The man in charge of the £6 billion UK National Health Service (NHS) IT overhaul said he may soon pull the plug on some of its suppliers who are not hitting project targets, leading to the opening of contract negotiations with other companies.

Richard Granger, the director general of the currently named NHS National Programme for IT (NPFIT), which is overseeing the upgrade of the NHS and Department of Health's IT infrastructure, said that parts of the project have experienced delays and as a result, some of the suppliers responsible could be dropped.

Speaking at the Healthcare Computing 2005 conference in Harrogate and in an interview published in the Financial Times, Granger declined to name which companies face the axe, but took pains to point out the local service providers (LSPs) - the companies in charge of its five regional contracts - are not on the firing line. Those companies are Accenture, BT, Fujitsu Ltd. and Computer Sciences (CSC).

Granger is quoted in the FT as saying that if suppliers cannot do the job, they may be replaced in a move that "will occur over the next few months." A spokesman for the NPFIT confirmed the remarks, but stressed that those companies facing canceled contracts still have time to rectify the situation as no definite plans for terminations exist. The NPFIT spokesman declined to give any further details.

One centerpiece project that has fallen behind schedule is an online appointment booking system called Choose and Book that was scheduled to make 205,000 bookings by the end of December, but only managed 63 live electronic bookings. Atos Origin was contracted in 2003 to deliver a functioning system with Cerner providing the software.

Granger has already shown he is unafraid of the expensive process of retendering contracts. Last year, the NPFIT pulled its 10-year, £90 million e-mail contract awarded to EDS and gave it to Cable and Wireless. EDS threatened to sue over the matter, but later settled with the NPFIT for a reported £9 million.

Tola Sargeant, an analyst with Ovum speculated that the under-performing companies in question may be top sub-contractors to the LSPs, or one of the two main US-based application providers: IDX Systems and iSoft, Microsoft's main health partner in the UK.

"Changing some suppliers at this stage in the 10-year programme will be a painful process for all those involved. For the suppliers concerned it is likely to be an expensive process - the contracts are structured so that they don't get paid until they deliver - which will have repercussions for their reputation and performance on a global scale," Sargeant said in an e-mail assessment. "Of course, it won't be a picnic for the NPFIT either."

Swapping suppliers would most likely result in further delays, while negotiating new contracts with fresh suppliers could also result in higher costs for the IT project, Sargeant said.

Granger said that "substantial progress" has been made as systems and equipment are beginning to be installed and test projects are coming back with encouraging results. Granger pointed out that all large-scale projects experience an "entirely predictable dip," but that the government is working to address any problems or criticisms.

The British Medical Association (BMA), has been warning since last November that the current lack of engagement with the medical profession may doom the entire project to failure. In January, the National Audit Office (NAO) warned that if low levels of doctor and clinician support were not addressed, the project was in danger of missing its deadlines. The NAO, the department in charge of independently auditing government departments, is also in the midst of an investigation into the cost of the project, which it hopes to publish in the third quarter.

Another upcoming date on the NPFIT calendar is its name change. As of 1 April, the NPFIT will become an agency of the Department of Health and will be renamed Connecting for Health, said the Health Minister John Hutton. Granger will at that time become chief executive and senior responsible officer for programme and systems delivery, though he'll also retain his title of director general for IT, Hutton said.

The spokesman also said that the new moniker is in no way affiliated with the US group Connecting for Health, which describes itself as a public-private collaborative to a promote electronic connectivity in the health care field. "We are aware of the group but there is no connection and there will be no confusion caused by the similar names," the NPFIT spokesman said.