Select Committee on Health Appendices to the Minutes of Evidence


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:


  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.


  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.


  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.


  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

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2001
Prepared 28 March 2001