GPs are reporting more problems with N3 connections and system speeds which they say are affecting their ability to run both Connecting for Health applications and local surgery systems. The problems appear to be particularly acute for practices with branch surgeries.
In Kent Dr Stephen Meech’s Maidstone practice has a 1MB connection which he has always argued was inadequate for the practice’s needs with two sites and 8,000 patients. A few weeks ago the branch surgery was connected up to the main surgery via the N3 line and the practice’s 2MB Megastream landline switched off.
However since then partners have experienced slow speeds over the site with internet site speed-tests show that N3 is running at between 400 & 650Kbps downstream.
Dr Meech told EHI Primary Care the PCT had told him he cannot reconnect the Megastream landline. He added: “NPfIT has left us with a connection that is slower than what we decided we needed ten years ago. It’s not half as fast at running our clinical system or internet browsing.”
In Yorkshire the Fisher Medical Centre in Skipton is also reporting no improvement to its broadband speeds over N3 at both main and branch surgery experienced for at least six months with some attachments taking up to 40 seconds to open during consultations at the branch surgery.
IT manager Mick Brighton told EHI Primary Care: “There has been no change to the N3 service either here or at the branch surgery, and there seems to be little prospect of any such changes.
“Some small changes to one of our routers helped with the ‘freezing’ problems but the overall experience does not seem much different. I have just tested the ‘Set session Role’ screen took 14seconds to load, the ‘Choose & Book’ home page about 17 seconds and a patient search by name and address within C&B a pretty good 3 seconds.”
The link between slow Choose and Book speeds and N3 problems has been strongly disputed by Connecting for Health which has claimed that any Choose and Book speed issues are down to local configuration problems.
GPs themselves, however, remain unclear about what is the cause of the slow speed problems and how to fix them.
In Lincolnshire Dr Ian Pace said: “There are still times when it takes up to 10 minutes to do a referral which is completely unacceptable when under the old system I say ‘I will refer you’ and you say ‘goodbye’.”
Dr Pace, who wrote to his MP and CfH director general Richard Granger about his problems with N3, said bandwidth was still an issue and would soon be put to a severe test as the practice planned to switch over to EMIS Web and stream its data over the connection.
Dr Pace added: “Bandwidth is not just about Choose and Book it’s about running the practice.”
Dr Gerard Bulger, a GP in north London, was visited by BT earlier this year after complaining about problems with N3. He said he is about to set up a practice based commissioning data collection site for local GPs but planned to do so over the internet rather than NHSnet.
In Warwickshire Dr Paul Thornton’s practice had substantial problems with slow operation of the link to branch when their server was upgraded to Windows server 2003 from WinNT server and it was expected that upgrading to a VPN link over N3 would solve it.
Dr Thornton said: “After a protracted lack of progress, the CEO of the part of BT with responsibility for N3 came to our surgery with a team to investigate and he quite impressively "owned” the problem though his team were confident that the available bandwidth was sufficient and under used. There had clearly been a problem with the various agencies involved each very rapidly attributing the problem to someone else.
"In the end it was found that the amount of data being transmitted at each screen refresh was altered by the server platform upgrade. This was somehow reset and the system was much improved such that we are just able to get by with it. However, our impression is that viewing images is still not as good as it was with WinNT and the 56K Kilostream link.”
Since EHI Primary Care’s Fair Deal for NHS Broadband campaign last year some changes have been made to the N3 service including changes to the priority given to different types of traffic over N3 and work on the connection between EMIS practices with branch surgeries and N3.
BT has also been developing an 8Mb Business DSL service for some of its smaller N3 customers such as ambulance trusts and earlier this year CfH told EHI Primary Care that the service may be extended to GPs.
At least one practice is trialing the service and told EHI Primary Care that it was better than its old N3 connection.