Views & Reviews From the Frontline

Error report

BMJ 2009; 338 doi: (Published 23 February 2009) Cite this as: BMJ 2009;338:b798
  1. Des Spence, general practitioner, Glasgow
  1. destwo{at}

    Meatloaf blasted from the jukebox. Tears welled in her eyes as she looked down into her Lambrusco. I met my mate’s eyes and nodded. We left, heading for the arcade games—huge gaudy machines, with only two buttons and a simple joystick. “Rolling Thunder,” “Hang-On,” “Gauntlet,” “Galaxian”—these monsters consumed my grant, time, and headspace. They were simple, intuitive, and fast, but the computer programs behind them were tiny. These days computing is big business, with the NHS spending £12bn (€14bn; $18bn) on a national integrated records system. London’s Royal Free Hospital is trialling this new system, but its recent crash blasted clinical staff back to the stone age of pen and paper. How can this be?

    In primary care computer systems have evolved for 20 years from those set up by small companies started by practising doctors. We now have paperless systems, meaning an end to illegible handwriting (if not illogical content), no lost records, no Brownian filing, multiple access, up to date prescribing records, integrated laboratory results, and electronic transfers between practices. Some practices even offer online appointment bookings. These systems are stable, flexible, functional, and familiar. We have huge vested interests in making these systems work.

    But in 2004 responsibility for our IT passed to the primary care trust, and we have lost local control. Increasingly we see an obsession with security; currently I need six passwords to access the full system, and these change constantly at ever decreasing intervals. New systems seem to need high spec hardware, only to run more slowly. Why is this? Because now commissioning is detached from the users. As a result procurement is overly ambitious, overly complicated, and driven by management priorities, not clinical ones. Also, trusts are addicted to the safety of big monolithic contractors whose creativity long ago became trapped in the mire of corporate hierarchy. These projects, devoid of accountability, always promise all things to everyone but deliver nothing to anyone.

    We are always told health is different from other sectors. It isn’t. Why can’t we develop a secure, intranet based solution that is shared across the NHS with one common record, is simple and intuitive to use, and has the look of traditional paper records? This would be cheap and easy to develop. In 2004 a college student set up Facebook, which now has 175 million users. So let’s get the teenagers with heavy metal T shirts off their computer games and give them a three week deadline, because the current system simply isn’t good enough.


    Cite this as: BMJ 2009;338:b798

    View Abstract

    Log in

    Log in through your institution


    * For online subscription