By Ian Quinn
Exclusive: The Government is planning to switch to a scaled back, ‘patient-held’ electronic care record, severing central control over the controversial programme, but stopping short of scrapping it altogether.
A senior Government source told Pulse of moves to substantially reform the Summary Care Record after researchers found it had spectacularly failed to deliver a raft of promised benefits to patients and doctors.
The official evaluation, by researchers at University College London, concluded the programme’s problems were so deep routed they could not be solved, and claimed senior IT managers had deliberately rushed the rollout in the run-up to the election to save it from the axe.
The Department of Health’s signal that it plans a more patient-focused approach to the care record came as it emerged that almost 90% of nearly 9 million patients who have been mailed information may have given consent without realising it.
A senior source said the Government was ‘profoundly, deeply troubled’ by the rollout and planned major changes including axing IT bureaucracy and switching to a simpler system based on patient control at a local level, including a back-up system for vulnerable patients.
Connecting for Health had claimed the Summary Care Record would make GP out-of-hours telephone calls and visits 15% shorter, cut time spent on A&E and walk-in centre consultations by a third and make mental health crisis intervention encounters 60% shorter.
Yet, the 250-page report, based on three years of data and costing £1m, said: ‘When the care record was accessed by doctors, consultations were significantly longer.’
The report, published in shorted form by the BMJ, did find a ‘rare but important’ impact on medication errors, but warned some records contained ‘incomplete or inaccurate data,’ including failing to list medication or listing allergies the patient probably didn’t have.
It also claimed a revised consent model brought in by Connecting for Health after huge pressure from the BMA, requiring clinicians to ask patients for consent each time they entered one of 1.2m records created as of March this year, was routinely ignored.
Connecting for Health is accused of deliberately ramping up the speed of the rollout and reducing consultation with GPs, in an attempt to reach a critical mass of record use before the general election.
Study leader Professor Trisha Greenhalgh, now professor of primary health care at Queen Mary’s University, London, told Pulse: ‘I cannot see how they are going to solve the problems we have found. The whole idea of a shared summary record sitting on a shared database is problematic.’
Professor Greenhalgh added: ‘If the Government ignores this report it will be a disgrace. If we’d found out there were real benefits to health, that it saved lives, them maybe we’d think it was worth it. But it hasn’t.’
Summary care record UCL report findings
ON BREACH OF CONSENT:
‘Some clinicians accessed SCRs before calling patients back in order to orient themselves to the case…..They answered ‘yes’ to the question of whether the patient
had given consent.’ This included spending £7m paying for the mail costs of SHA’s to drive an acceleration in the rollout
‘When asked to justify this, they said that if the patient sought care from the service they were obviously consenting to staff accessing their record.’
‘The patient’s consent ….was perceived as a hassle by front-line staff and some felt that the disadvantages of asking patients outweighed the advantages.’
ON THE POLITICAL TIMESCALE:
‘A change of government was seen as a significant risk to the SCR programme
…the policy of engaging GP practices by a personal visit was replaced by an ‘information pack’ containing clickthrough Powerpoint presentations and a DVD.’
ON THE IMPACT ON CONSULTATION TIMES:
‘When the SCR was accessed by doctors, consultations were significantly longer
ON DEEP-SEATED PROBLEMS:
‘A number of pervasive, seemingly insoluble problems became recurring agenda items including content and scope of the SCR and data quality.’
Source: UCL Report on Summary Care record Rollout