Primary care trusts (PCTs) have been told that current N3 broadband links provide enough bandwidth to run all Connecting for Health applications and that no local top ups should be necessary in most cases.
The newly-published guidance, which sets out the requirements for IT infrastructure now and in the future, makes it clear that in most circumstances PCTs should not pay for additional bandwidth on top of the current links provided to practices. Top-ups should only be considered except in the case of some branch surgeries or if practices have additional ‘local business’ requirements.
All but the biggest practices have been given ADSL links providing 512 kbps or 1Mb downstream and 256kbps upstream under the contract with N3 provider BT.
The guidance says this is sufficient to run all CfH applications including Choose and Book, GP2GP, the NHS Care Records Service, the electronic prescription service and NHS mail.
It adds: “PCTs should not need to assess bandwidth requirements nor consider purchasing a top up for GP practices that only require N3 access to these technologies.”
The guidance adds that if there are “consistent performance issues” these are often the result of local configuration issues.
The instructions mean GP practices that have claimed a 1Mb connection is inadequate to run their practices, as highlighted by EHI Primary Care’s Fair Deal on NHS Broadband Campaign will face an uphill struggle to get an upgrade from their PCT.
Practices have reported speed problems running CfH applications such as Choose and Book as well as internet browsing for online medical resources. The latest guidance says the NAA provides sufficient bandwidth for a range of CfH services and local service provider systems. It says PCTs additional bandwidth is available to support “local business requirements” in addition to these services but that any addition must be funded by the organisation requiring the upgrade.
GP practices with branch surgeries have faced particular problems over N3 and the guidance says work is going on this month to modify the Quality of Service rules that prioritise network traffic to provide “enhanced support” for branch surgeries using EMIS LV.
EMIS and CfH have been working on a solution to branch surgery speed issues, as reported last month by EHI Primary Care, and an announcement that those problems have been solved is expected by CfH this week.
Dr Manpreet Pujara, chair of the EMIS National User Group, told EHI Primary Care: “I have been told that they have been applying a fix and that it has made a tremendous amount of difference for practices with branch surgeries.”
However the IT infrastructure guidance states that the 1Mb links provided for GP practices may not be sufficient for practices with more than one branch surgery linked to a main site using local servers and in such cases PCTs will need to pay for a private circuit.
The cost of such upgrades has been one of the issued raised by the Fair Deal on NHS Broadband campaign with some PCTs quoted up to £30,000 to upgrade from a 1Mb to 2Mb connection.
The guidance adds: “BT N3SP is working with CfH to trial the use of ADSL as a lower cost alternative for multiple branches which do not make heavy use of the network, and will publish details of alternatives in early 2007.”
Practices have complained that their clinical systems have been running extremely slowly over the branch surgery links and the guidance says that although local traffic is given a higher propriety than internet browsing or bulk transfer such as GP2GP, it is still given a lower priority than national applications.
The guidance adds: “It is recommended that PCTs purchase top up services, where required, to ensure that the amount of bandwidth guaranteed to AF2 [local traffic] is sufficient to support the locally hosted GP system architecture.”
CfH told EHI Primary Care earlier this month that trials of an 8Mb Business DSL service would begin shortly and that although GP practices would not be the early implementers additional functionality was being developed which could extend the target audience to GPs.
General Practice IT Infrastructure Specification [PDF, 420K]
Discussions underway on 8Mb broadband for GPs
BT investigates slow connections for GPs