A fanfare for the near completion of the new NHS network, N3, has been met with complaints that some GP practices with new broadband connections are not receiving enough bandwidth even to use the e-referral system, Choose and Book, effectively.
Announcements last week from the network’s purchaser, Connecting for Health, and supplier, BT, brought numerous comments from E-Health Insider readers who were critical of the performance experienced by some users.
Clinicians in affected areas who attempt to use Choose and Book through their clinical applications are experiencing login times of up to four minutes and finding their keyboards unresponsive.
Meanwhile, users are unable to distribute critical application patches and updates over their connections and GPs are reportedly "tearing their hair out".
Readers posting comments say that Connecting for Health has told practices that have complained about their lack of bandwidth that there is no financial assistance for an upgrade, and they must pay BT for the necessary upgrades to their line.
One implementation manager told E-Health Insider: "There’s a lot of positive spin for something that’s going so badly. N3 is ‘going great’ but that’s just not the case here."
In February 2004, the DH awarded BT a seven-year contract to build, install and manage the N3 network, as part of the National Programme for IT. The contract, worth around £530m, covers 18,000 sites.
When the contract was announced, it was expected that in GP practices, links of 256Kbps would be upgraded to 1Mb or 2Mb. However, while this might have happened for download speeds, several sources have reported that upload speeds are still slow.
These types of connections, known as asynchronous, are being put in place in practices with under 50 network stations, following assessments by CfH under its National Allocation Algorithms. However, these algorithms result in lower connection speeds to GP surgeries than other NHS sites that have the same number of network stations.
Any upgrades requested by sites are carried out by BT, who in the vast majority of England owns the local copper lines. The upgrades were originally paid for by CfH.
But practices are now being told that they or their PCT must pay for the work. One manager explained that this was not just difficult because of the extra cost but because a definite quote could not be given until work started. "How can we do financial recovery when we are looking at N3 upgrade bills?" one manager told E-Health Insider.
Bandwidth issues are compounded with practices which have branch sites. Although these have their own separate connections to N3, in order to use Choose and Book with their clinical applications they must connect through their central hub and share the limited bandwidth.
The difficulties are causing problems on a regional as well as a local level. Last month, EHI understands, a primary care trust in Leeds was unable to agree a go-live date due to the poor performance speeds of N3 over their intra-practice virtual private network.
Pressure on the network and ambitions for using broadband are growing too. In its announcement on the success of N3, CfH cited remote diagnosis as a new use of the high speed connections. “Patients can receive the convenience of local specialist advice and treatment instead of the inconvenience of travelling a distance to specialist centres. The highest quality images and video examinations can be sent to specialists who conduct the diagnosis remotely,” it said.
E-Health Insider asked CfH why the agency was not funding local upgrades. A spokesperson replied: "N3 is able to support the requirement of local business needs and customers are able to order additional, locally funded bandwidth for this purpose where there is a known need for higher bandwidths.
"However, local business IT requirements for networking are controlled locally, and are both complex and diverse. NHS CfH cannot be responsible for sizing, ordering or funding to support these local needs."
The spokesperson added that the system was specified in a fair manner and an improvement on the previous broadband connection through NHSnet. "As local organisations order N3 service, they provide information related to user base and device count which is used to determine the actual bandwidth delivered to each site.
"In this way N3 can ensure that adequate bandwidth to support the National Programme is delivered. The majority of all GP surgeries receive a minimum 1Mb of bandwidth compared to between 64Kbps and 256Kbps under NHSnet."