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'Pull the plug' on Summary Care Records, says GPC IT lead

Exclusive The Summary Care Record programme should be scrapped because only a small proportion of records are being accessed and the current utilisation rate means each viewing to date has effectively cost an estimated £1,200, the GPC’s IT lead has said.

Dr Paul Cundy, chair of the GPC’s information technology subcommittee and a GP in Wimbledon, south London, said that while almost 23 million Summary Care Records (SCRs) have been created, they are being accessed in just 98 of the several thousand institutions such as out-of-hours services and hospitals eventually intended to use them.

In an exclusive interview with Pulse as part of our Big Interview series, Dr Cundy said he believed the Government should ‘pull the plug’ on the entire SCR programme, although he later stressed he had been speaking in a personal capacity and that the BMA’s policy remained that the SCR should ‘stand on its merits’.

According to the latest NHS Connecting for Health bulletin, almost 23 million people in England - more than one in three - now have an SCR, and 50 PCTs have created SCRs for more than 60% of their patients. As of last week, there had been 242,341 clinical accesses of SCRs in urgent and emergency care.

But Dr Cundy said this represented a disappointing utilisation rate, and that his estimate was that even in the 98 institutions currently using SCRs, records are only viewed ‘on average eight times a day’. His own calculations suggested that the cost of each individual viewing was so much that the system should be discontinued, he said.

‘If you look at that in terms of utilisation rate, it means that each time an SCR has been accessed for a patient it has cost £1,200 per access,’ he said. ‘The system is an absolute disgrace and the plug should be pulled out on it as soon as possible.’

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Video interview: ‘The system is an absolute disgrace, and the plug should be pulled on it as soon as possible’

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Most patients were not aware that records are being created because in many areas public information programmes were run several years ago, he added.

‘These records are now being created and patients are not aware of what’s going on,’ he said.

Dr Cundy’s comments were backed by Dr Chaand Nagpaul, the GPC’s lead negotiator on IT, who said the low utilisation rate was a matter of real concern.

‘The Government does need to take very seriously lack of access,’ he said. ‘It’s an expensive use of public resources at a time of cutbacks. They need to look very seriously about whether it represents value for money.’

But Dr Amir Hannan, primary care IT lead at NHS North West and a GP in Hyde, Greater Manchester, said SCRs were part of a broader trend of society become increasingly digitised.

He said: ‘It is useful to recognise that society is moving that way. We have a mixed economy of systems: from patients who are not interested to SCRs, EMIS Web and patient access to records on the other end of the spectrum. They all have pros and cons. The SCR isn’t a panacea, it’s just one solution.’

A Department of Health spokesperson said that SCRs are backed by patient groups such as Diabetes UK and the British Lung Foundation and help prevent medication errors, improve clinician’s confidence, and improve support for patients who may have problems communicating.

They added: ‘Summary Care Records are gaining increasing support from clinicians in urgent and emergency care because they offer quick access to key information about someone’s health - which means safer, quicker care for patients when they need it most.’

 

Telehealth ‘not evidence-based’

Dr Cundy was also highly critical of the telehealth DES proposed as part of the Government’s package of contract changes.

He said: ‘It’s a continuing disappointment that all governments are always pushing through non-evidence based policies.’

‘The problem with telehealth is that patients aren’t interested in it. There are a few niche areas where the use of telehealth can be very valuable, but for the average patient who lives half a mile from their practice, and who has conditions which are not terribly urgent and is mobile, for them telehealth is of no value whatsoever.’

He added: ‘It’s all very well being able to monitor someone’s blood pressure 12 times a day but someone somewhere has to assess those numbers. So you go from a situation where you take someone’s blood pressure once every six months to 24 every day. That overwhelms systems. We have to be careful not to do things because they can be done.’

Read more from Dr Cundy in the full Big Interview, published next week

Pulse Live: 30 April - 1 May, Birmingham

Pulse Live

You can find out more about digital health at Pulse Live, Pulse’s new two-day annual conference for GPs, practice managers and primary care managers. Dr Kartik Modha, a GP in London and founder of Tiko’s GP Group, will be speaking on how technology and social media is changing GPs’ practice.

Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.

To find out more and book your place, please click here.

 

Readers' comments (9)

  • It's worse than that. There may have been "242,341 clinical accesses of SCRs in urgent and emergency care.". But a large number of those will be because SHAs and PCTs have pressured OOH organisations into meeting targets for accessing the records, regardless of whether the clinician thought it would be useful or not. Only a very small proportion of these accesses will have been of benefit to the patient by showing something that the patient was not already aware of and able to tell the clinican anyway.

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  • In an A&E setting, the problems with using the SCR are a) staff are so busy they barely have time to access our own internal systems (A&E Discharge Letters anybody?) b) it requires a smartcard to access it which is not needed for internal systems c) the demographics are ok, but the clinical information available is not useful enough d) we're not allowed to build interfaces to pull the information into local systems e) the combination of SCR, patient authentication and Choose and Book causes duplicate patient records to be created which is a clinical risk. Many areas are developing local shared health care records which overcome these obstacles - That's the way to go.

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  • Well the BMA have been the biggst hindrance to the joining up of IT records ever. Once the SCR is switched on properly it will be a great help in urgent situations. I am also impressed by it's implementation in our cliniclal system-vision. I cant wait for it to in action in my area-Harrow

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  • This comment has been moderated.

  • Has it occurred to anyone who has been involved with this system that the primary goal may not be to improve patient care? Other goals may include:

    - someone wanting to be paid to deliver & maintain IT packages

    - someone other than clinicians wanting to collect info on patients. The pharma industry and the insurance industry are interested in this data and the latter has been a driver of market reforms in the NHS for years through lobbying etc. It has great potential commercial value to both sectors. There was a late amendment to HASCA 2012 putting responsibilities on every level of the NHS to yield up this data to unspecified recipients, with apparently no provision for them even to pay the NHS for commercial exploitation of the data. This has never been explained except in the vaguest of waffle.

    If it is no use to clinicians, why has it been pushed on them - a waste of scarce time and money in patient care terms, isn't it?

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  • My experience using them on my occasional out of hours sessions in Lothian is that the content is often rubbish though sometimes a little more illuminating than the minimalistic info provided by NHS 24......................

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  • ?David Lloyd

    I've worked both sides (GP, A+E Middle Grade) and the number of occasions on which the data is accessible AND clinically useful is absolutely minute.

    Additionally, the 'presumed consent' model under which this data is uploaded is ridiculous. Despite supposedly being mailshotted and the 'extensive' media campaign, ask a patient about the Summary Care Record and they have no clue about what you're talking about . Turning a blind eye to this blatent breach of confidentiality and flouting of consent guidance is totally unacceptable. We're operating an opt-in system. Unsurprisingly, there has been very little demand.

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  • Dr Cundy is spot on.

    I have all my medical records online 24/7 i.e. my GP, Hospital, Dental and Ophthalmic records if I had a social care record that would be in my online records too.

    Cost the to me and the DoH was the square root of zero.

    I also keep my advanced directive and power of attorney documents in the records just in case.

    I control who sees this material and can call the records up from my iPhone / iPad just before I walk into A&E or the Consultant clinic usually just after the hospital system has crashed.

    When I got the letter explaining SCRs I went to the GP surgery that very day and opted out – one reason is that the NHS let hackers know which security system they use and certain other bit of useful information – on their web pages. B***** idiots.

    I think Mr. Hunt or one of his little helpers should send a second letter reminding people that they are in the SCR system because they did not opt out.

    In the same letter should be this statement from the NAO: Cyber attacks ranked as one of top four UK national risks in 2010.
    Source: http://www.nao.org.uk/publications/1213/cyber_security.aspx

    I think informed consent is wonderful, as I am sure do most clinicians, so why not as the geeks in the DoH to practice what the DoH preaches to hard working clinicians on a regular basis.

    I think or friends and families down under have the right approach

    "Personally controlled electronic health records (PCEHR) for all Australians. From July 2012, all Australians can choose to register for an electronic health record."

    "The ‘Learning Centre’ will help you find out about the benefits of an eHealth record, how to get involved and how to use the eHealth record system. Register now for an eHealth record.
    Source: http://www.nehta.gov.au/ "

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  • This is disappointing to hear.

    At Northumbria we are in the process of rolling out SCR to Clinical Pharmacy teams and medical/prescribing nursing staff in A&E across the Trust.

    Speaking from a Pharmacist point of view, we are using SCR to excellent effect in order to improve the level of care we provide to our patients, whilst also improving patient safety and experience. SCR has been particularly useful in supporting our Pharmacy weekend clinical service provided to the admissions unit whereby the information contained within SCR has allowed us to provide patients with an improved level of care (e.g. finding out the doses of a patients Parkinsons Disease medicines, identifying that a patient had a previous anaphylactic reaction with pencillin.........etc) which we could not have done had SCR not been in place.

    SCR availability in Northumbria is approximately 70-75% on average so this has aided rollout and getting people on board with the idea. Surely the answer is to push on with rollout, getting more GP practices on board, rolling out into places like secondary care and hence reducing the overall cost per use, whilst improving patient care?

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  • As a patient, I hate to imagine doctors flying blind. To me, any record is better than none. I find therefore the opposition of Cundy and most of the anonymous commenters perverse. If they had all engaged seriously from the outset, we would have a meaningful SCR by now. But no, the reaction was always a blank Niet. Not helpful at all.

    What is most unforgiveable is that Cundy et al never bothered to think up a Plan B in the place of the SCR which they found so flawed. So, five years have been wasted, and patients are as likely to receive innappropriate treatments as they have always been.

    David Jones (not anonymous, please note) seems to be only doctor around who sees what should be done. A lone voice in a wilderness of negativity.

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