Billions are to be pumped into the NHS while it is reformed into a modern, consumer-led service, leaving the old patrician ways behind. Old demarcations are said to be outmoded and inefficient and unnecessary. Do they include the need for professionals to stand between the public and medical knowledge? "Cybermedicine" is growing. A recent study in the British Medical Journal showed 27% of women and 15% of male users of the internet access health information at least once a week. How reliable it is can be gauged from the chart below which is based on a study of information available on a particular condition.
This week sees the second anniversary of a Blair flagship innovation, NHS Direct. Lately GPs' complaints to government ministers have been about little else. But NHS Direct has an extraordinary 90% public approval rating. Until now we have lacked objective evidence on the effect of providing direct, unfiltered access to medical advice on the phone and online. It seems to show that NHS Direct is not increasing the burden carried by professional providers of health care; nor is it lightening it.
"There has not been any obvious or dramatic effect on demand for emergency ambulances, accident and emergency (A&E) departments or GP cooperatives," says James Munro, clinical senior lecturer at Sheffield's medical care research unit who carried out a study for the Department of Health. "There has been a small, subtle but real effect on the way demand for out-of-hours general practice is changing. NHS Direct is associated with halting the increase in out of hours demand."
That should be cause for celebration, the government might think - and should have raised a smile on the face of doctors who complain often enough about their burden. There also ought to be sighs of relief that NHS Direct is not pushing up the numbers of people seeking a doctor or emergency treatment, as was earlier feared.
But this is a small result for such a big innovation. Dr Munro points out that his study of three of the pilot areas running NHS Direct - Lancashire, Northumbria and Milton Keynes - is far from the end of the story.
The nurse-staffed helpline is available to 30m people at the moment and is expected to cover the whole of England by the autumn. The NHS Direct website was launched last December and is about to be expanded. So far NHS Direct Online is proving more popular than was expected, with an average 100,000 hits per day. The DoH says the main interest is proving not to be diagnosis from checklists of symptoms: those logging in have generally been diagnosed and now need to know more about their medical problem. Meanwhile a new National Electronic Health Library (the NHS database of approved trials and studies) is due shortly.
There are plans to integrate the NHS Direct phone helpline with GP out-of-hours services, social work and mental health services. Before long, it will become "proactive" - for example elderly people will be phoned automatically to remind them to have a flu jab. Most significantly, the ambulance service is to be allowed to refer minor calls to NHS Direct, removing its obligation to send an ambulance even if the caller admits to nothing more than a hacking cough.
All of this makes it difficult for the Sheffield team to evaluate which phone calls would have turned into an unnecessary trip to A&E or a night-time summons to the GP. It may be, muses Dr Munro, that we should be looking at it not as a pressure valve for the NHS, but as an engine for change in itself, a catalyst for modernisation. "Because NHS Direct is there, a lot of other services are having to consider the way they provide their own services, whether they do it as well as they can and how they interact. That is probably a good thing. This is almost about being customer-focused."
Whether or not ministers foresaw that NHS Direct would so happily help them towards their now stated goal of a consumer-led service, they are now more than keen to make the most of it. Sheffield's next report will look at cost effectiveness for the £70m NHS Direct will cost next year. But whatever figures they produce in a couple of months, it is likely ministers will consider NHS Direct worth every penny.
• Sarah Boseley is the Guardian's health correspondent
