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How I am implementing the Care Record in my practice

Dr Jon Orrell describes the mechanics of implementing the care record in his early adopter PCT, what the workload has been - and how his patients have reacted

Dr Jon Orrell describes the mechanics of implementing the care record in his early adopter PCT, what the workload has been - and how his patients have reacted

When Summary Care Record pilots were introduced, our practice was predisposed to be in favour of the scheme.

We have 18,000 patients on two sites in Weymouth, Dorset.

The population of Weymouth increases significantly in the summer months, with tourists who bring themselves but not ‘those white pills; you know the ones – can't you look them up?'.

So the prospect of finding out such details from the records of temporary visitors and improving emergency care locally has kept us going during the testing times involved in being an early adopter area.

Once the care record is rolled out we will be able to look up the medication and allergies of patients who come

hundreds of miles just to visit us.

Reassuring experience

GPs are right to be cautious about ideas from on high that often increase their workload needlessly.

But in this case, our experience might reassure them.

The problems we experienced, such as they were, were not severe.

Of course I would like to be able to report a perfectly functioning computer system - we use EMIS LV - but is it ever so?

In the event, there were delays in getting care records to work.

On the other hand, many organisational and computer changes are launched in a big bang with no site testing first.

The national care records service (NCRS) is a refreshing exception.

It has been using six areas to explore the practical challenges.

The lessons have been fed back and changes made to the whole national plan before a wider launch.

The change in consent is a fine example of such a lesson.

This should offer reassurance to GPs from other areas that they will not be getting an untried and untested product.

On the technical side, the GP system supplier has to come up with the goods, and while iSoft and Vision have forged ahead, our system supplier has been somewhat left behind, and we are not yet able to participate fully.

The latest news is that this situation will be sorted in the next few months.

So patients in Dorset have not yet benefited from their records being uploaded - Bolton and Bury lead the country in making such progress.

Public hotline

The initial letter informing patients of the plan and giving them the opportunity to find out more or opt out comes from the PCT.

The first point of contact is a local helpline, NHS Direct and drop-in sessions at the library.

This means there is no deluge of patients in the practice after the mailshot.

A drop-in session was held in the practice but it was staffed by people from the PCT and the care records project, again meaning there was no disruption to us.

There was some administrative adjustment to the new patient registration process at the front desk but this simply involved giving out a leaflet.

We will be looking at inviting patients to consider the benefit of having an enriched record uploaded, which means adding immunisations and major summary diagnoses to the basic medications and allergies.

The workload for GPs in the practice has been minimal.

There was an initial awareness session for all staff, but this could be added to the appraisal portfolio.

We intended to quantify the extra workload for GPs and cost this for a local enhanced service.

However, the impact was tiny on GPs.

Even though I was the lead GP and the media spokesperson I had only four people ask me about care records during consultations.

Patients determined to opt out - and there were remarkably few - were directed to a member of the administrative team to ensure they had the pros and cons of not having a record explained.

Those wanting to opt out were generally adamant and determined and no barriers were placed in their way.

We adapted the local paperwork to make it easier for them to sign opt-out forms.

After an initial period, the number of patients wanting to opt out has settled down to about two a month, so some weeks there is no additional work.

Consent changes

The questions patients ask are varied and interesting.

Many are keen on the concept and want to sign up for an advanced Healthspace account.

Indeed, most of the grumbles from the public have been of impatience from those wanting more rapid progress in seeing some content on their Healthspace record.

The change in consent is a great step forward.

We were involved in a similar project five years ago that used the safeguard of asking for permission to view before opening the record, with the clinician's identity being logged and known for later checks.

This idea has worked well in Wales, and the visit from Professor Trisha Greenhalgh's University College London evaluation team and subsequent report has resolved many of the legitimate objections to the programme.

The change in consent model will mean some extra work for our PCT but not for practices.

There will be a new mailshot to ensure patients are informed of the additional safeguards and opportunities the project brings.

In other parts of the country all this can be done with the first mailshot.

Either way there should be no work for an individual practice as a central PCT project team can do all the letter folding and stamp licking.

In many ways all our GP work for the project has already been done as part of normal good practice.

The adoption of the good practice guidelines, and more recently the IM&T DES, has meant the computer records in our practice have been receiving attention and have already improved to the level needed for the NCRS.

A clean record

The requirements of spring cleaning registers for the QOF, scanning all incoming letters for new diagnoses, and keeping up standards as a training practice, means that for us, and for all local practices, GP records are of a high quality.

This always comes as a surprise to the general public and political planners, who might naturally assume that the shiny expensive hospital sector had the best IT.

The truth, known to all GPs, is that we have the best computer record in the NHS, having invested our own money and time over the years.

This solid bedrock is now a firm and sure foundation upon which others can build using integration software.

Interoperability is the way forward, as this project clearly demonstrates.

Our local A&E and out-of-hours services are ready and waiting for this new step forward.

The usual response from patients is astonishment that the NHS has not been running a national care record already.

Dr Jon Orrell is a GP in Weymouth, Dorset, and care record lead for Dorset PCT

Dr John Orrell: 'Patients usually astonished NHS not already running a national care record' Dr John Orrell: 'Patients usually astonished NHS not already running a national care record'

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