I’m going to be brutal here: in my experience, most staff in a GP practice aren’t the most computer literate.

They are ok as users; but they don’t see possibilities or show much willingness to experiment with what systems can do.

I watched the Steve Jobs movie the other day. In it, he gave his daughter a Mac and said: “Don’t worry, you can’t break it.” I think some of our staff think they can break the computer; and their belief is probably not helped by it crashing all the time!

GP IT is stagnating

I don’t think that many of the more senior managers in practice are any better. Indeed, while many of my younger partners are found on Facebook and internet forums, they still don’t really get IT.

This means that, while primary care IT might be miles ahead of hospital IT, it is stagnating because of a lack of investment in training and in managers who know what is possible and how to deliver it.

To prove or disprove this theory, we have been doing some in-depth IT health-checks for the practices within the two local GP federations that we have been setting up locally.

As far as we know, we have done these at a much greater level than anyone else has done previously. We have tried to understand the use of IT, the level of knowledge, the things that go well and the things that could be done better – with a view to finding solutions and sharing best practice.

We are learning from each practice that we do and we will need to go round again, possibly a few times, because it is amazing how different two practices can be when it comes to doing the same thing.

Sometimes both approaches are equally valid; sometimes you wonder how a practice copes with its seemingly bizarre procedure.

Gripes, knowledge and training

Our checks have turned up lots of gripes. The usual: poor desktops, long start-up times, crashes, printers not waking up…. Some relatively simple fixes have made a big difference.

For some staff, just being shown how to get on to the wi-fi in their own building is a revelation. For others, networking a printer so they can work from wherever they want has helped.

Now, I must point out our commissioning support unit support is good. The CSU will network up a printer if it is asked to do that; but you need to know that a printer can be networked and that it might be the answer to a problem you have before you can ask.

Getting into these kinds of questions is partly what we are trying to achieve. Meanwhile, we have found that there is a huge variation in the software being used by practices.

While we are all on Emis Web – and have our struggles with it – there is a wide range of additional tools available to help. Some are better than others; so we are in the process of evaluating the 140 plus EMIS accredited partners to let our practices know which have products that could help them.

It also turns out that when a lot of software – Emis Web, Docman and so forth – is first installed there is a day’s training.  People rush in and out of rooms having their ten minutes; unable to stop the daily grind.

This training takes place on software that is setup one particular way. Over the years, people change. Often, even the people who managed to get to the initial training are no longer at the practice. 

So it turns out that most of the people who actually use the software have been trained by Chinese whispers.

Also, people get stuck in working in one way; even though others have worked out better ways. I’ve had a local IT manager tell me that Docman couldn’t do something that I know it does; because I’ve I set it up in my surgery to do it.

Missing out on possibilities

Another reason for this is that new versions come out with new possibilities. Often, these are hidden in the release notes.

For example, Docman has single sign-on. This is a good thing. If I’m logged into Emis, I shouldn’t have to re-login to Docman. It should share my authentication.

But this is only in theory. I found out about this in a release note, but we’ve never implemented it. When I asked why, I was told that, when the release came out, it was felt there was an issue with it.

However, nobody was sure and nobody was tasked with re-checking whether there really was a problem and, if there was, whether it had been resolved.

Another example. Docman’s Intellisense scans letters for you, extracting data from them. My practice’s belief was that this was time consuming and error prone; and why would anyone want it, anyway?

However, this was based on an assessment made five years ago, when it came out, and there was a charge for using it. Now, Intellisense is free and improved and our new DPM is familiar with it from a previous practice. So we are using it.

Another example. A lot of our practices use Lexacom digital dictation. The latest versions have what appear to be really interesting features for reporting and appear to offer the potential to work collaboratively with other practices. However, none of our practices are using these features.

Federations need to employ IT teams and trainers

The whole health-check process has been very worthwhile. We have come up with three or four amazing ideas from listening to our practices that could change the face of primary care IT; if we can get them implemented.

Perhaps the best idea, though, is that federations should employ their own IT staff. This website has long pushed the idea of chief clinical information officers, and of getting clinicians involved in IT to drive the agenda.

My thought for primary care is almost the opposite. Now we are federating, there is a huge potential for an information/IT team to help maximise the use of IT and to help staff get the benefits of doing that; a role that I don’t believe CSUs have been delivering.

There is clearly a huge training challenge if practices are going to get the best out of their software. Lots of the big companies charge a fortune for daily training. Employing in-house trainers has got to be the way to go.

Dr Neil Paul

Dr Neil Paul is a full time partner at Sandbach GPs; a large (22,000 patient) practice in semi-rural Cheshire. He is also one of the directors of Howbeck Healthcare Ltd.
Dr Paul has been involved in primary care IT and health service management for more than ten years in various roles, including PEC member and urgent care lead. In his spare time, he writes medical iPhone software and is a keen photographer.