Your IT update (special report, 29 October) stated that 5 per cent of hospital doctors have access to a computer in outpatient clinics compared with 80 per cent of GPs. These numbers mean nothing unless you look into the level of use.

GPs use their systems in one of three ways. The first group of GPs uses the system to its full potential. The second uses registration and item- of-service links, acute and repeat prescribing and will add data relating to income. The final group is the 'it's still in the box'. These will use registration links, but will not have bothered or managed item-of- service links, repeat prescriptions or immunisation and cytology data. The GP will either not have the computer switched on or will have it on just for show.

All the data entry in these practices is administration-based. The computer is an administrative tool, not a clinical aid.

We know how many are in which group because of the state of the notes we receive when patients transfer. A large number are not sorted or summarised, and very few come with a printout. The 80 per cent was reached because of targets for computerisation and registration links. These targets get PCs into practices, but there is no incentive to use them.

The practice of which I am manager is as paperless as current IT and trusts allow us to be. We hope we will be able to do more when we become an NHSnet pilot site shortly. Going paperless requires a great deal of effort for all practice staff. Our admin staff input the historic data, but it was summarised and prioritised by clinical staff. It was a huge investment for the practice, but we turned a staff overspend into an underspend.

Investment should be aimed at getting us all to the same level, as the electronic patient record will require. There is little point in spending vast amounts of money to get 90 per cent of practices on NHSnet when a large percentage of the computers will not be turned on and the GPs will still require a hard copy result.

To work well, primary care groups will need information and communication. I cannot see many GPs' systems supplying either.

Bobbie Pryke

Practice/fund manager, Essex