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How long can the care record survive the new austerity?

The Summary Care Record has escaped for now, but serious questions remain about its future, says London GP Professor Trisha Greenhalgh

The Government this month decided to spare the Summary Care Record, releasing two reports that set out what data would be uploaded and how to handle communication with patients.

The reports are welcome and have addressed – for now at least – two of the most significant issues that have contributed to the stormy fortunes of this controversial programme. There is a new sense of restraint and containment around what was in danger of becoming a runaway project. But the reports' authors had a frustratingly narrow brief, and their recommendations leave three fundamental questions unanswered.

First, who will pay for the continuation of the programme? Early business plans predicted that once the technology was up and running and in regular routine use, the cost of maintaining it would be generated from the efficiency savings it would bring – specifically, shorter consultations in emergency and out-of-hours care and a reduction in unnecessary hospital admissions.

In reality, the care record is not up and running in very many localities. Even where it is, its use is patchy and no significant efficiency savings have materialised. Sir Bruce Keogh reports that stakeholders believe the care record could bring significant (albeit rare) benefits – but what services will be curtailed in order to achieve them?

Second, who will address the question of data quality – and how? General practice electronic records in England are among the most accurate and complete in the world. Despite this, summaries of medication lists drawn from those records have common and potentially serious deficiencies.

This is partly, but not wholly, attributable to fixable deficiencies in GP-held data. A patient seen in a GP out-of-hours clinic on Saturday may have developed an allergic reaction to a medication prescribed in a hospital outpatient clinic on Wednesday. Typically, the patient's own GP will not yet know what that medication is – or even that the patient has been seen. The most accurate list of current medication may be the dog-eared, handwritten list, complete with rough crossings-out and amendments, which the patient has taken it upon themselves to keep in their handbag or jacket pocket.

Should we be putting more effort into encouraging and valuing patients' own efforts to document their own drugs and allergies and promoting low-tech solutions such as MedicAlert tags?

Third, who will solve the time famine in the NHS? Information governance measures that make perfect sense to committees in Whitehall may prove unworkable in the time- and space-constrained setting of front-line clinical care.

Professionalism in clinical staff is increasingly articulated in terms of how assiduous they are in logging onto the Spine and obtaining point-of-care consent for access to the personal data hosted on it.

But in circumstances where universal use of smart cards is only possible by cutting corners in other aspects of clinical care, achievement of this ‘quality standard' may ultimately prove a pyrrhic victory with its own (as-yet undocumented) safety hazards.

The Summary Care Record is not going to go out with a bang. But what odds would the bookmakers put on it remaining sufficiently high-priority to survive the era of austerity the NHS is now entering?

Professor Trisha Greenhalgh is a GP in north London and director of the Healthcare Innovation and Policy Unit, Barts and the London

Professor Trisha Greenhalgh