Happy New Year: From the consulting room

GP columnist Neil Paul looks back – less than fondly – at 2007, and puts together a wish-list for primary care computing in 2008.

In the first column of the New Year, it is traditional – but also useful - to reflect on the year just gone and to look forward to the year ahead.

Although we had GP Systems of Choice (GPSOC) in 2007, I don’t feel it was a great year for primary care IT. The software on my desktop computer crashes just as often as it ever did and it doesn’t seem to have developed any stunning new features that help me.

 “The software on my desktop computer crashes just as often as it ever did and it doesn’t seem to have developed any stunning new features that help me.”

Small savings, big costs

IT management still seems poor, at least locally. A health visitor told me about a classic example recently. In a near-by, brand new building - built as a PFI project at the cost of over £10 million - the IT department has reportedly refused to buy extra line licences so that health visitors can access GP computer systems from their desks.

Instead, they apparently have to walk down a set of stairs, through two sets of swipe-card doors, and into another room, where they have to wait for a free computer to access a patient’s records or check their messages.

Hardly the utopia mentioned in Professor Colin-Thome’s document, Keeping it Personal, which makes the case for expanding the work done by primary care professionals, given state of the art facilities.

Meanwhile, the money “saved” on each un-bought license must surely be wiped out by the loss of work done by health visitors if they have to walk up and down stairs trying to find a computer.

And where’s the innovation going to come from?

Looking forward to 2008, I am increasingly worried that an ever more centrally controlled and managed IT strategy will squash and stifle innovation. As a partner in a large “super-surgery” I understand the cost efficiencies that come from size.

However, when something is planned on a national scale there is a tendency to listen to a few voices that lobby hard and to forget about the end user. Also, as a GP, I am concerned about getting good quality, timely clinical information that helps me help my patients directly.

A manager somewhere up the chain is more concerned with getting information on what I am doing and whether their targets are being met or about to breach. I am not saying these two things can’t co-exist - just that the people setting national policy need to remember the bit I want.

Meanwhile, patients themselves have opinions. I hope that, if they thought about it, they would like their doctors to be stress free and to be maximising the amount of the day they spend with them. In this context, it’s worth remembering that every minute I wait for Choose and Book to load is a minute I am not spending – usefully - with a patient.

 “As a GP, I am concerned about getting good quality, timely clinical information that helps me help my patients directly.”

In 2008, I would like...

Therefore, my wish list for IT in 2008 is:

• Timely and accurate information, transferred electronically, on things done to my patients.

In particular, the ability to get – quickly and electronically - test reports that otherwise sit on a consultant’s desk for six weeks, while the patient who sits with me wonders when their follow-up appointment is going to be.

• Functionality to allow me to better “manage” my patients’ healthcare experiences and to help with Practice Based Commissioning.

For example: at the moment I can order a blood test online, but nothing tells me if a patient hasn’t had it done within a certain period of time. Therefore, I have no way of knowing how many patients are waiting for investigations and whether I could swap providers and get a better deal for them.

Similarly: I have no way of knowing how many people are waiting for follow-up appointments after investigations, which is, to my mind, one of the hidden delays in the NHS at the moment. I am interested to know what software people like Kaiser Permanente use to track this sort of thing and will happily accept an all expenses paid trip to the US to find out.

• Better training for all. The amount of time lost because people don’t know how to do something simple, such as how to use Microsoft Office to organise a meeting, must be huge.

• More intelligent prompts. I have noticed that our IT supplier, EMIS, is experimenting with pop-ups that say things like “is this patient diabetic - his last sugars were high?” Although this can feel “Big Brotherly”, there are numerous areas in which such prompts might be useful: cardiac risk, falls risk, osteoporosis risk and secondary prevention all spring to mind.

There are also plenty of conditions were the computer could track whether relevant investigations had been done and highlight those that hadn’t.

• More joined up thinking. Why do I have to log in to five different programs with five different passwords? Why does my district nurse have to record her information on four different systems?

Well, that’s my list for 2008. I’d be interested to hear yours.

About the author: Dr Neil Paul is a full time GP working at the Ashfields primary care centre in Sandbach. He has just been appointed to his primary care trust’s professional executive committee and has a lead role for IM&T and Payment by Results.