Andrew wrote:

> Subject:       RE: Locality Communications

> Dear Mike,
> 
> The NHS may not be a business to you, but it is to GPs, who, by and large,
> do not get paid salaries and have to live off the difference between the
> expenditure they may make on patient services, and the income from them.

You have my sympathy.  I am not sure what the views of most GPs are 
in respect of the present system under which they act as small 
'businesses'.  I know what my views of the situation are;  I would 
much prefer that GPs were paid a proper salary, commensurate with 
their inate qualities, training, workload and responsibilities, and 
not required to be what they were never trained to be, namely small 
businesses.
 
> This is part of the reason why NHSnet is making such slow progress among
> GPs, who are being expected to fork out sums of money to connect to NHSnet,
> which when everything is being taken into account, would pay the
> mortgage/school fees/care HP etc., for some quite considerable length of
> time.

This is a large part of the reason why I believe it would be far 
better to fund NHSNet centrally, using top-sliced funds, and make the 
sevice free at the point of use.  I suspect that at present we have 
something rather near to the worst of both worlds, with the NHS 
centrally having to meet many of the irreducible standing charges 
associated with creating  a network, while the actual level of use is 
still low.  As a consequence the unit costs on the NHSNet look (are?) 
high;  if usage went up dramatically, this would dilute the effects 
of the standing charges.  Paraoxically, the overall cost to the UK 
taxpayer would be no higher, usage would be greater, and a great many 
folk, including the beleagured staff who are trying to get NHSNet 
to fly, would be better off. 

> I suspect this part of the equation is not easily visible to many people
> whose level of salary do not reflect their decisions on capital and revenue
> costs. Over the last five years, GP expenses have risen much more strongly
> than income, and NHSnet is a no-hoper in this environment, regardless of the
> technical arguments.
> 
BIG SNIP

I think it is all a great shame, especially in view of the relatively 
small fraction of the total NHS budget, or even of the existing NHS 
spend on IT, that is at stake.   If we restrict ourselves just to 
GPs, most of them will have bought about £5K worth of equipment 
(hardware + software) each;  assuming that GPs are no different from 
the rest of the IT using sector, they will be spending about £5K each 
year on supporting and exploiting this.   The investment and 
recurrent spend needed to provide a network connection to each GP 
practice is thus a fraction (depending on the size of the practice) 
of its existing IT budget.  I strongly suspect that the figures for a 
Hospital would be broadly similar.   

However, the situation is that few within the NHS are prepared to 
make this marginal expenditure, because the benefits are even more 
marginal.  For GPs it represnts a direct loss of their trading 
surplus.  For Hospitals, since relatively few GPs are currently 
reachable, the potential gains from investment in either equipment, 
(which is cheap) or staff effort to exploit it (which is both scarce 
and expensive) are presently small.  As a consequence, the rate of 
take up is disappointing.

Mike Wells 
***************************************************
*     M. Wells                                    *
*     9 Hall Close                                *
*     Bramhope                                    *
*     Leeds LS16 9JQ                              *
***************************************************


%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%