David Rainey has a few tips for NHS masterminds

You get a strange feeling when you learn that the future of the country's most loved institution is critically dependent on how well you do your job, when the clear message is that, unless the services you deliver work - 24 hours a day, 365 days a year- the NHS plan cannot be realised.

It was ever thus, you might say, for the nation's largest service industry. But there is a new and profound challenge to the NHS, which is to deliver the plan's objective by the efficient and creative use of computer technology - to move this vast enterprise forward into the future with the minimum upheaval and cost.

Take the electronic health record. In four years' time, the plan states, this will be used routinely across 50 per cent of primary care (by then 75 per cent of hospitals will be using electronic patient records).

Across the NHS, test results, prescription records and appointment bookings, all linked with patient records, will flow in and out of GPs' consulting-room computers via a plethora of IT systems and software packages in a totally new networked world, accessible by authorised staff.

To make this work, half the 105,000 practice staff will need to be familiar with ways of using these new systems. They will also be working in tandem with their counterparts in NHS Direct, which by then will be the nation's 'one-stop shop' into the service.

It sounds a tall order, and it is. Technically, it is feasible, given the expected professional approach. BT will have to manage the infrastructure well, because if the network doesn't work, nothing else will. Electronic patient records/electronic health records, NHS Direct triage software, human resources and finance-shared services, telemedicine, telephone systems and even bedside television: all will depend on a sound infrastructure.

BT has invested heavily in NHSnet - which works well and is expected to improve with time. It is a sound foundation on which to build, and over the next four years will enable the vision of the NHS plan.

Even so, brave decisions will be called for by trust boards across the country. If IT is to be the key enabler of the plan, management time must be devoted to it. But will IT delivery have to become a core in-house skill of the NHS?

Most IT experts would strongly argue not.

Crucially, boards must set the objectives, choose the supplier team, and focus on outcomes and service levels, rather than on technical questions best judged by experts.

Suppliers need to be chosen on the basis of cultural fit, too. Ideally they will be in place for a long time, considering the major challenges ahead.

Investment decisions, and the scale of the challenge and reform, may seem daunting, but the news is not all bad.

A good team, by simply replicating the best practice that already exists, may now safely take the first step towards the sort of IT environment that will deliver the NHS plan's targets.

It must be obvious that if an existing system costs nothing extra, it will be sensible to use it.

NHSnet is just such a resource. It cannot transport matter, but it can carry most other information, and by 2004 will be able to costeffectively transmit even television to the joint EPR/TV monitor at the patient's bedside.

The success of teledermatology shows just how a new way of working, coupled with use of technology, can make a striking impact on waiting times - in North Manchester, for example, they have been reduced from 18 months to 17 days.

Which brings us back to the real challenge for the NHS: to change the way it works in order to make the most of the information systems the IT industry can provide.

The challenge for the suppliers is to deliver the right systems and to step up to the mark on service, doing what we each do best exceptionally well.