GPs have forced on the centre what hospitals and health authorities could not: a climbdown on NHSnet. Peter Mitchell reports

In one of the biggest climbdowns since the Read codes disaster, the NHS Executive has conceded virtually all the demands made by GPs for a total re-hash of the service's private national network, NHSnet.

From now on, GPs will pay nothing to dial up the network: all phone costs will be paid by the NHS Information Authority. The reliability and performance of the network - created by British Telecom and Cable & Wireless - will be kept under str ic t scrutiny. An encryption strategy for clinical messaging has been written.

And, most welcome of all, the X.400 messaging service is being scrapped in favour of Internet-style SMTP.

The first hint of the cave-in appeared in a letter sent to reg iona l directors by Alasdair Liddell, the Executive's director of planning, at Christmas.

Mr Liddell's letter announced a new deal ('novation') with BT and C&W on the GPnet project. But for long-serving followers of the saga, the best part of the letter was its admission - for the first time - that NHSnet has been plagued by technical problems.

'. . .General concern about NHSnet reliability and performance following some high-profile problems in June and July. . . problems over the summer with NHSnet are being resolved. . . improvement plans have been agreed with the NHSnet contractors. . . implementation has begun to ensure that historical problems do not recur and that future performance is assured.'

Peter Dyke, head of BT's GPnet marketing operation, said: 'BT and Syntegra [the BT-run company that manages the messaging service] experienced two major outages during the summer.

'The first related to the failure of a Megastream link providing access to the messaging service - it was duplicated soon after. The second related to complex firewall and configuration and addressing problems. The root causes of that were also eradicated.'

Simultaneously, BT issued an apology to the many health authorities and GPs who had complained about their bills after they connected to NHSnet. The company admitted it had not been allocating the bills correctly, but had been unable to do anything about it - or even talk about it - before it had negotiated a solution with the Executive.

It also admitted that some GP practices had been presented with very large bills because of badly configured network connections that kept dialling up NHSnet over and over again.

This is a change from the Executive's traditional strenuous denial that anything could possibly be wrong with NHSnet.

According to Dr Paul Cundy, chair of the joint IT committee of the British Medical Association and the Royal College of GPs, these new NHSnet connection arrangements are essentially now agreed with the Executive (and should have been signed by the time this is in print).

'The revamped NHSnet is literally being rebuilt stepwise to meet the requirements of GPs, to provide SMTP e-mail and all the other things we want, ' he says.

At the top of the GPs' must-have list was reliability.

'We need simple and sensible e-mail on every GP's desktop, with 100 per cent availability. It just wasn't possible for us to accept an infrastructure that wouldn't deliver this, ' says Mr Cundy.

'The performance issues were all associated with the fact that NHSnet was first configured for X.400 e-mail, whereas half the traffic is now SMTP mail going through the NHSnet Internet gateway.

'Now that's going to be sidestepped. I don't envisage any more email on X.400 - the new NHSnet is predicated solely on SMTP.'

The BMA/RCGP committee will be watching this closely.

Mr Liddell's letter talks about 'discussions with BMA colleagues on how to make the contractors more directly accountable to service users for reliability issues'.

An NHS Information Authority spokesperson said that it intends 'to ensure that NHSnet performance is entirely open-book to the user community, and that users have a strong voice in stating requirements for NHSnet development'.

The second issue was the phone charges: 'Our negotiating team has looked at the payments issue and they are almost certain that it is resolved, ' says Dr Cundy.

The remaining issue is confidentiality. Doctors have been waiting for an NHS encryption infrastructure for some time to ensure that pathology and other messages do not traverse the net 'in clear'.

1Now, at last, the Executive's information policy unit has drafted a strategic cryptography policy document.

The draft is not expected to be made public until the end of March, but it has been circulated to the GPnet programme board, the NHS encryption programme board, and the Bellingham confidentiality committee, says an Information Authority spokesperson.

'The strategy will lead in the not too-distant future to secure patient flows replacing all the paperwork of the past, ' says Mr Cundy. But over which network? 'If it is delivered, and we really do get secure clinical messaging, it won't really matter whether the e-mail goes over NHSnet or the Internet, ' he says.

'The distinction between the Internet and a physically separate NHSnet is being blurred.'

For example, practices will have completely free dial-up access to the Internet, with the phone bill paid - provided they access it through the NHSnet gateway.

The NHSnet framework contract only has three more years to run, with re-procurement scheduled by March 2003. Will it be replaced by the Internet? By then, it may not be easy to tell which is which.


1 Mitchell P. Secrets and sighs. HSJ 1999, IT update ; 109 (5684): 12.