Internet can be accessed from NHSnet

Editor—Keen raises several issues in his article about the cost effectiveness of the NHS computer network, NHSnet, for general practices.¹

Firstly, he seems to present the internet as an alternative to NHSnet, implying that practices can choose between one or the other. In fact the internet can be accessed from NHSnet though a secure gateway (though internet users cannot browse NHSnet). Thus practices connected to NHSnet can access useful internet sites, such as Medline, Bandolier, and the Cochrane Database, as well as a range of on line journals including the BMJ. These can be accessed direct from their internet addresses or via sites designed to bring together useful sites of electronic information.

Secondly, Keen has not taken into account the rate of development of general practice computing. Increasing numbers (around 10%) of general practitioners are now “paperless” and consulting just electronically (NHS Executive information management group, May 1998, personal communication). Many of these receive their pathology reports electronically but have to rely on scanning or manual summaries of paper hospital letters to ensure that there is an electronic record of these hospital consultations. These documents could be word processed by the consultants’ secretaries and sent to the practice by electronic mail, which would cut out the expense of printing, postage, and handling and manually entering or scanning the data into the general practice system. Large cost savings can be made if this information can be sent within a secure network. An ISDN (high speed digital phone line) connection to the NHSnet can be acquired for less than the cost of setting up a scanning system.

Thirdly, creating links to sources of good evidence is not given sufficient emphasis. The importance of clinical governance has been emphasised in the white paper on the new NHS.² Primary care groups for populations of around 100 000 will have to communicate and share policy; the NHSnet provides a secure medium within which this should take place. Information systems giving timely access to sources of evidence based medicine are a part of this. We have found in our project—the doctor’s desk,³ in which pilot general practices have been given access to these sources of evidence based medicine via NHSnet—that having this information on the consulting room’s personal computer can be useful in decision making. The NHSnet can be an information source to foster good practice.