Trust IT upgrade led to cancer diagnoses not being recorded, GPs warn 

Exclusive Delayed communications from a hospital trust to GP practices have led to cancer diagnoses not being recorded and to other serious patient safety issues, GPs have warned.

GPs in Sheffield said that letters not being received by practices for up to three months post discharge resulted in cancer diagnoses not being recorded despite multiple follow-ups from practices – as well as incorrect prescriptions being given; missed appointments; and obstetrics failing to inform a practice that a newborn baby was palliative.

The LMC said this was due to delays to discharge summaries following an electronic patient record (EPR) upgrade at Sheffield Teaching Hospitals (STH).

The delays also caused community follow-up services not being requested appropriately because the GP was unaware of a terminal diagnosis; and DNACPR forms being partly completed and therefore invalid, putting patients at risk of inappropriate attempted CPR.

Earlier this year, Pulse revealed that Sheffield GPs had already warned of potential patient safety issues and a significant impact on practices following the EPR upgrade.

Now Sheffield LMC secretary Dr Alastair Bradley has written to the trust to raise concerns, after the LMC surveyed 22 affected GP practices, who reported the patient safety issues which had happened a five-day period (10 to 14 November). 

It follows STH adopting the Cerner Millennium EPR in July this year after signing an £85m, 10-year contract with American technology company Oracle Health in 2023. 

Dr Bradley said: ‘We note that this is only a snapshot of the problems, but this is four months after implementation and practices are seeing no let-up in workload associated with Oracle.

‘These are only some of the serious consequences being picked up in general practice due to Oracle.’

The letter also added that the possible roll-out of the same EPR to other trusts could ‘result in
serious consequences for patients’ and that these need to be ‘learning events’ so the ‘same mistakes are not repeated and again’.

As well as patient safety issues, the letter said incorrect or confusing correspondence has necessitated extra staff time needed to deal with it – averaging more than seven hours extra work a week across the 22 practices. 

Dr Bradley said: ‘Practices have noted that they are receiving up to six copies of the same letter, although some are tag with “Amended letter”. Many of these are paper copies.

‘Practices are having to employ more staff to sift through all these letters to check whether there has been an amendment or not (usually not).

‘Department names are often missing or wrong. Diagnoses are embedded in the body of the text and not clearly stated. A&E letters now extend to four pages with no additional information.’ 

The LMC also demanded that the trust compensate GP practices for the clinical time lost to deal with the issues.

It said practices would ‘need to be compensated or else there will be reduction in primary care activity elsewhere’ and it urged a meeting with the trust to discuss compensation for GPs ‘for the financial cost to them of employing more staff to deal with this additional workload’. 

When concerns about the discharge summaries were first raised earlier this year, the trust said it had ‘acted quickly’ to identify the problem and it cited human error – due to a new process for discharge letters not being followed – as opposed to an IT systems fault. 

Despite this, the LMC said their concerns ‘have not abated’ though ‘STH have been informed of many of the issues’. 

STH chief medical officer Dr Nick Lyons told Pulse that there is a system in place where GPs ‘can raise any patient care concerns’ directly with the trust, and these are reviewed by a patient safety group led by the chief medical officer.

Dr Lyons said: ‘We are addressing the issues relating to timely discharge summaries as a matter of urgency and share the concerns raised by our primary care colleagues.

‘We meet regularly with locality leads to provide updates and gain any additional feedback and there is a system in place where GPs can raise any patient care concerns with us direct. These are reviewed by a patient safety group led by the chief medical officer.

‘We have made significant progress over recent weeks on the technical fixes, and we have also put in a manual process to ensure any summaries “held” in the system are checked and issued out quickly. This has significantly increased the number of summaries going out on time. Some of the remaining issues are related to staff familiarity with the EPR system and we are therefore supporting our staff with additional training and support to ensure the summaries are issued correctly and promptly.

‘We will of course meet with the LMC to discuss how together we can move forward and resolve the remaining issues as quickly as possible. We thank colleagues for their ongoing support and apologise that they and their admin teams have been impacted by these initial issues.’

Pulse has contacted Oracle Health for comment.

The Oracle contract with STH included the option for other South Yorkshire trusts to adopt the same EPR. Doncaster and Bassetlaw Teaching Hospitals Foundation Trust previously confirmed to Pulse it does not have an EPR in place but planned to adopt the same system as STH when it does so, scheduled for 2027. 

Last month, Pulse revealed GP leaders in Nottinghamshire were seeking compensation for GPs affected by ‘ongoing’ issues with Nottingham University Hospitals NHS Trust’s (NUH) laboratory information management system (LIMS).

Pulse has looked into patient safety issues and increased workload for practices due to delayed or missing hospital communication as part of its award-winning investigation You’ve not got mail.