N3 provider BT has been investigating ways in which it might improve its service for GP practices using the EMIS computer system which have been struggling with slow connection speeds to their branch surgeries.

EHI Primary Care understands that BT has been running experiments on alternative configurations and that solutions identified by that work will be rolled out early in the new year.

EHI Primary Care’s Fair Deal on NHS Broadband campaign, launched in November, has been highlighting problems faced by GP practices with N3 connections with the aim of securing a better service for primary care.

Staff working in branch surgeries have faced particular difficulties where the N3 connection via a virtual private network (VPN) connection to the main surgery means even opening attachments such as consultants’ letters or clinical photographs can be painfully slow. In some cases GPs have reported occasions where there has been a delay of several seconds between making a keystroke and the character appearing on the screen.

The issues facing branch surgeries have been acknowledged by NHS Connecting for Health GP clinical leads Dr Gillian Braunold and Prof Mike Pringle and are due to be discussed at the January meeting of NHS Connecting for Health’s GP Pan User Group.

An announcement on improvements may be made to coincide with that meeting.

EMIS users at branch surgeries are thought to be particularly badly affected by slow speeds over the NHS network and Dr Manpreet Pujara, chairman of the EMIS National User Group, had asked for the problems with N3 to be put on the GP Pan User Group agenda.

As well as work being undertaken by BT, EMIS is rolling out its own reconfiguration programme for EMIS LV users by the end of January which it hopes will resolve many of the issues for its practices with branch surgeries.

Problems with slow connection speeds have not been confined to branch surgeries with many single site GP practices complaining about slow speeds when using Choose and Book or going on to the internet for online resources. Most practices have a 1Mb ADSL connection which delivers a maximum upstream speed of 288 kb/s.

Dr Laurie Miles, a GP in St Helens and member of the executive of the National Vision User Group, said problems with slow speeds had meant the practice had so far decided not to go for the integrated Choose and Book system.

He told EHI Primary Care: “Even on a good day we never get the 1Mb potential. When we want to run anti-virus and programme updates it is just ridiculous. The other day it was going to take three to four hours to download a 500mb update from Semantics so I actually went home, downloaded the software on my 10mb home connection and drove back to the surgery with it which was much quicker.”

Dr Miles said his own problems should be solved next month when a local Community of Interest Network (COIN) will provide practices with a 10mb connection.

He added: “I am going to be OK but I am campaigning nationally because we do get regular problems reported on the Vision user group list and on other GP discussion lists. I don’t know how anybody could risk having a hosted server linked to N3.”

A BT spokesperson told EHI Primary Care that BT N3 chief executive Stuart Hill has been visiting GP practices which have highlighted concerns about their N3 connection and given practices a leaflet setting out its position.

BT has consistently told EHI Primary Care that its performance monitoring has shown that the vast majority of N3 services delivered to GP sites are working well below the available bandwidth and statistics cited on the leaflet from November state that only 334 GP sites out of 8675 are using between 50 and 100% of their available bandwidth.

The suggestion is that applications such as Choose and Book may be the source of some of the problems rather than N3 itself. In response to the problem “I can’t access Choose and Book properly” the leaflet says “A Deployment Issue Resolution Team from within CfH has investigated many of the complaints and none of the cases have been related to N3 bandwidth issues.”

The leaflet adds that N3 will be “6LayerQoS” enabled by March 2007 which it claims will mean better traffic management for GP practices and says that on December 19 the NHS network’s internet gateway was increased from 550Mbps to 1 Gbps, scalable to 2.5Gbps.


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