Intended for healthcare professionals


England’s national programme for IT

BMJ 2013; 346 doi: (Published 28 June 2013) Cite this as: BMJ 2013;346:f4130
  1. Trisha Greenhalgh, professor of primary health care 1,
  2. Justin Keen, professor of health politics2
  1. 1Centre for Primary Care and Public Health, Queen Mary University of London, London E1 2AB, UK
  2. 2Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
  1. p.greenhalgh{at}

From contested success claims to exaggerated reports of its death

The national programme for IT, which promised to revolutionise care in the English NHS, was originally planned to run for two years and nine months from April 2003.1 Policy documents predicted that by the end of that period, a near paperless working environment would be the norm. This would include electronic systems for booking outpatient appointments, referring patients, producing discharge summaries, and transferring prescriptions between general practice and community pharmacies.2 3 4 In emergency care, key clinical details would be available at the touch of a button wherever in the NHS the patient presented.5 Patients would be “empowered” by remote access to their NHS records.1 5

The reality was different. Contracted deadlines for delivering key systems were repeatedly missed.6 7 8 Technologies that were meant to make tasks and processes more efficient at the clinical frontline were more cumbersome and time consuming, and in some cases less safe, than their paper equivalent.7 8 9 10 11

Ten years on, only a handful of hospitals can be described as paperless, and most communication between NHS organisations still occurs by snail mail, fax, or patient messenger. …

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