"An Elephant--

a mouse built to Government specifications."

I may be paraphrasing slightly, but so says Lazarus Long in his collected sayings partway through "Time Enough For Love". Today my old friends on Radio 4 have been talking a lot about NHS IT which is a case in point.

Most UK readers who have visited their own surgery in the past 15 years will have been aware that their surgery is computerized. In the past decade we have become increasingly reliant on IT for prescribing and note recording. Indeed over the past 3-4 years many (over 80%) of practices have finally done away with those little brown envelopes (still referred to in GP circles as Lloyd George folders- dating back as they do almost 100 years to the National Assistance Act brought in by that eminent philland'-- ummm philanthropist who "knew my father"). We have gone "paperless" in the jargon of the day, though to look at my intray this morning you'd never believe it.

The process has been one of evolution. We started with green and black CRT DOS based systems which would hold records and run prescribing for us but were very slow and clunky when it came to data handling. We recoiled in horror when presented with the new fangled "Windows" systems of the mid '90's, but within three years had one installed. We have upgraded twice more from there and now the system will do just about anything we want it to, (and lots we don't, like nagging us to check the blood pressure of every third patient and ask toddlers -- oh, ok, fourteen year olds-- if they smoke).

This experience has been repeated in most practices up and down the country, at a variable rate, but always "demand led". There were perhaps 8-10 suppliers of GP systems in the beginning and these have dwindled over time to 2 or 3 "big" ones and a couple of bespoke niche suppliers. With each new release of their operating systems they have included features suggested by users or (more recently) mandated by changing contractual arrangements. The key has been slow piecemeal development.

The process has not been entirely painless. At each change of operating system some oddities have been thrown up by data transfers, (most spectacularly all our patients with allergies to any form of medication suddenly switched to having an allergy to deodorant on our last data transfer), but none have been unrecoverable and some, as above, have been a little amusing.

But now Big Brother (you remember-- the original one not the endemol rip off one) has decided to get in on the act and computerize the NHS for the good of all. No longer will we need to back our records up to our own secure servers. We are to get a "Spine" supplied by BB himself to do the job for everyone. Referrals will be based on "choice" and be as easy as "booking an airline ticket" (god forbid). We will all have an electronic health record so that anyone authorized anywhere in the NHS will have access to our full record at the click of a mouse.

So far the whole project is at least two years adrift and stands to come in at least three times over budget. The initial choose and book launch involved a tiny minority of practices and crashed within a few hours of launch, though like the "dead" man in MontyPython and the Holy Grail it "thinks it's getting better". Many clinicians have fears that BB will want others to have access to certain levels of the "Spine" for less than pure motives (e.g. the DSS or DoE).

We have legitimate fears that we are going to be presented with an Elephant at the end of this process. One can only hope that it won't turn out to be as pale as it is threatening to be at present.