Already stretched to their limits by the year 2000 bugging imbroglio, IT managers are now be asked to deliver on Frank Burns' punishing new strategy. Can it be done, wonders Peter Mitchell

Mandatory targets are at the heart of the NHS's new IT strategy, published last week after 18 months' joint cogitation by NHS Executive IT chief Frank Burns, the Department of Health and the Treasury.

Every health authority, trust and primary care group must now get together and plan comprehensive, life-time electronic patient records at every GP surgery for delivery on-line to the rest of the NHS, 24 hours a day.

To equip the service with sufficient computing and communications kit for this target, Mr Dobson is offering ring-fenced money averaging 10m per HA - on top of existing IT budgets - over seven years starting in 1999.

Can it be done? Opinion is divided, especially for the shorter-term targets. IT staff are already up to their armpits in their year 2000 debugging programme, designated by the Executive as the service's highest non-clinical priority. There may be enough money, but are there enough people?

Both the NHS Confederation and the Institute of Health Services Management cautiously welcome the announcement, but express fears that it will see managers struggling to meet targets that are beyond their control.

Confederation chief executive Stephen Thornton comments: 'Although consistent progress is being made on the year 2000 date change, it will be difficult to meet the targets set out in the implementation programme as well.

'Getting the NHS up to speed in IT will require a huge training and development agenda.'

The first year's task - to be completed by March 2000 - is to get every GP onto the hitherto little-used NHS Net.

That has to be the starting point because GPs will be custodians of computerised patient records, and so must be set up to receive electronic reports of their patients' encounters with all other NHS organisations.

But according to Mr Thornton, this is no easy task: he expects the biggest problems to come from GP computing because of its fragmented nature.

Nor is NHS Net connection the only short-term target. Also by 2000, the NHS Direct phone-in service has to be made available to the whole population, and some of the 'beacon' electronic medical record sites have to be set going through local collaborations under HA leadership.

All this, says the confederation, will demand significant extra management input that could over-tax the IT skills available in both HAs or regional offices.

And chief executives themselves are ordered, in the health service circular sent out with the strategy, to get the implementation groups moving.

Confederation policy manager Tim Jones says: 'It is very ambitious to want to put in place this new infrastructure in such a short time scale.

'There are a lot of time-consuming tasks, involving ripping up and replacing the wiring and the rather old and creaky servers that most HAs still have.'

Getting rid of procurement bureaucracy will be vital to meeting the targets, says Mr Jones. 'But some of that is to do with advertising in the EU Official Journal, and it isn't clear whether that is a movable item.

'One option to cut through the delays might be a regional or national panel that was given the authority to assess projects and give them a rubber stamp of approval. Even so, getting the local groups to sit down together and work out local implementation plans is going to take a lot of time.'

Yet the mechanisms to set up such groups are already there, says Mik Horswell of the IHSM.

'HAs have been encouraged to take the lead on putting together local IT strategies for at least two years now, and those best placed to take it further are clearly health service managers. It is going to need a top level, chief executive commitment.

'The year 2000 issue is certainly a concern, but Frank Burns has got all the elements correct and we now know that the investment is substantial.'

Mr Burns obviously believes his targets are realistic, stressing that not everything has to be done at once.

'There needn't be any big delays in getting this started. We just want people to be sensible and plan their projects so that the different procurements will work together to deliver our objectives.

'That shouldn't be a problem anyway with modern IT systems.'

Given that suitable acute hospital software, at least, is already available more or less off-the-shelf from several suppliers, the strategy should foreshadow heavy spending on hospital systems in the financial year 2000- 01.

The nursing and medical professions too welcome the announcement - though, true to form, British Medical Association chair Ian Bogle stresses that the issue of confidentiality of patient data remains close to its heart.

Mr Burns' view is that this problem is soluble by technical means, though just how much patient consent will be needed is up for negotiation.

Less easy to resolve will be the perennial disagreements over who will pay for GPs' computer equipment - although the strategy's undertaking that GPs will no longer pay for their use of central services like NHSNet is welcomed.

BMA negotiator Grant Kellys comments: 'Reimbursement for GPs remains to be sorted, although this strategy begins to send the right messages.'