NHS broadband leaves GPs in slow lane

Many GP practices are struggling with inadequate broadband speeds over N3 (the new NHS National Network) which are slowing down their day-to-day work and limiting their ability to use key national computer systems from the £12.4bn Connecting for Health programme.

Choose and Book has been particularly affected and GPs have told EHI Primary Care about the frustrations of trying to deliver the e-booking system with the connection speeds available to them. The problem particularly affects branch surgeries, linked to main practices.

The problems are being exacerbated because primary care trusts say they cannot afford to buy additional bandwidth for practices from N3 service provider (N3SP) BT with quotes of up to £30,000 to upgrade a practice from a 1MB to 2MB line.

The costs are partly thought to be so high because the price list is based on a seven year contract NHS Connecting for Health (CfH) signed with N3 provider BT at the beginning of 2004 when bandwidth was more expensive.

BT and CfH are coming under pressure to review the contract so that it better reflects market conditions and delivers adequate broadband speeds for practices at an affordable price.

However a statement issued to EHI Primary Care by CfH insisted that they have no knowledge of problems with speed of connection relating to N3. BT’s advice meanwhile is that practices needing an upgrade above their 1MB service will have to opt for a 2MB Private Circuit. It does not make it clear how this would be funded but since such circuits are outside the National Catalogue specification for GP practices the cost would almost certainly fall to PCTs.

CfH’s statement says: “Some issues have been reported and attributed to N3 that are in fact associated with the localised performance of certain applications. Whilst these are not network issues, but relate to the configuration of customer systems, N3SP is working closely with local IT staff, systems suppliers and NHS CFH deployment staff to remedy these issues. We are not aware of any issues regarding speed of connection that can be explained with reference to N3.”

A total of 97 per cent of GP practices in England had N3 installed by September this year, according to CfH, with CfH chief executive Richard Granger hailing N3 as a “quiet success story” earlier this year.

However the National Catalogue set out in BT’s contract with the NHS means the majority of practices, with up to 49 network devices, are now limited to a 1Mb ADSL connection with upstream rates of 288kb/s.

Dr Stephen Meech, a GP in Maidstone, Kent, is one of many practices who have highlighted the problems to EHI Primary Care. He said that a number of BT engineers have visited the practice after its concerns over slow speeds but they have been told they cannot have a faster line.

He added: “Our N3 connection is limited to 1MB and with test speeds in the region of 200kbps it is inadequate for a practice of 9000 patients with sixteen workstations on two sites connected by a landline, for internet browsing, email and access to online reference resources. Goodness knows how we’ll get on with Choose and Book which went live last week.”

Another GP in Kent, Dr Paul Molony, said his practice also has a 1MB connection.

He added: “To download a 1Mb file from home, where my service is not working very well, might take 10 to 15 seconds but here [in the surgery] it is taking one and a half minutes. We are early and enthusiastic users of Choose and Book but using it can be like walking through treacle and I am struggling to keep my clinicians engaged and using it.”

Problems are particularly acute for branch surgeries where the ability to run normal consultations and open attachments is in some cases being severely compromised.

Dr Paul Thornton, a GP in Kingsbury, Warwickshire, said looking at images stored using document management software at the branch surgery was much slower than when the practice initially used the software, before the introduction of N3.

He told EHI Primary Care:” The link is far too slow to easily view scanned images of consultants’ letters at the branch surgery and causes substantial delays in consultations.”

Dr Philip Denisleseve, a GP in Brighton, told EHI primary Care that his practice shares a 2MB link between 19 users but tests demonstrate a speed of 200-400 kb/s.

He added: “All I know is that my home 1MB connection is far superior to what I am forced to use at work. One of our PCT IT people has told me that they are well aware that the broadband speed is inadequate when shared between many users in a practice.

They are getting lots of complaints as people can’t understand why their home connections are far superior to those at work.”

Until now CfH has maintained that demands for extra bandwidth must be handled locally but the impact on take-up of CfH applications such as Choose and Book could mean it becomes more of a national priority.

Dr Denisleseve added: “We are meant to be starting Choose and Book this month but I can’t see it being used unless we have a fast and reliable link to the NHS spine and to the secondary care provider’s database.”

A statement issued by BT to EHI Primary Care says that many GP sites are currently being provided with N3 access via a 1MB DSL connection with an ISDN-based backup.

It adds: “The deployment of DSL based N3 services for low bandwidth users (including GPs) has provided the NHS with excellent value to date.”

The current upgrade path for any customer wishing to increase their N3 access bandwidth (beyond 1MB) requires 2MB Private Circuits to be deployed as the primary connection with a 1MB DSL service providing a resilient path. 2MB Private Circuits provide a key benefit that many N3 customers seek – providing identical upstream and downstream bandwidths. As N3 users increasingly access locally hosted applications which require higher capacity links to operate optimally (local GP Applications for example) – the use of a 2MB Private Circuits delivers an 8-fold improvement in access speeds.”

BT was unable to confirm or deny reports of quotes of up to £30,000 for an upgrade for a practice from 1MB to 2MB as it said too many variables were involved. However its statement adds: “N3 Upgrade charges comprise a variety of costs, which will vary from customer to customer. Cancellation charges for the current Catalogue Service, installation charges for new circuits and equipments, and ongoing service charges are key contributors. Also, private circuit pricing is distant dependent, so is driven by the cabling distance between the customer site and the nearest N3 node."

BT added: "The N3 contract requires N3SP to offer best value and all quotations for upgrades are derived from generally available products, services and pricing in the wider telecommunications market.”

BT also said that it had finalised an agreement with CfH in September that “refreshed the N3 Catalogue content with a new range of products and prices that will allow the NHS to further benefit from competition in the telecoms market. All pricing has been updated to reflect current supplier terms and will be available for the next two years.”