The conference aimed to introduce GPs, their staff, and others interested in primary care, to the internet, to demonstrate its relevance to the field, and to give practical experience in using internet tools, particularly a World Wide Web browser and an email package.
Ian Purves started the day by finding out that three of the 26 delegates already had an internet account, and only two of these used email regularly. Nine of the delegates had seen the World Wide Web.
Neill Jones gave a lively session describing the internet and demonstrating the wide range of sites and resources available. There are many millions of users, and millions will be linked at any one time, from businesses to academia to individual users.
The internet is essentially a network of networks which is getting bigger all the time. It started as a resource for the US government as a defence against disruption of communications in case of a nuclear attack. No-one controls it (not even Bill Gates!), and indeed users fight attempts at controlling it. Messages will find routes around attempts at censorship, and essentially the internet functions by mutual respect.
Delegates had some questions about the costs of using the internet. Various Internet Service Providers (ISPs) were described, and the myriad sources of free software once you have access to the internet. It is difficult to make a profit on the internet - but commercial companies are working hard at this. Academics have been using the internet for decades, and indeed this is how UNIX came to be written - and eventually became a commercial product. So although using the internet is not free, it can cost as little as £120+VAT per year for full internet access, plus the cost of local calls (60p per hour at the weekend) - as someone remarked, we can all drink beer faster than that!
Part of Nick Booth's role at this workshop was to take on "Nerd surveillance" - whenever incomprehensible techie terms were used, he undertook to demand explanations with menaces.
He considered what might be the place of the internet in the consultation. There would be very little impact until there was a culture change to "paperless practice". The possibilities of using the internet included access to:
Some of the obstacles include:
Email might be one way of taking a first step towards these visions of the future: email can be used both within and outside the practice, and central document resources could be made available via the internet or the NHS Wide Network (though neither of these are fast enough yet for use within the consultation). Using this technology would have an effect on management structures, making them less bureaucratic. Investment would be needed to make it happen!
Ian Purves took a look into the future: every day sees an exponential growth in the number of sites, and also in the function of both hardware and software. At the same time there are major developments in telecommunications technology: fibreoptic cable is very fast and will cope with enormous amounts of data flow. The ways in which we pay for telecommunications services will change in the future: we will no longer be charged for time online, but for the information and services being accessed. Computer size will shrink, smart cards will become a reality, and the global village is already happening.
There are developments in 'groupware' which will make communication between groups of people in different locations collaborating; for example, collaboration on creating guidelines between several teams can be done in the virtual environment. Such an aid to co-ordination should improve patient care: significant event audits almost always find a problem of communication or information flow. This way of working empowers individuals, and 'horizontalises' management structures.
The future will be here sooner than we think!
Next, Neill demonstrated accessing the various aspects of the internet. This demonstration was slightly atypical, using the university computer, with much faster access times than most personal computers:
The first practical session involved setting up each delegate with an email address, configure the email package, sending and receiving email. GP-UK subscribers must have wondered what on earth was going on!
Andrew Herd described the World Wide Web and showed some favourite sites; delegates then explored the Web until lunchtime.
After an excellent lunch in the Medical School refectory, we reconvened for an interactive HyperText Markup Language (HTML) session. Rob Wilson had designed an online tutorial (http://www.ncl.ac.uk/~nphcare/PHCSG/INTERSIG/march/htm1.htm), but the brief for the afternoon was for delegates to design their own Web page). Delegates had all brought photographs of themselves or their families as a starting point, but otherwise the content and design was up to the individual.
The programme was crammed - in fact, the content could profitably have been fitted into two days! All the delegates seemed to have enjoyed the day, and it was certainly a very lively session. It would have been useful to have had some handouts with basic instructions, but the organisers were very active in helping individuals during the practical sessions. This was particularly needed in the HTML session: the HTML software doesn't always make things obvious, for instance how to put a background on your homepage. The overall organisation was, perhaps, less than polished, but this was more than compensated for by the enthusiasm, knowledge and helpfulness of the organisers.