Neil Paul and his colleagues have had just about enough of primary care IT problems, with infrastructure and software alike causing headaches. So why – our GP columnist asks – is focus being placed on non-fundamental features and his STP talking about potentially cutting primary care IT investment?

“I just can’t stand it anymore”: that’s one of my partner colleagues said to me the other day after a week of particularly bad IT. I tend to agree with her, as we’ve not had a good time with IT lately.

WannaCry hit us hard. The news might have been all about the hospitals it attacked but our primary care infrastructure was severely hit. At the time there were a lot of meetings and a lot of fuss about improving the system and working out what went wrong and about how to improve our security. Yet I’m not sure much came out of it other than us being given McAfee antivirus.

Now this seems to have caused more trouble than it’s worth. On starting up your PC, it can now take eight minutes to get to the log in window. Apparently that’s due to the antivirus triple checking everything.

Of course, our machines are old. They are on Windows 7. They have little memory, yet we increasingly have multiple applications open. I can be running eight to 10 pieces of software at any one time, and I suspect some don’t support older operating systems properly – in exactly the same way as modern websites don’t work on old browsers. We have been promised new machines but I’m not holding my breath. I also worry that by the time they have been sent out they will be out of date.

Overzealous security

McAfee appears to not only stop bad software, but in fact to stop anything. We tried installing and being an early adopter of the primary care communications solution AccuRx. For weeks we couldn’t get it to work. It turned out to be the antivirus. Recently Vision installed their population health software on a server in my building, so I could take a look at it. Everything was fine until we couldn’t get the client to work. The problem? Again, the antivirus software.

Perhaps this overzealous security is the price we have to pay for reduced risk of cyberattack. But I’ve been told there are alternatives that aren’t as bad and I’m eagerly waiting to try them.

The challenges we’re experiencing don’t just relate to McAfee, though. We recently upgraded to Docman 10, which manages clinical correspondence. Personally I think the UI could use some work: it’s too easy to click on the wrong thing and not that straightforward in places. However, I suspect that my perception has been coloured by the internet issues we’ve experienced, and which have meant on several occasions I’ve not been able to view the letters about a patient I am seeing.

We complained and complained and eventually we were told the local DNS nameserver wasn’t working correctly. It was losing the connection to the cloud server and causing errors. This was fixed, and things got slightly better but still things would grind to a halt.

In-depth analysis showed our internet pipe isn’t big enough. We have 25,000 patients, 60 plus staff, a whole host of attached and community colleagues, and frankly when we are all online it maxes out. Apparently when a community nurse synced her Outlook calendar it maxed out the connection and stopped anyone else doing anything. We are currently awaiting an upgrade.

But even when it is upgraded, I’m not convinced all our problems will be solved. The NHS N3 internet gateway appears to be flaky. We use Lexacom Cloud for our digital dictation. It’s great but it’s not on N3 (which is being replaced, nationally, by the Health and Social Care Network – HSCN). Lexacom Cloud relies on the internet connection. Apparently, it’s been going wrong recently. No one appears to know when it will be fixed, but hundreds of practices are affected.


We are thinking of putting in a separate broadband connection. Of course we will have to get the local routers to cope. I worry no one will be able to program them given how bad our wifi is.

The other day I joined my MacBook to the NHS staff wifi – it worked fine. I then tried connecting my iPhone. It used to work. It no longer does. The friendly local IT help guy tried a few things; nothing worked. I finally reported it formally, to be told 24 hours later to be told that smartphones aren’t supported and to try 4G or NHS Guest instead.

I suspect the wifi isn’t working properly but they don’t know how to fix it. I’m not the only one who finds the wifi flaky. You can be under one of the access points and you can’t detect the signal, yet at the other end of the building its fine. In some buildings it works fine in others you appear to have to reboot your machine forget the network and rejoin. (And rebooting is not a fun proposition when your antivirus software means it takes eight minutes to get from reset to login.)

But it’s not just the infrastructure that’s an issue. At my wife’s practice, the rollout of an patch to EMIS resulted in the software crashing every time they put in a problem title or printed a prescription – processes that happen in mot consultations. Turns out her practice is an early patch adopter despite never asking to be. It took two days to fix.

Internal messaging problems have long been an issue in EMIS. We have issues with tasks not being deleted. There are also random crashes that don’t help, though some of these might be more the above infrastructure issues.

EMIS Remote Consultation – the new flagship enterprise cross practice system –worked really well in testing. Then we used it with the fist patient and it didn’t work. We think we’ve fixed it. Meanwhile EMIS recently issued an emergency message informing us that double clicking in Workflow Manager might inadvertently close multiple tasks, and to therefore be careful. Not great if an accidentally-closed task was important or clinically relevant.

Meanwhile, OptimiseRx – a medicines optimisation software that runs alongside EMIS – seems to want me to click and click multiple times to get it to do anything.

Oh, and NHS Mail webmail appeared to stop working for a while today.

Just before I went home, we were told to leave our machines on as suspicious activity had been detected on the network and they wanted to run antivirus overnight. Given the antivirus is running all the time it puzzles me what good this will do, but I’ve almost given up asking.

Let’s get the basics right, shall we?

Some might say it’s the nature of delivering an IT system that things will go wrong. But I wonder about whether we have the right skills, expertise and enough money to buy what we need. People often talk about planes not flying if something goes wrong on them. Yet with all the problems above, we never shut nor turned away one patient – despite potentially giving poor care and putting ourselves at risk of being sued. The IT people don’t get the complaints that my practice manager has to deal with.

I also worry that amid all this talk of AI and online services we aren’t fixing the fundamental issues, and instead planning to spend money on speculated benefits rather than the basics. Let’s get some safe, secure, fast internet links in. Let’s give everyone a decent high spec machine that works.

I recently saw a local STP document that basically said the big plan was to stop investing in primary care IT, arguing it had been over-invested in and that hospitals needed more money. But 90% of care happens in primary care and, as our experiences show, it is definitely not a time to cut investment.