Right of Reply Dr Grant Kelly

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The Independent Culture
A general practitioner with

the NHS responds to yesterday's article detailing

the launch of the Internet version of NHS Direct,

the 24-hour medical helpline

NOWADAYS, WEB technology is a New Labour talisman, and clarity of purpose disappears provided an "e-innovation" can be announced with ministerial fanfare. And so with NHS Direct Online. Laudably, the service intends to inform people, and so reduce demands on an over-pressed NHS. That may be a good premise, but why use Web technology? It's the wrong technology for the task.

Leaving aside arguments about the accuracy of diagnosis, Internet decision support systems can provide information, but they cannot put that knowledge into context.

Context is vital for illness advice, and the trained human supplies context that is matched to the patient and circumstances. Most people instinctively know this, and in circumstances of illness few will place all their trust in this site for their guidance.

Equally understandable is the site's own anxiety to avoid mistakes, often referring the patient back to phoning NHS Direct, its natural competitor.

Speaking to a trained nurse over the phone refines the ability of the patient to frame his or her question properly, and allows exchange of ideas and better understanding of the problem the person faces. This produces greater satisfaction and, ultimately, less resource usage.

The families that really need the knowledge are less likely to have access to computers and, with an ill child, would they choose to lift the phone, or trek down to the local chemist to look up a website for advice?

Will it reduce demand? Oh, please. Advertising never results in reduced demand, and increasing the knowledge of patients about what our under- funded NHS should supply (but doesn't), will please neither patients nor staff. Another NHS/ IT own goal gained by trying to fit the people to the technology.