In the second article in this series, Dr Nigel Watson explains the structure of the NeLH, highlighting the benefits for primary care professionals and patients

In 1998, Information for Health,1 the information strategy of the Department of Health, announced the establishment of a National electronic Library for Health (NeLH) by March 2002.

A pilot version of the NeLH, a web-based information library for health professionals and the public, is available at, or at for users of NHSnet.

In any health service, it is essential that all professionals have access to the best current knowledge available. In the past this knowledge has been gained from textbooks or learned medical journals, such as The Lancet or the British Medical Journal. Today, the internet provides technology that enables this information to be delivered electronically.

The role of the NeLH is to provide health professionals and the public (through NHS Direct Online) with knowledge and know-how to support healthcare-related decisions. It aims to provide access to the best current knowledge on healthcare for all.

The NeLH has four basic principles:

  • To concentrate on the quality of knowledge and not the quantity of information.
  • To be concerned with both knowledge and the skills to manage and apply that knowledge.
  • To be open equally to patients, clinicians, the public and managers.
  • To create and sustain a community of users.

Most clinicians are overwhelmed with paper information. It would be equally possible to be overwhelmed with electronic information, as a result of searches on the internet providing thousands of references. The NeLH will act as a quality filter to enable the busy clinician to make the best use of the information provided.

The NeLH will be embedded in NHS information systems such as the electronic patient record. Access to the NeLH will be via the Atrium, the help desk for the NeLH.

The Atrium

The home page of the NeLH (see Figure 1, below) will be an Atrium, offering help to all those who wish to use the resource.

Figure 1: Home page of the National elecronic Library for Health – pilot version
nelh home page

The intention is to involve all relevant professional groups, to ensure that help is available when needed. The needs of each professional group will be met by its professional society or college; the NeLH is multidisciplinary.

It will be organised in three floors:

  • The know-how floor
  • The knowledge floor
  • The knowledge management and health informatics floor

Know-how floor

The National Institute for Clinical Excellence (NICE) has been given the responsibility to lead work on producing guidelines to support decisions about referral, investigation or treatment, and also systems needed to audit to assess quality.

The Commission for Health Improvement (CHI) has already started work on inspecting hospitals and primary care. It has a responsibility to ensure that quality care is being delivered by the NHS, and to make recommendations on how the care provided by the organisations it has inspected can be improved.

It is envisaged that NICE will have the main responsibility for developing this floor, and CHI will make an important contribution.

This floor currently includes:

  • NICE guidance
  • National Service Frameworks
  • NeLH guidelines database
  • NICE referral practice leaflet

Knowledge floor

This floor contains knowledge that is quality filtered, distilled and kept up to date. It will be similar to a traditional library, but contain electronic journals and books. It could also include databases, image banks and tutorials.

This floor currently includes:

  • Clinical Evidence – this resource has been licensed for all NHS staff and service providers in the NHS in England. It provides a regularly updated guide to evidence about the effectiveness of care. It is only available through NHSnet.
  • The Cochrane Library – NHS staff are able to search this resource through NHSnet.
  • NHS Economic Evaluation Database
  • MEDLINE/PubMed
  • Research Findings Register
  • Abstracts of Reviews of Effectiveness (DARE)
  • Effective Healthcare bulletins

Knowledge management & health informatics floor

Knowledge management is seen as production, distribution, appraisal, implementation and storage of knowledge.

This floor has educational material related to these issues, allowing those who use these resources to develop their own eLibrary or develop their own skills.

The National electronic Library for Health Informatics (NeLHI) is one of the planned virtual libraries of the NeLH. The NeLHI aims to create a more integrated approach by health informatics community across the NHS and related organisations.

This floor currently includes:

  • Resources for researchers – contains links to the Medical Research Council, and possible sources of funding for research
  • Methods for researchers
  • Skills for individuals
  • Critical appraisal checklists
  • User guides.

What can the NeLH do for general practice?

The pilot offers three types of service to general practice:

1. Access to high quality information resources including:

  • The Cochrane Library
  • Clinical Evidence
  • British National Formulary
  • Database of information leaflets for GPs to give their patients
  • Database of clinical guidelines

2. Virtual branch libraries

These are independent online communities that create and share information relating to healthcare.

The list of initial proposed virtual branch libraries include:

  • Cancer
  • Communicable diseases
  • Diabetes
  • Learning disabilities
  • Lung disease
  • Health management
  • Heart disease
  • Mental health
  • Primary care.

3. Accredited web-based health "nformation for patients, provided through NHS Direct Online.

Primary care virtual branch library

This has been developed by GPs and includes more than 300 web links aimed specifically at primary care professionals.

The NeLH and the NeLH-PC are different, but linked, developments. The NeLH-PC currently lacks funding and hence development. A pilot site can be found at:

It is well worth looking at this site and exploring the information. To see how information on a specific area could be presented, look at the excellent information on diabetes at: (see Figure 2, below)

Figure 2: Main page of the section on diabetes within the NeLH primary care virtual branch library
nelh diabetes page

The fourth floor was originally going to be the patient information floor, but this function has now been taken over by NHS Direct Online.


We live in an age of instant information provided by ever-improving information technology. Some may say that the NHS has been slow to utilise this technology. However, through Project Connect (formerly known as GPnet) all GPs will have access to email and web browsing facilities, from their desktop, by April 2002.

The concept of having a website dedicated to providing information and resources to busy practitioners is therefore logical, welcome and should be supported.

The NeLH is currently at the pilot stage and must be judged as such. The basic structure of the website is simple and easy to follow, but will become increasingly complicated as the NeLH expands. It will therefore be essential to have an excellent index and search facilities.

Although the web pages are simple, well laid out, and contain large amounts of information, some take a long time to load initially, which may cause some frustration. This will undoubtedly improve in the future.

The provision of full access to Clinical Evidence and the Cochrane Library for NHSnet users is an excellent example of providing valuable resources free of charge to NHS professionals. This model is particularly important for GPs, who seldom have easy access to NHS libraries.

Creating a personal virtual branch library and then making it your home page is quick and easy to do, with excellent results. I have done this in the surgery and find it very useful.

The structure of the diabetes section described earlier provides an excellent template for any condition. The information is well laid out, easy to access and the quality of the information is of the highest standard. I hope that all new clinical areas will have a similar structure.

It is well worth taking time to explore the NeLH website fully. I feel sure that many people will find areas they will want to return to at a later date. This is made easier and faster by adding the NeLH website to your list of favorites on your web browser.

I believe this is a very good start to providing electronic information to healthcare professionals and patients. I will follow the developments of the NeLH with great interest. There is a feedback form on the website: please ensure that the NeLH provides what GPs need by submitting your views.


  1. Information for Health: An Information Strategy for the Modern NHS 1998–2005. London: DoH, 1998.

Guidelines in Practice, February 2001, Volume 4(2)
© 2001 MGP Ltd
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