Patients' Net gain, but docs need their wiring chequed

Not much luck with glandular fever, actually. My fault, perhaps. I am never a patient soul on the Internet. But I did succeed in checking out prostate cancer, one of my hobby anxieties, and could see what a marvellous tool the new service is going to be for what we now call the 'information rich' - people like you and me who sit near a screen every day.

But what does it mean for GPs, I wondered? Surely this novelty is another blatant act of ministerial bigfooting on their territory, a blow to their autonomy and authority from a government which has already set up the telephone hotline and - in more frustrated moments - mutters about the need for a salaried GP service to replace independent contractor status.

When I rang two GP MPs I found echoes of my own concerns, but not gloomy ones. Dr Peter Brand is Lib Dem MP for the Isle of Wight, and Dr Howard Stoate is Labour's man for Dartford. Both welcomed the new move, but think the jury is still out as to the long-term verdict.

'It's a little bit unkind to wire up the patients, but not the doctors. A bit embarrassing if people know more than you do', says Dr Brand. The profession is pretty well wired on the island, but he finds it frustrating that his own PC can't talk to the path lab and that trusts can't talk to GP networks. It's all very slow getting medicine online, and perhaps this will squeeze some money out of the ('spent many times over') modernisation fund. 'If government wants GPs to do something I'm afraid they'll have to make it worth their while, ' he says.

Oh dear, that phrase reminds me of a lunch last summer when a frustrated minister told me: 'You can't get GPs to do anything new unless you make it worth their while. The real answer is a salaried service.'

That's not policy, of course. Indeed, Alan Milburn goes out of his way to say he wants to sustain the 1948 settlement - independent GP contractors and all that.

Dr Brand doesn't believe him. Like Mr Milburn, he's a keen enthusiast for PFI for primary care, getting more capital into an increasingly high-tech system, and that, he says, contradicts contractor status. 'There's gameplaying here. I don't think ministers are being completely open.'

More surprisingly, Labour's Dr Stoate agrees on key points. When Dr Brand calls NHS Direct Online 'a powerful tool to influence users of primary care' (ie telling patients what ministers want them to know), Dr Stoate calls it 'medical paternalism', making people more dependent on high-tech solutions, not the GP, pharmacist or neighbours. I'm not sure they're right. The thing about the Net is how it empowers users against doctors, governments and corporations.

It was the information revolution, not Star Wars rocketry, which finally crippled the old Soviet economy. They couldn't hack it with a secret policeman on every computer. So may it be with NHS Direct Online.

Will it take pressure off GPs and A&E? Or generate more demand, as Dr Stoate fears? Certainly, the NHS Direct hotline has generated more. And will the quality of information be good enough? Yes, I'm sure. In short, can the NHS cope?

As usual with the Net, we are in barely charted waters.

Dr Stoate thinks young GPs have a totally different attitude to that of their older colleagues. No more 24-hour, seven-days-a-week commitment. They want more of a normal life. 'Once you start having day shift, night shift, weekend shift, attitudes change. People start saying to patients: 'It's not me you want, mate.'' That points towards a salaried service. Young GPs are less hung up about that, too. Both MPs agree. Yet Labour's Dr Stoate thinks that hospital consultants get a worse deal as NHS employees than do independent GPs. What? Yes, GPs make more efficient use of staff, premises and equipment precisely because they are small-business people.

What a contrast with manager-driven services, he muses. There's a New Labour thought with which to end a millennium.