ABC of Medical Computing: COMPUTERS IN GENERAL PRACTICE--I

General practitioners have been at the forefront of medical computing in Britain for the past 20 years. The first systems were developed by enthusiasts and were designed to collect epidemiological data rather than manage the practice, but in 1972 the Department of Health sponsored the development of a system that recorded consultations for the first time. The project was limited to a small group of practices in Exeter but subsequently developed into a full practice management system that is still available today. In 1982 another government sponsored scheme (Micros for GPs) put computers into 150 practices across the country, but it was not until 1987, when two companies (VAMP and Meditel) began offering sophisticated computer systems to general practitioners free of charge, that practice computing really took off.

In return for their free computers general practitioners were required to record every consultation and prescription issued. Both companies planned to collect this information anonymously and then sell it to pharmaceutical companies to recover their investment. From general practitioners' perspective, the schemes were a huge success, stimulating many practices to computerise for the first time.

The sweeping changes to remuneration introduced in the 1990 general practice contract made computers almost essential for all but the smallest practices. By 1993 there were about 50 commercial systems to choose from and about 8500 practices were fully computerised. The free schemes have now ended, but the government continues to encourage computerisation through a complex system of reimbursement.