While the government builds up NHSnet, the race is on to find its replacement.Mick Williams reports from the Healthcare Computing 2000 conference

Great news for personnel managers.You have been specially picked to run the NHS Executive's latest information technology initiative, an electronic address book.The idea is the latest move to boost the use of the health service's mini Internet, NHSnet, after a slow roll-out and a run of technical glitches.

The difficulty in finding NHS employees' e-mail addresses is one of the more glaring gaps in the service's long battle to adopt electronic communications.Bob Grindrod, head ofthe project to get GPs signed up, suggests that misdirected mail could be the cause of the most common complaint about the network - the large number of 'bounced' e-mails.Users of the network are partly to blame for sloppy sending - the NHS has to 'get used to doing the housekeeping in a professional way', he says.

The NHS Information Authority's solution is to procure a directory service from a commercial supplier, Mr Grindrod told the Healthcare Computing 2000 conference in Harrogate.

But maintaining an up-to-date directory for Europe's largest employer will be a formidable task.

Keeping tabs on who should be in the directory would need a massive cultural change.The burden is likely to fall on personnel managers.

NHSnet, originally conceived in the early 1990s in the pre-Internet age, is now destined to be a key part of an online health service forming part of the prime minister's strategy to modernise government, NHS planning director Alasdair Liddell told the conference.

While NHSnet will handle sensitive medical information, the general public will use the open Internet for services such as NHS Direct online for health data and organisations' individual websites - to be given a common 'look and feel' - for 'back office' information about the NHS itself.But much depends on building NHSnet, which has been running since 1996, to critical mass.Mr Grindrod, speaking on the eve of his departure from the NHS, admitted that in the past the network had suffered 'teething problems and growing pains'.

'I think we lost the plot on person to person [connection], we lost the plot on web-browsing and we lost the plot on the growth of the Internet.'

But in a passionate speech, he defended the network against critics in the medical profession, the IT industry and the press, condemning the NHS obsession with failure.He says that NHSnet had now turned the corner - by listening to its customers.Changes in pricing and technology were 'not a climbdown, but asking customers what they want and doing your damnedest to deliver it'.

Four thousand GPs now use the network, he says, and 2,000 more are in the pipeline.The use of e-mail has tripled in the past 11 months.'That's a hell of an achievement.'

The biggest change, agreed with suppliers BT and Cable and Wireless in December 1999, is to provide bandwidth free to doctors.This ends the old system of charging per call, a heavy disincentive to using electronic messages.The NHS Information Authority has also reached new service-level agreements with suppliers to make the service more reliable - and will publish details of breakdowns on the Internet.The result is to transfer a large part of the risk to suppliers, Mr Grindrod says.

The next step is to complete the rollout to GPs and to persuade more secondary care organisations to use the Net.This will be done under a new scheme called 'Project Connect'- in effect a re-naming of the present GPnet initiative.

But organisations will only use NHSnet if it carries services of real value.One priority is to connect pathology laboratories, so that GPs can receive test results instantly.

These messages will be encrypted for secrecy.

The NHS must now start thinking about the network to replace NHSnet, Mr Grindrod says.The present contracts with suppliers expire in 2003: given the length of time taken to place a major NHS IT contract, work on the new system must begin now.

There are several choices.At one end of the scale, the NHS might hook up to a sophisticated governmentwide network, connecting citizens with 'joined up'public services.At the other, it could just end up buying ordinary commercial services.The time to start looking at the decision is now, he says.

NHS Information Authority chief executive Nigel Bell also spoke at the conference on the theme of risk and blame.He warned that the seven-year strategy to create an electronic NHS posed real risks, which could not be designed out of the system.

Private industry understands the problem, he says.'We need to initiate a dialogue about the mature management of risk within the NHS.'