Our new coalition Government is keen to disassociate itself from flagship Labour Health Projects.
As a paid up Labour supporter, I have found myself caught up with several Labour ideas:
• Out-of-hours care and its detachment from normal general practice
• The development of polyclinics
• The Summary Care Record
The Summary Care Record is too important to go quietly.
Dr Gillian Braunold, clinical director of the SCR, is a formidable operator and all of those involved in the roll out of the care record feel strongly that it should survive the likely cull at Connecting for Health.
Despite the negative spin given to the latest independent report on the SCR in the national press from Professor Trisha Greenhalgh, she herself makes the point that it is difficult to research the introduction of a new and complex system into clinical practice and that the advantages may be subtle.
But don’t just take my word for it. A recent survey of GPs working with the SCR out of hours embedded in the Adastra system revealed that it helped decision-making in 34% of all consultations and helped treatment in 32% of consultations.
Some 67% of OOH clinicians felt that a more enriched SCR with more than just medication would improve their decision making even more. The Adastra survey was based on the evidence of 22 clinicians working out of hours, Professor Geenhalgh bases her experience on just 34 consultations.
Out of hours will also survive but with GPs firmly in charge. My worry about out of hours is that good OOH could be too costly for the health service in the short term and that its present delivery model will change to keep costs down.
All change at the top does not change the basics of out-of hours-and the SCR. Out-of-hours desperately needs the SCR to meet the challenges of the 24/7 society we inhabit. And in many ways the patients we see out of hours are ahead of the game; they already assume that their records are up on the screen.
In this connected world, the NHS is still disconnected; vital information sits in silos guarded by GPs clinging onto the belief that they are the only ones that can be trusted with the rights to decide who knows what.
Connecting for Health has been determined to introduce a little democracy into this system and from the outset of the SCR project has put the patient at the centre of the plan. Central to the dissemination of information via the SCR is the ability for patients to be able to access, own and alter what is known about them via the Healthspace system.
Quietly and without a fanfare, the Healthspace website has been developing. It’s at the core of the Choose and Book system, it allows patients to store their own information about themselves, it provides information about how to stay healthy and now it shows them what is on their SCR.
Connectivity is essential for out-of-hours providers too. Many patients contacting out-of-hours will need follow up the next day or weeks, what’s been done to them, what’s been given to them and wheat they’ve been told is vital information to transfer to general practice as soon as possible.
For many years that process has been paperless; Information is inserted into GP computer systems with a complete note of who did what and when and what follow up is needed.
Information flows the other way too via the ‘special notes’ system so that vulnerable people with extraordinary needs can be flagged up if they contact out-of-hours services. Practices and more often palliative care teams upload information about their patients, so that, for example, end of life wishes can be taken into account during OOH encounters.
Quietly without fuss, bits of the NHS have been breaking down the IT barriers so that information can be at the right place and time for informed decisions to be made about planning care.
The SCR seems a small step in that process. It is a read only summary of, at first, medication and allergies. Later, the SCR will show the GP summary and soon after that recent A/E and OPD letters.
But what a fuss! Independent observers must surely wonder why the BMA and others have been so obstructive to the progress of the SCR when the process went so smoothly in Scotland so that their NHS have had access to a summary record for several years.
And for some of us who sit on committees and debate with representatives of all NHS tribes and patients the consent model for the SCR, the frustration at the slowness of the roll out is intense.
Everyday I come across examples of how the SCR will improve patient care. Take yesterday, and an ordinary four-hour shift in the polyclinic. Two patients came in at either end of the sick spectrum.
A middle aged man with a skin infection arrived who could not get an appointment that day to see his own GP. It seemed minor at the time and I was in two minds whether to treat it. He had already told me about the pills he was taking and I was on the point of sending him away when I commented on his extensive psoriasis-it was then that he told me that the Enbrel (etanercept) injections were not helping very much!
Once I knew that he was on one of those incredibly powerful disease modifying drugs, the whole tenor of the consultation changed and he went out with a bag of pills and stern warnings.
Thirty minutes later and a mother brings in her wheezy three-year-old old. She was worried because the inhalers given to her by her GP did not seem to be working.
What inhalers I asked, she had no idea, so I relied on the usual conversation about the colours of the tubes. I established that he was on a brown one and a blue one but that was it. I had to construct a treatment plan which took into account every possible strength of the brown inhaler that she possessed.
Now even the basic SCR would have changed both of these consultations radically. I would have known about the dangerous drug in the first case straight way and would have been far more suspicious of an infection-I’m sure many of you have seen what terrible things can happen when these new anti-TNF drugs are given. And the second case would have been much quicker and more joined up.
A less publicised effect of having a record connected to the spine is that out-of-hours organisations can access the PDS or patient demographic service.
At last we can check the names of patients against the NHS record and avoid duplication of records. Subtle misspellings of surnames create multiple records of the same patient and fragmentation of the clinical record.
All OOH sites using the SCR report that this is a much smaller problem for them. Without too much imagination, you can see how admissions can be avoided and money saved with the SCR.
Working in an affluent multi cultural north-west London Suburb, my practice has an active patient group. They wrote to Dr Braunold a few months ago inviting her to their AGM.
She was amazing. To the groups’ largest ever audience, she completely won over the sceptics about the SCR and recruited a band of patients who are impatient for the SCR to be rolled out. To my mind it’s a battle that that should never have taken place but every time it does, the SCR wins.
High-quality out of hours services are essential to patients, essential to the NHS and essential to the government when money is tight. Good shared information about patients will improve care, cut down admissions and save money.
Connected medical records are controversial, but in one area of medicine, out of hours care, they are essential if we want safe and cost-effective cover. Support the SCR and rest easy at the end of your working day.
Dr David Lloyd is medical director of out-of-hours IT at NHS Connecting for Health and a GP in Harrow, Middlesex
Dr David Lloyd Click here to read the rest of our special issue on IT and information governance. Guest editor