Everything Digital Health

A Chat with the Impressive Mary Hawking - GP and Clinical Informatician

In this episode of Everything Digital Health, veteran GP and clinical informatician Mary Hawking recounts a career that spans pediatric training in the United States, a brief stint in transplant medicine, and a return to UK general practice in the late 1970s. Her narrative illustrates how the absence of formal postgraduate pathways in Britain pushed her abroad, where she experienced highly structured residency programs that later informed her systematic approach to primary‑care data. Hawking describes the seismic shift triggered by the 1990 GP contract, which introduced performance targets for immunisations and chronic‑disease management. The resulting need for accurate patient registers forced her practice to adopt a computerised system in 1992, ultimately selecting the EMIS (then called EMISS) platform after exhaustive stakeholder interviews. The system’s configurable templates allowed rapid retrieval of clinical metrics—such as the last HbA1c or foot‑check—enabling the practice to meet financial targets and improve chronic‑care monitoring. She also highlights persistent challenges: the “black‑market” diversion of repeat prescriptions, the ethical tightrope of restricting medication for suspected abuse, and the chronic under‑funding of staff budgets that limited the practice’s capacity to fully leverage the new technology. Hawking’s critique of the NHS IT strategy—particularly the continued reliance on paper records in hospitals—underscores a systemic gap that hampers the vision of a single, longitudinal patient record. The interview underscores that robust electronic medical records are not merely administrative tools but essential infrastructure for meeting contractual incentives, safeguarding prescribing integrity, and advancing integrated care. Hawking’s experience serves as a cautionary tale for health systems worldwide: without coordinated funding, staff support, and universal digital adoption, the promise of data‑driven primary care remains incomplete.