NHSnet: reversal of fortune?

After a near-disastrous year, NHSnet is trying to regain the confidence of GPs with tighter network contracts. But it has a long...

After a near-disastrous year, NHSnet is trying to regain the confidence of GPs with tighter network contracts. But it has a long way to go. Lindsay Clark reports

NHSnet is entering a new era. A year ago GPs were being forced to join a network that had no guaranteed service levels, no encryption policy and for which they paid to pick up and to receive e-mail messages. GPnet, the scheme to link family doctors to NHSnet, looked in serious trouble.

But things are starting to change. GPs can now access a 64Kbps-link to NHSnet with no call charges, following negotiations between the BMA's GPs Committee and the Department of Health.

In addition, contracts between NHSnet suppliers BT, Cable & Wireless and BT Syntegra and the NHS have been reworked to tighten service-level agreements and included penalties for underperformance of the network. The result should be an end to availability problems that have undermined the network as a carrier of patient data in the eyes of the medical profession.

Giving his last public presentation as GPnet program director, Bob Grindrod accepted that there had been problems with the development of the network. He said the service had "lost the plot" over messaging and lost the confidence of GPs and other users over the purpose of an NHS-wide Intranet.

Yet Grindrod is more confident about the future. "NHSnet is going to turn around and the future is going to be more positive," he said.

Speaking at the HC2000 healthcare IT conference in Harrogate, Grindrod said the service had to make strong commitments to suppliers to get them back on board.

"The suppliers were disillusioned," he said. "If you want to get a step change in the relationship with them, you have to go to the board level. We told them what we wanted - quality, measurement and investment. But you cannot do that unless you have vision for the network. It is a two-way street."

The NHS managed to get a capped rate from BT and a fixed rate from Cable & Wireless, both at a bandwidth of 64Kbps. The BMA's GPs Committee believes this is sufficient for the immediate needs of doctors on the network, although they will have to pay more for extra bandwidth at tariffs that have yet to be decided.

Grindrod said that there had been a massive uptake in use of the network in recent months. E-mail use had grown by 300% in a year, and the use of ISDN had doubled in the past two months.

The NHS Information Authority is putting two initiatives in place to ensure the rise in use continues. First, greater user involvement in developing applications on the network will be promoted through NHS IA stake-holder groups. Second, suppliers will have to be more transparent in their dealings with NHSnet.

"One of the biggest problems we have had in the past is that we had not communicated very well about NHSnet," Grindrod said. "Together with the providers, we are also moving to be much more public about the quality of the service."

He said the NHS IA will commission research into NHSnet's performance and make the results public to drive the suppliers to maintain high standards.

"We want NHSnet to be open to users," he said. "We want customers to say what they want to do with it. It's important that we regain user confidence that has been lost over time."

Although Grindrod leaves the GPnet program having at least addressed some of its users' concerns, his replacement, Steve Walker, still faces several mammoth projects. Walker will head Project Connect, the next stage in GPnet, which plans to widen its brief to work with health authorities and trusts.

The first challenge is a result of an astounding oversight in NHS planning.

When the first contracts for NHSnet were drawn up, plans for messaging were not in place and the network was built without a directory. "Why be bought an e-mail service without getting a directory with it, I will never know," Grindrod admitted.

In the coming months, the Department of Health will tender a contract for the directory, which will attempt to store the addresses of all NHSnet users to ensure secure and reliable messaging across the network. The task is huge, Grindrod said. Not only will the supplier have to account for the NHS's massive and ever-changing workforce, it will also have to co-ordinate with the health service's disparate human resources organisations.

The NHS and suppliers will have to overcome these difficulties if they are going to implement security systems such as data encryption that is necessary to carry patient data on the network, according to the BMA. Walker said that, although it may take up to three years to get the directory up and running, the project is "mission-critical" to the success of NHSnet.

Yet as this project nears completion, the NHSnet will enter a new period of uncertainty as the suppliers are asked to re-compete for the NHSnet contracts in 2003.

Grindrod emphasised that NHS IT managers now must start to implement applications useful to healthcare professionals on the network and have a long-term vision for its future to maintain suppliers' interest. "We must give ourselves time to think this through carefully," he said.

"We want NHSnet to be open to users and customers to say what they want to do with it"

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