The time to be spent by hundreds of thousands of NHS staff in registering for smartcards and Pin codes is necessary for the security of systems that will allow authorised users to access a database of 50 million patient record summaries and other systems. The smartcard also allows auditors to track who has accessed or amended a record.
But the time that doctors and nurses have said they need to spend registering for smartcards has not been discussed with most NHS staff and is seen by some clinicians as an encroachment into the time they have for patient care. It also comes at a time when politicians are promising to reduce paperwork for front-line staff so they can do their main jobs unimpeded by bureaucracy.
Officials working for Connecting for Health, the new name for the national programme for IT in the NHS, say that a rigorous registration process for the issuing of smartcards is needed to verify the identify and roles of users, to ensure that they see only the information they are entitled to view.
But some doctors say the process is too time-consuming.
Paul Cundy of the British Medical Association's GP IT committee said the registration process is necessary for security but will be a "big burden for the NHS".
Early adopters of the system in Barnsley have expressed concerns to the NHS that it takes 10 minutes at best and typically between 12 and 20 minutes to issue a smartcard to a member of staff.
When this is multiplied by the number of smartcard users, the total time spent by the NHS, including more 660,000 clinical staff, on the registration process would be between 160,000 and 266,000 hours.
In addition, thousands of clinicians will need to sponsor colleagues to verify their identity and bona fides before smartcards can be issued. The time overhead for hard-pressed doctors and clinicians raises questions about whether they will try and avoid registering to use the new national systems unless IT suppliers and the NHS reduce the bureaucracy and system delays.
The registration process involves completion of a six-page "RA01" form which cannot be submitted online.
Doctors, nurses and other staff must prove who they are, either by sponsorship from a senior clinician or manager, or by showing evidence such as a passport or driving licence. They must also have their photos taken for the cards - which officials say can take longer than expected as some individuals request photos to be retaken.
Officials say that as specialists gain experience of issuing smartcards, the average time taken to issue them could be reduced to about 10 to 12 minutes. But this estimate does not take into account the time that clinicians and managers will need to spend deciding what information each member of staff can access, or the re-issuing of access authorisations when users change jobs and roles.
An additional concern for doctors and nurses is that, once a smartcard is issued, it takes 40 seconds every time the card is used to open a browser or use the first software application. Cundy said many doctors will not use any system that delays access to patient records for 40 seconds every time they use their card.
A spokesman for Connecting For Health said, "Early-adopter sites provide us with feedback that we use to improve what we do as we roll out further to the NHS. We are in discussions with human resources on the most effective and efficient way of operating the registering process."
NHS IT diretors' smartcard concerns
IT directors in the NHS say there are unanswered questions over the issuing of smartcards:
- What will happen if doctors and nurses forget to bring their cards to work?
- Will ward staff and GP practices try to make life simpler by sharing cards and Pin codes?
- How well will the smartcard systems work? Kingston NHS Trust, an early adopter of the NHS Care Records Service, which includes summaries of electronic patient records, has reported that smartcard and registration equipment is slow and unreliable.
- Does the NHS have enough staff dedicated to ensure that people who leave the health service will have their card revoked, or could these end up still in circulation, used as spare cards or without authorisation?