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Cutbacks will ruin depression care

If you adapt and plan carefully, it is still possible to get extra life out of a geriatric computer ­ Dr John Couch shows how

It was never easy obtaining reimbursement for computer costs. Now it has become akin to climbing the north face of the Eiger. It is virtually impossible to get replacement hardware and software. This has been the case since PCTs were given the task of both owning and paying for 100 per cent of computer kit with a limited and uncertain budget. As for a major upgrade, forget it!

The upshot is that many of us have to cope with increasingly geriatric systems at a time when computerisation of clinical data, driven by quality points, is ever more important. It you adapt and plan carefully it is still possible to wring a little more speed and functionality out of your system and replace dead terminals or printers.

At the same time, however, you must ensure you achieve an optimal position in the queue for your next major upgrade.

All new hardware funded by PCTs from April 1, 2003, is owned by them. Prior to that date hardware belongs to the practice. Over the next few years, as old hardware is replaced, it will all belong to the PCT. One hundred per cent of clinical software installation, upgrades and maintenance costs are paid directly by the PCT.

Bids for any of the above have to be approved by the PCT IT committee. Due to budgetary constraints all bids are supposed to be prioritised. The budget is much less generous than in previous years which places extra pressure on practices.

Check your warranty

Before you do anything else you should check your hardware and clinical system warranty. To maximise the speed and functionality of your system in future it is likely you will use hardware and software technicians from alternative sources, possibly the PCT. You must not invalidate the warranty. Read it carefully before you do any work.


The saying 'all computers have either crashed or are waiting to crash' is never truer than with an ageing system. This means your clinical system back-ups must be meticulously done every day and verified regularly. A back-up must be kept offsite in case of fire or theft. The same applies to practice finance files.

Do not forget the non-clinical system files stored on each PC. It is surprising how many each of us gathers in time. The PCs provided by PCTs rarely have CD writers, and floppy disks are too small to save much data. The cheapest solution is to have a portable CD writer which can be used for all PCs to provide a CD back-up of personal files. This must be done regularly. Review your back-up procedures for all the above as a priority.

Use a reliable computer expert

Once warranty issues have been confirmed, find a reliable local computer expert who can come at short notice if necessary. Many PCTs have now sourced these. Befriend them, treat them like royalty (regular tea and biscuits) and the dividends will be worth it.

Monitor your server regularly

Your main computer server is the heart of your system. You should not wait for it to develop a fault. Monitor performance, and especially hard disk space, regularly. Your clinical system company almost certainly does this remotely anyway so keep in touch with them. Never ignore screen warnings about falling hard disk space. Contact the PCT immediately if potential problems are spotted.

With more data and documents now being stored electronically, hard disks fill up ever more quickly. If your system is running more and more slowly this is one of the likely problems.

In this instance, and also if you have an old server but are not at the front of the queue for upgrading this, a hard disk upgrade for a larger faster version is a reasonably cheap option. The PCT is quite likely to agree to this which may tide you over for a year or two.

De-clutter software and files

An existing hard disk, whether on your server or individual PC, will also work more quickly if unnecessary software and files are removed and/or tidied ('defragmented'). This is really a job for an expert but once again could improve functionality.

Boot up early

Some systems, including EMIS, run more slowly for the first few minutes after start-up. It is therefore not a good idea to boot up your system just before surgery starts. Do it as far in advance as possible. If the system crashes you will also have longer to get up and running before patients arrive.

Have spares available

When printers or PCs fail it is useful to be able to replace them immediately, even if only temporarily. You could borrow kit from a room where someone is on holiday, but you will still face time constraints getting a repair or replacement.

It is much better to have a spare PC and printer available at all times. This is difficult if you rely solely on PCT funding, although the PCT should always be the first contact.

Many practices have actually bitten the bullet and bought a spare themselves. Printer and PC costs are falling all the time and PCTs will often allow you to buy from their bulk purchase supplies, saving costs further.

Diplomacy and information

You will be in a better position to replace and upgrade if you keep in contact with the PCT IT lead. Find out who this is. Try to keep on regular and friendly terms.

In this way you can keep abreast of latest developments and ensure you keep your practice's name firmly on their list.

All practice systems should have been audited by the PCT, so they will know who has the oldest or most problematic hardware or software. While it is only fair that the neediest practices are top of the list, if your system has changed for the worst you must make the PCT aware.

Plan for crashes

Have a written emergency plan for crashes including

·Reboot procedures

·Who to phone

·Arrangements for records

Not only will this minimise down time but it will also ensure data continuity

John Couch is a GP in Ashford, Middlesex

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