sentences:  A January 2005 survey among doctors indicated that support for the initiative as an 'important NHS priority' had dropped to 41%, from 70% the previous year.There have been concerns raised by clinicians that clinician engagement has not been addressed as much as might be expected for such a large project.Concerns over confidentiality, and the security of medical data uploaded to the Spine have also led to opposition from civil liberties campaigners such as NO2ID the anti-database state pressure group and The Big Opt Out who provide patients with a letter to send to their doctor so that their records are withheld from the database.