Your article on primary care computing by Michael Cross ('Burned Out', Special Report, 5 November) rightly draws attention to the critical importance of information to primary care groups, and the absence of easy solutions. However, the conclusion that PCGs must either 'plug existing practice management systems together' or replace them all with a single networked system, seems misleading on two counts.

First, we should distinguish the operational needs of practices and their primary care teams from the management and epidemiological requirements of PCGs. Primary care-derived information will be an important, but by no means the only, source of information for PCGs. In fact their information needs will be hugely diverse - trust league-tables, consumer views on current services, variations in spend on non-generic drugs, trends in deprivation and unemployment... There is unlikely ever to be a single 'proper system' to cope with these disparate needs - rather PCGs will need to become adept at browsing and nibbling choice morsels from near and afar.

Second, the main constraint, currently, on PCGs exploiting the potential wealth of information to be derived from primary care is not a technical one, as the article suggests, but the highly variable quality and coverage of data held on practice systems. This probably has more to do with the different cultures within and between practices than with the shortcomings of the current generation of systems. One of the challenges for PCGs will be to shift the information culture of the masses to the level of the enthusiasts.

Bruce Don


Bruce Don Consulting Ltd