Can the Summary Care Record ever deliver for primary care?

The new fast-tracked rollout will soon make the care record part of our normal working practice, says Dr Phil Koczan. But Dr Peter Swinyard is unconvinced, believing expensive but inflexible national schemes can never deliver solutions for local health needs

My practice has had a computer system for more than 20 years and we have a vast amount of data locked up inside it.

We are managing very complex cases in the community. And yet, when out-of-hours or emergency care is needed for these patients, vital information is rarely available to clinicians treating the patient at that time.

There is, in my view, a clear and urgent need to share essential information about patients' medical care. In my experience, unconnected healthcare causes untold and unnecessary angst at often very difficult times for my patients.

The Summary Care Record provides easy access to that information. It improves patient safety, avoids duplication of tests and improves access to essential patient data during episodes of urgent or unscheduled care.

For many patients, making this information available is common sense and they are surprised it does not happen already.

Clinicians are also working with the care record to improve the management of patients receiving terminal care and those with long-term conditions, as well as for reconciling drugs when a patient is first admitted to hospital.

Patients also have a choice: they can choose not to have a Summary Care Record. Patients are written to at least 12 weeks in advance of records being created to explain what they are and their choices.

Initial rollout of the care record has been carefully scrutinised and adapted as a result. University College London undertook an independent evaluation. Patient consent is now obtained before the record is accessed at the point of care.

The result is a simpler consent model providing reassurance for patient confidentiality. At the same time, the burden on GPs is not excessive, especially when creating the initial records.

Searching for a care record needs to become second nature for emergency medicine. For this to happen, it needs to be available for a large percentage of the population.

This explains the PCT target to introduce it by March 2011 and recent changes to speed up the rollout. Until recently, introduction of the record has taken a practice by practice approach, which has been very slow and time consuming.

To address this, NHS London, and other SHAs are adopting a more effective regional approach. Patient letters are co-ordinated over a larger number of practices and de-coupled from the creation of records.

PCTs can then focus on engaging with practices to deploy the care record and significantly reduce mailing costs. To date, one million Summary Care Records have been created for patients. By the end of March more than 20 million patients will have been written to about it.

GPs are still required to record a patient's opt-out wishes by adding the appropriate Read code (93C3) to their patients record. Currently less than 1% cent of patients has chosen not to have a record. The procedure for the upload of the care record by GPs remains unchanged and training will be provided as in the past.

Increasingly, we are encouraging patients to take more responsibility for their own health. Healthspace (healthspace.nhs.uk) allows patients to access their own records on line, allowing them to see what details are recorded about them and to contribute to the record adding further information.

In London, we are working with Londonwide LMCs on the rollout and recently held a conference to discuss it. Delegates were told ‘the Summary Care Record is coming, it is inevitable, let's make sure we implement it correctly'.

I am certain that the new rapid rollout approach will speed up delivering the Summary Care Record to our patients while ensuring we adequately address the consent issues and minimise the impact on practices. The time has come for the care record to become part of our normal working practice.

It will allow our patients to be treated more safely and more efficiently in other care settings. We need to ensure that the roll out is as quick and efficient as possible to maximise these benefits while minimising the additional work required in primary care.

Dr Phil Koczan is a GP partner in Waltham Forest, east London and clinical lead for the NHS London Programme for IT. His own practice was one of the first in London to roll out the summary care record.

For more information about the Summary Care Record see: www.nhscarerecords.nhs.uk/summary

It's a lovely idea, isn't it? Everyone's illnesses, allergies, medications and medical history available for any clinician anywhere in the country at the touch of a button.

No longer will you have to interrogate the inebriate in casualty, negotiating with the visiting old dear who has forgotten to bring her tablets about which of the little white ones it was for the water or the sugar.

Anyone who has been involved with NHS computing for any length of time will know that what appears to be a simple and straight forward project to a clinician ends up clunky, short on functionality and as user-friendly as a set of bagpipes.

The trouble is that we expect IT to be easy and logical. We would even have expected the boffins to manage something which one anticipates to be simple, such as GP2GP record transfer, to have been in place for years instead of being still at the ‘rollout' stage.

One of the problems with a national Summary Care Record is that GP computing has grown organically (that would please Prince Charles) and the amount of data encoded varies enormously from practice to practice.

Enthusiasts will have every consultation and prescription from 1990 and a summary of every hospital letter on disk. Others may just have some basic data and the prescriptions.

Drug allergies may have made the cut or may not. For a hospital or out-of-hours doctor to rely on this data when faced with an unconscious patient (the usual sales line for the data divas) is unwise at best.

Even worse, people seem to have a natural tendency to believe what a computer is telling them and common sense is subsumed in the worship of the miracles of technology.

Even after two years of rollout in some areas, Professor Trish Greenhalgh, professor of primary healthcare at University College London concluded in an interim report: ‘Information needed to manage unconscious and other major patients is predominantly real-time, rapidly changing data on the patient's here-and-now condition.'

It said this was ill-matched to the care record, which was a ‘historical', relatively static document' and ‘seems to make a limited contribution in most acutely sick patients'. There was also the risky assumption that the hospital's IT would be up to reading the data quickly.

Then there is data security. I sometimes wonder is it just me when I try to protect my patients' private and personal data from the risk of publication.

Admittedly, most people are much freer with their personal information than I am and sign away their rights in pursuit of, for example, compensation for a real or imagined injury. Would an investigative journalist really find it that hard to borrow an NHS access-chipped card?

Legend has it that one of the offices of Connecting for Health has drink mats made out of computer CDs with ‘Highly Confidential' written on them.

Data is always disappearing from what are meant to be the most secure national databases – details of children have evaporated in the recent past and no system is truly secure.

I am not advocating the return to purely paper records – that would certainly be a retrograde step – but the easiest way to get at GP-held data for a hospital doctor is to give us a ring. I know we are not in the surgery over the weekend but there are very few medical problems for which they must know our data that urgently.

It may be that there is a case for local IT solutions linking general practices and out-of-hours centres and district general hospitals. After all, most of the patients dealt with by out-of-hours are local.

There is precedent for this – Swindon had a lovely, simple and functional local electronic referral system before the heavy, dead hand of Choose and Book forced it to be turned off.

NHS NPfIT had a budget of £5bn and seems to be on target to spend £13bn. At a time when inevitably there is going to be a major squeeze on the Government's enjoyment of spending our money, I would suggest that the NHS remains in its present state – spineless and disconnected.

Dr Peter Swinyard is a GP in Swindon and chair of the Family Doctor Associaion. He is on the GP user group for the electronic prescription service of NPfIT (unpaid).