But who pays?

I thought GPs were independent businesses who contracted to the NHS?

NHS technology is so out-of-date it takes 17 minutes to log into PCs in the morning, the UK’s top family doctor has said.

Dr Helen Stokes-Lampard, chair of the Royal College of General Practitioners revealed she could almost complete two appointments in the time it takes to start up her 10-year-old IT system.

The Midlands GP said her practice is still forced to rely on Windows 7.

Independent businesses run their own IT, no?

Or is that being hopelessly naive about how the NHS actually operates?

This post brought to you by Windows 7. Probably.

24 thoughts on “But who pays?”

  1. How aboit “When it come to calculating their own taxes GPs insist they are independent, trading in partnership with their fellow GPs. For everything else, including demanding we pay more taxes so they can spend more, they are employed by the heavenly NHS, envy of the world.

  2. Yes, they are independent, no, they are not necessarily capable of doing their own IT.

    At a guess, they got tied into an NHS system and nobody bothered to see if would work on anything other than Win7.

    And she should count her blessings multiple times during that 17 minute log-on time; light some incense and a spot of light chanting- Win7 isn’t Vista.

  3. The existing system provided by the NHS for GPs’ IT systems “ends” (not ended) in December 2018:

    https://digital.nhs.uk/services/gp-systems-of-choice

    Its replacement “will” replace GPSoC, although no mention of when:

    https://digital.nhs.uk/services/future-gp-it-systems-and-services

    It looks like a good idea, except for the fact that it’s the only idea in town, and it’s a long term centralised plan based on current technology. AI, ML, DL and RL are the future of healthcare and the UK won’t be getting it any time in the next decade or two.

  4. I’ve seen similar slow startup as the result of roaming profiles over a relatively slow LAN link. It’s easy to fix, if you’ve (a) got some staff with a clue; and (b) are aware of the issue.

  5. How many billions (STEM billions not Arts billions) of £££ were lavished on the NHS ill-starred IT overhaul and did any of that project ever reach fruition?

  6. I think this may be referring to logging into Spine, the NHS portal, rather than the PC itself, and the client uses card verification which is probably only available for Windows 7.

  7. About £8bn, from memory, Mr B. Wasn’t it Two Jags’ pigeon? For that alone he should have been tarred, feathered and stripped of his pension.

    Self-employed advocates in Crown Courts have now gone paperless. They use an online system which organises the paperwork, but were required to buy suitable hardware to use it. For many, it wasn’t a big problem. They already had laptops, so perhaps just had to buy a few bells and whistles more to make it work. But for the old-timers who were diehard paper users, especially the impecunious ones, it struck me as an externality (if that’s the word I want) of the government’s cost-cutting measures: they had to buy kit in order to work to the government’s order.

    OTOH, that’s a good example of why I no longer do that kind of work. If you’ve got a single customer, of course he is going to end up having you over.

  8. “it struck me as an externality (if that’s the word I want) of the government’s cost-cutting measures: they had to buy kit in order to work to the government’s order.”

    Just like all the taxpayers who had to buy new accounting software in order to have the privilege of paying the State the taxes the State demands by law – the Making Tax Digital requirements that came in for VAT in April of this year. And thats not a once off cost, its ongoing, as all the accounting software providers no longer just sell you the software, its all on a monthly subscription instead.

  9. Windows 7? Ten years old? I was working on a contract in 2014 replacing the Windows XP software *and* *hardware* in GP surgeries across a large CCG, so close to all GPs should be on 5-year-old Windows 7 systems. And on Monday I start all over again upgrading them all to Windows 10.

  10. W7 or W10, there’s not a huge difference in performance unless one has one of the newer PC’s with an SSD instead of spinning rust as a datastore. Should take a max of 1-2 minutes to boot windows (absent irritations like Updates – which should be non -existent for W7). Could be the network login if they are booting remotely and have (as noted above) a slow WAN link, but 17 minutes is almost impossible. I used to have a couple of users on 2003-4 era PC’s upgraded to W7 and even they booted in a couple of minutes (usually !)

    Sounds like there’s more to it, maybe the total time to start the PC, then start a VPN, then login to a remote gateway, then login to a system at the other end of that gateway, and to bring up some data. If the back end system is slow and working over ADSL type speeds, the 15 minutes or so is believable.

  11. Good point, Jim. Although I switched from Quickbooks to FreeAgent which is, at least for now, free.

    While we’re on the subject, the self-employed are, it seems to me, also unpaid tax collectors of VAT.

  12. @Edward Lud

    “the self-employed are, it seems to me, also unpaid tax collectors of VAT.”

    As are employers the unpaid collectors of income tax and NI via PAYE.

  13. @ Jim
    I de-registered for VAT when HMRC’s “making tax digital” became compulsory for VAT. I am, and shall be, a bit worse off (a chunk of my expenses are zero-rated, so only a bit) but I was not prepared to be legally liable for the cock-ups in HMRC’s computer systems.

  14. “I think this may be referring to logging into Spine, the NHS portal, rather than the PC itself, and the client uses card verification which is probably only available for Windows 7.”

    Ah, the old thing of large organisations drawing up an insane and complex list of requirements which means they can’t use the standard, off-the-shelf option, but instead some obscure bit of software from a massive agency, which means you don’t get updates.

  15. It’s unlikely to be a hardware issue.
    Most all pcs from the last 10 years should be fast enough to run office type software without hiccups.
    Anecdotally, my cad pc runs windows 7 and I will be loathe to move on to windows 10 when I have to. Boots to a useable desktop in less than 20 seconds.
    The probability is that they have issues connecting through a VPN to the main server.
    Wife does a similar type of thing with a locked down laptop using propriatory software. Any issues have to be logged with a central maintenance team who are under staffed and under resourced. Hence the laptop takes 15 minutes to boot up. 15 minutes to shut down and 15 minutes to get connected if it works at all.

  16. I think one of the main issues is that GPs are dealing with sensitive data. I would hope that computers used by the GPs in question are encrypted and passworded by default and any connection to the outside world routed through a secure firewall.
    All this stuff is pretty well known by now and should be straightforward to set up. I can’t imagine that Practices are that hard up that they cant afford to do this properly.

  17. So “17 minutes” includes the time to boot up? Agree with the posters that docs should stop complaining and Work The Problem.

    With you this morning on the Big Machine (XP). 2-minute boot-up is compensated for by not having Microsoft scan all my removable devices (“metadata only,” yeah, sure) and being able to run without images, JavaScript, and surreptitious software upgrades.

  18. Can any of the accountants here tell me why MTD isn’t giving you all the jitters?

    As far as I can see, if and when its crinks are ironed-out, I am unlikely to need an accountant, not even as an insurance policy against an audit …

    Andy C, another fair point. I am in the (unusual?) position of being self-employed and an employer. It’s a weird set-up, I won’t bore you with the details

  19. Not looked at it too closely, but I would assume it’s not the concept it’s the governments implementation of it that’s causing concern, along with HMRC being well known for refusing to acknowledge their mistakes and blaming the taxpayer or anyone else they can find.
    Maybe one of the problems the GP has logging on is the timing, I recall a school system that was ruled out locally that ran into responsiveness problems when all the teachers logged on at the same time, which given they all have the same schedule is easily predicted, but hadn’t been. Quite possibly the remote systems are having to deal with a spike as all the GPs in the country try to login over a small window of time.

  20. BlokeInBrum,

    “Anecdotally, my cad pc runs windows 7 and I will be loathe to move on to windows 10 when I have to. Boots to a useable desktop in less than 20 seconds.”

    I wouldn’t go back. There’s a load of under-the-bonnet security and performance improvements, like Win10 makes better use of the features of an SSD drive than Win7. I know a few companies in the audio software area found that latency was reduced. Take a look around on YouTube with people doing their own tests of Win 7 vs Win 10.

    I’m not saying it’s essential, but it isn’t a bad upgrade.

  21. Our GP Practice runs their own IT and has been using VOIP too for many years. However the woman who maintains their website is useless – repeat prescriptions down for 9 months as she screwed up a captcha update, bet she’s a GP relative

    Maybe Dr Helen Stokes-Lampard Practice is one of the NHS owned ones – SNP is quietly nationalising GPs

    17 minutes to boot and logon – I don’t believe her

    .
    @Chris Miller October 25, 2019 at 8:46 am

    +1 on network, I’ve seen those “slow boot” times on many NHS PCs where staff blame “crap PC” when PC is a dumb terminal waiting for network download.

    @The Meissen Bison October 25, 2019 at 9:02 am

    £12 Billion – 2009ish

    @Jim October 25, 2019 at 9:39 am

    +1

    Making Tax Digital handed a blank cheque to the Gov’t Approved providers – Gov’t have created a closed shop cartel

    It’s disgraceful. Breach of yummin rights?

    This post brought to you by Windows XP – <1min boot time

  22. “17 minutes to boot and logon – I don’t believe her”

    I do. I have senior IT mgmt experience in Public Sector and the average boot time, i.e. time from pressing the power on button to the point you can actually do something on your desktop was around 10 minutes. We had no VPNs or remote servers either – everything was hosted in the building.

    Even better, it was about 5 mins to the login screen, then 3 mins after that, so you had to interrupt your coffee or corridor conversation to go and login, then go away again.

    I never managed to get my chaps to fix it. Could have been any or some horrific combination of
    – the domain/AD set up
    – some nonsense sync with profile
    – group policy check
    – the appalling – as in 100Mbps – user LAN

    This is completely believeable – if the local AD server is having to get its policy updates from somewhere else over a shitty ADSL – or leased line… – I can easily see 17 minutes.

    It’s, like anything in the Public Sector, just pure bloat.

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