existing databases for efficiency and safety reasons, as is being done to create the central summary clinical record. The Department of Health believes that this will be of great benefit to a great majority of people, improving healthcare and preventing unnecessary deaths."
Ministers are preparing a public information campaign to persuade patients of the medical benefits of a national electronic patient record. About 50 NHS primary care trusts have volunteered to trial the electronic record by uploading a summary of key medical information about patients, but excluding sensitive medical histories. Ministers have shortlisted six PCTs for the trials.
Local information campaigns will tell patients they can deny NHS staff access to their medical details, but doing so may damage their chances of getting the best treatment. However, once the record is stored on the Spine, there will be no way of deleting it.
Medix said the sample of 1,026 GPs, consultants and other doctors was fully representative of the profession. The survey was commissioned by the Guardian and four magazines and websites with an interest in NHS IT. It was conducted online this month, about a week after a Guardian inquiry found a lack of safeguards against access to medical records on the Spine.
