The frustrations of GP e-mail

Dr Neil Paul

I was recently enraged by an e-mail. It clearly stated that it should not be shown to staff who did not need to see it, yet it had been sent to every member of staff in our primary care trust.

When challenged, the sender said this was the easiest way of passing on information. I tried to argue that it wasn’t, as everybody just ignored this kind of mass message.

What was even more annoying was that while I replied to the sender directly, others used the ‘reply to all’ button and so included everybody in their complaints about receiving unsolicited e-mails!

The sheer number of pointless e-mails drives me insane. I have set up rules to auto-delete things from certain individuals, in the knowledge – or hope – that they will never send anything useful.

I know some of my partners never open Outlook because of the problem. Unfortunately, this means I can’t e-mail them and have to find a different way to communicate with them.

To try and overcome this, we recently had the bright idea of creating rules in their Outlook clients so that e-mails from the practice manager and partners moved into a special folder and were highlighted. This works; but it is a pain to set up on multiple clients.

In any case, we have too many inboxes to check. Every day I check my Outlook e-mail, my EMIS e-mail, my EMIS practice notes, my Docman letters, my incoming pathology results, prescription requests and GP2GP transfers.

At my wife’s practice, they decided to deactivate EMIS e-mail, but when I suggested it at my practice I was almost lynched – such is the hatred of the rubbish that comes via Outlook.

But attachments are even worse

Then there are attachments, which are a pain. Opening multiple attachments is tedious. You can rarely tell what they are, because they are poorly titled. And when you get them open, they are often just a Word document that could have been cut and pasted into the body of the e-mail. Why can’t the preview pane preview attachments?

Some attachments are worth keeping and here again I have problems. Unlike a friend who saves every attachment in a custom folder structure of her own devising, I don’t delete the original e-mail.

However, finding it again can be another pain, as the search function never seems to find the one I want – and our IT department won’t let me install Google or Microsoft desktop search. I have heard of third party applications that help to manage attachments – however we can’t install non-standard software, so we are trapped by the limitations of what is available.

Version tracking is another issue. We have had problems with different people using different versions of a document to apply for things. Here, I admit, we probably don’t use the PCT Intranet enough, as you can send links to a central document that can be kept up to date.

The problem is probably lack of training. Our chief executive’s PA has obviously been on the right course as agendas for PEC meetings come in one Adobe PDF file with active hyperlinks to other documents on the PCT Intranet.

Does business do it better?

Rather than choosing which e-mails to delete, I wonder if it would be better to choose which to keep and have the default that they auto destruct. E-mails could have their priorities set by the sender and any that are trivial could auto-delete after a month – although I suppose this is open to abuse by people who feel everything they send is important.

I have this view that a ‘real’ business would be much better at handling e-mail. This is probably a fantasy; I met a drug rep recently who told me her laptop was away being fixed for two weeks and she had no way of checking her e-mail at all.

Until recently I have not found much need to use NHSmail but, following the recent discussions on E-Health Insider, I thought I would give it a go.

I was pleased that NHSmail is less obsessive about passwords than it used to be, particularly when I first tried it, and I like the fact you can have IMAP remote access to it so you can access it from home or a laptop without having to go through a VPN secure token logon that is required by some systems including my PCT’s.

However, I don’t like the limited functionality particularly compared to Outlook 2007. Unfortunately, and no doubt some readers will castigate me for this, I am one of those people who uses e-mail as a filing cabinet. E-mail to me isn’t just about sending and receiving mail. Outlook is my life, all my notes, calendars, to dos and e-mail are on it. It is on all the time and I even wish it integrated with our appointments system so I didn’t have to check two places all the time. I don’t obsessively save attachments to a folder – who has the time? I did trial an add-on to outlook that did this automatically but then I usually wanted to read the e-mail as well. I agree it should be easier to attach links to documents rather than the documents themselves. This would also allow people to keep using the most up to date version and save space. I also just want better search functions inside Outlook.

I feel some people are missing the point as sending patient identifiable data (PID) isn’t the most important thing to me. Almost none of my e-mails have PID in them. I need more task and project management functionality as well as more group work and sharing features and the training to use it better. Patients who I do communicate with by e-mail aren’t covered by the security anyway and encryption could easily be added to e-mails by using something like a PGP add-in which encrypts the e-mails between users at the touch of a button using their public keys which could be looked up in an NHS wide address book.

I worry that the NHS doesn’t invest enough time in training people to deal with e-mail, as I am sure that most of our problems could be solved if people only had the latest software and knew how to use all its advanced functions properly.

I would welcome any comments on your experiences.

Dr Paul is a GP in Sandbach, Cheshire and a member of the professional executive committee for Central and East Cheshire PCT and has a lead role for IM&T and practice based commissioning. A version of this article first appeared on the Microsoft NHS Resource Centre.