GNCR medical director calls for culture change on NHS IT


The medical director of Great Northern Care Record has said that the culture that led to the failures of the national programme for IT (NPfIT) is being carried into NHSX.

Speaking at the Northern, Yorkshire and Humberside NHS Directors of Informatics Forum’s (NHYDIF) annual conference in York, Professor Joe McDonald suggested the key cultural lessons from NPfIT had not been learned and it remained very difficult for local NHS IT leaders to have honest conversations with the centre on NHS IT.

“I think NHSX is the right idea, pulling the strands together, but I’m not sure it’s working, and that the negative culture that stymied NPfIT is unfortunately alive and well,” McDonald said at the event on 7 November.

Prof McDonald – who was “let go” a decade ago as a clinical lead for NPfIT for “career limiting frankness” on Lorenzo – also said he “was worried that NHSX may lose the dressing room before they get their team on the field”.

He added: “There’s lots of money out there, but an incoherent funding arrangement and a confusing NHS alphabet soup.”

Prof McDonald called for fundamental cultural change, far greater honesty and for budgets to come out to the frontline.

“There has to be a massive change in culture; we need to have the honest conversation about what needs to happen,” he said.

The culture needed is one willing to listen to dissenting voices and alternative perspectives, McDonald stressed.

“One of the signs of being in a culture that stamps down consent is that the real conversations happen in Whatsapp groups, but not with government,” he said.

Speaking about the development of the Great Northern Care Record (GNCR), Prof McDonald spoke about the pressure to “torture truth” by signing up to artificial targets set by NHS England and NHSX.

He said that unwillingness to commit to such targets had cost GNCR Local Health and Care Record Exemplar (LHCRE) funding.

“We’ve not yet got LHCRE funding and may miss out because we have a real problem with the phoney milestones set by the centre,” Prof McDonald said.

“If you have to torture truth about what is achievable on phoney milestones – we don’t want to do that, we want to be a trustworthy and truthful.”

The issue was rooted in organisational culture, McDonald argued.

“The culture is not great, and it’s really wearing to operate in culture in which any form of dissent is seen as disloyalty to the programme.  But my loyalty is not to ‘the programme’ but to my patients and colleagues.”

McDonald also argued that local leaders must feel that they were able to speak truth to the centre and push back on projects and ministers chasing the latest technology hype.

He added: “In the North East I have three trusts in my region who don’t even have an EPR, they are just going to be dark on data sharing and their patients will not see the benefits.

“To be spending £250m on AI first, rather than sorting out the basics, is just bonkers and we need to be able to say that.”

The former chair of the CCIO Network said that it was a key dimension of NHS IT leadership to “have a duty to be talking back to the centre,” but added this was really gruelling and contributing to key local leaders leaving the NHS.

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