Just over the road from Newcastle’s Royal Victoria Infirmary stands a legendary pub; The Trent House.

It is favoured by football supporters for its proximity to Saint James’s Park and by young doctors for its proximity to the nurses’ home.

The latter houses several hundred pretty student nurses, making the pub what my more politically incorrect colleagues referred to as “a target rich environment” back in the 1980s (ref: Top Gun 1985).

To complete the package, it was run by the only black landlord in Newcastle, Tommy Caulker, who was something of a visionary; not to mention local legend.

The juke box was free and stocked with a red hot collection of black American music, reggae and soul. You could play any music you liked; so long as it was Tommy’s music.

Tommy had a talent for précis. He had distilled all of human history, philosophy and religion into a sign on the wall that was put up in response to racist attacks on his pub: “House rules: Be Nice to People. Don’t be a twat.”

Consequently, The Trent House was a self policing island of multicultural harmony in otherwise difficult times, populated by the coolest early adopters in Geordieland.

The pub played a major part in the ‘Geordies are Black and White’ campaign which drove racism off the terraces of St James’s Park in the 80s, and also spawned literary efforts like Viz Comics, which did its early advertising.

We loved Tommy and we loved The Trent House. When we returned home from university or from our new jobs in London, Nottingham, Liverpool and so forth, the old school gang would always meet in the Trent on Christmas Eve before going home to our separate family Christmases.

Christmas past

Christmas Eve 1985 we gathered in the Trent to have a couple of beers to get in the mood. We were cooing over Tommy’s latest addition to the pub’s entertainment.

Where once the pub had just had the juke box and a pool table, Tommy had added a coffee table that had a Space Invaders machine built in!!!!! I kid you not, built in!!!!!

We were amazed until my mate’s brother, Paddy, walked in, fresh from his new job in London. He was living the dream as an estate agent in the loadsamoney era.

“That’s nothing!” he said, sneering at Tommy’s technical wonder.

“Look what I’ve got,” he trumpeted, producing a small but obviously heavy brief case to which a futuristic-looking telephone handset was attached by a thick curly wire.

“What the **** is that supposed to be, Paddy?”

“It’s a MOBILE phone.”

We fell about laughing.

He told us what it cost.

We laughed even harder.

He told us how much a phone call cost.

Pants were wet.

He told us they were all the rage in London.

Sides were split.

The juke box played ‘Heard it through the grapevine’ by Marvin Gaye.

Christmas present

Plainly, I failed my spotting-paradigm-shifting-technology exam; but predicting the future is fraught with danger.

Little did we know how apposite the juxtaposition of Paddy’s massive mobile and Tommy’s high tech table would be.

We didn’t know that phone and videogame platform would combine, add a computer, a high definition television, and an infinitely huge juke box, and become a device small enough to hold in your hand.

On the other hand, the ‘Tomorrow’s World’ shows of my childhood, with former Spitfire pilot Raymond Baxter, predicted that by now I would be wearing a Bacofoil suit and having a small collection of pills to fulfil all my dietary requirements.

So I am wary of pointing out the next big thing and how it might apply to healthcare. But I’m going to risk it.

All of my five years in health informatics have been in the world of secondary care, both in the acute and mental health sectors.

I’m ashamed to say that in that time I’ve never been to have a proper look at a modern general practice electronic patient record system.

Having saved up a lot of annual leave – which I am obliged to use or lose – I took a day’s leave last month to have a proper look under the bonnet of a GP system.

I know, that’s a pretty sad use of holiday, you don’t need to tell me. My wife said: “Why can’t you be a normal bloke and just take a day off and be a couch potato? Instead, you’re some sort of work… some sort of work… Dammit you’re a work vegetable!”

If you can name a workaholic vegetable to stand in as the opposite of a couch potato, please get in touch. In the meantime, I’m glad I finally took the time to visit GP land for I have seen the future!

Christmas future

While we were busy with the National Programme for IT in the NHS, the GPs have been grinding away at the usability glitches in their systems.

Over many years, like a shard of glass polished by years of rolling in the surf, the systems have become shiny pebbles of smoothness that ache to skim elegantly over the waves in the hands of a skilled stone skimmer.

The difference between secondary care systems and modern GP systems is staggering. It’s the same degree of difference as there was between Paddy’s massive mobile and my iPhone5.

And what makes it so is the same 20 years of end user feedback, which has been listened to and acted on.

I’m sure that my GP colleagues have known this for years and that all we needed to do was ask them, but the fact is that if we really want an NHS electronic patient record system it should be grown from general practice, not the Department of Health or the NHS Commissioning Board.

I’m sorry it took me so long.

If you would like to be part of the surf, grinding secondary care systems into shiny pebbles of usability please send me a frank assessment of your current secondary care system, in confidence, via www.comparethesoftware.co.uk.

If you’d like to know what a good EPR looks like, talk to a GP. If you’d like to know how to put a working EPR into a secondary care setting, talk to a psychiatrist.

Merry Christmas to you all. See you in The Trent House on Christmas Eve.


About the author: Joe McDonald is a practising NHS consultant psychiatrist. Over the past five years he has been an NHS trust medical director and national clinical lead for IT at NHS Connecting for Health – a stint that included 18 months as medical director of the Lorenzo delivery team!

His experiences in the National Programme for IT in the NHS have left him with a passion for usability and "end user knowledge networks.” He is the founding chairman of the National Mental Health Informatics Network. Motto: we don’t get fooled again. Follow him on twitter @CompareSoftware