APPENDIX 45
Letter from Dr Graham Archard, Royal College
of General Practitioners, to the Clerk of the Committee (PH 17A)
Specifically in reply to your further enquiries:
1. THE ROLE
OF NHS DIRECT
IN PUBLIC
HEALTH
I feel it unlikely that NHS Direct could have
a substantial role in public health. There is little doubt that
a national body such as this might be able to identify patterns
of infection and illness over the country, but these patterns
would be hampered by the fact that only out of hours contacts
would be made and then a firm diagnosis would rarely be made.
There are various other sources of information
which could be used to identify these trends, such as the data
gathering system from Nottingham University, Miquest, or private
IT companies which already collect these data regularly such as
IMS Health.
As a pro-active facility for a role in public
health it is difficult to see how NHS Direct could have an effective
role in its current format.
2. THE BACK
TO SLEEP
CAMPAIGN
Sudden Infant Death Syndrome (SIDS) is a concern
of most, if not all, parents. The possibility of finding one's
child dead in their cot is too dreadful to imagine. Not surprisingly,
the public attention to this syndrome, coupled with a catchy phrase
did a great deal to encourage better sleeping habits in babies.
Healthy eating and similar campaigns have neither
the emotive flavour nor the public view that this is as important
as SIDS and probably rightly so. If the public cannot be persuaded
to stop smoking or to stop drinking and driving I feel it unlikely
that a catchy publicity campaign about healthy eating would bear
a fruitful harvest. In the end it took legislation to force the
public to use seat belts and crash helmets. I think it unlikely
that education and publicity will contribute significantly to
changing lifestyle habits.
3. THE OPERATION
OF HIMPS
HIMPs should, in my opinion, operate at Primary
Care Organisation level. They would benefit from merging with
the Community Plan, and, no doubt in level 7 PCTs this is almost
bound to happen. Local ownership of HIMPs will encourage useful
participation and a sense of purpose that can be lost with HIMPs
being produced at a high level.
4. RECORDING
OF DATA
INCLUDING CANCERS
There numerous practices, which have huge and
accurate databases of health data regarding their patients. This
is used by these practices to develop their services and to practice
high quality clinical care. There are a large number of practices,
though, that are comparatively computer illiterate and do not
have electronically recorded health data. Add to this that there
are so many different computer systems and that these systems
are used differently by different practices, it can be seen that
rarely can one practice merge their information with another.
This is of particular importance in PCOs.
It is regrettable that IM&T was not managed
pro-actively more than 10 years ago so that a good database would
by not have existed. That being said, there are numerous practices
with written data, but the problem is extracting this data from
notes. To properly resource practice computing is expensive. The
latest upgrade in our surgery cost our partnership, even after
any available grants, over £20,000. This is a large personal
expense for a small practice to bear among its partners, and we
are aware that, no doubt, to remain at the forefront of this technology
we will probably have to spend another similar amount in three
years time. Meanwhile our possibly more financially sensible colleagues,
would not dream of spending their own money on this sort of venture—and
who could blame them?
Only when a properly resourced IM&T structure
for Primary care, which crossed the boundaries of general practice
and community care, is introduced will an effective health database
be possible.
24 December 2000
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