Dr Emyr Wyn Jones is Clinical Ambassador at the National Implementation Summary Care Records Service: he tweets at @emyr_wyn
Were you aware of the existence of Summary Care Records (SCRs)? They are mentioned in one of six Quick Guides that are included in a section of the NHS England website on Transforming Urgent and Emergency Care.
Almost every person in England now has a Summary care Record (SCR). To be exact, more than 55 million people or 96% of the registered population have had a SCR uploaded electronically from their GP record to the National Spine. This number is still increasing. In the foreseeable future, an SCR will have been created for everyone in the country apart from those people (only 1.4% of all those who were contacted) who have indicated that they wish to opt-out of having a SCR.
SCRs are available to be viewed by authorised staff providing direct care to patients away from their GP surgery, anywhere in England, any time of day or night. All SCRs contain details of the patient’s prescribed medication (repeat medications, acute medications and, in most cases, discontinued medications). Also, details of recorded allergies and adverse reactions.
Importantly, it is now technically straightforward for SCRs to be further enriched with additional information from the GP record. The patient’s explicit consent is required for this to be done. This is something that a clinical member of the Primary Care team should discuss with the patient. If the patient is not able to provide explicit informed consent then information can be added to the SCR by the GP if that is thought to be in the patient’s best interest.
This Additional Information can include: Significant medical history (past and present); Anticipatory care information (such as information about the management of long term conditions); Communication preferences (as per the SCCI-1605 national dataset); End of life care information (as per the SCCI-1580 national dataset); Reason for medication; Record of Immunisations.
The BGS has welcomed this development and has stated that: ‘When treating older patients, the Summary Care Record, enriched with additional information gathered during the process of Comprehensive Geriatric Assessment, or as part of the proactive care processes within the primary and community care setting, can be used to support decisions from the beginning of any new episode of care. This will increase the likelihood that complex conditions are accurately recognised and more appropriate treatment plans put in place. This will contribute to safer, more effective and efficient care for older people across the urgent care system, potentially avoiding the need for hospital admission or helping facilitate earlier and safer discharge.’
We know that the clinical problems and needs of older patients are often substantially different from those of younger patients. Older patients often have multiple co-morbidities, polypharmacy and complex social care needs. Older people attending Emergency Departments are more than twice as likely to be admitted to hospital as younger people (48% compared with 20%). This is exactly the group of patients whose care would be made easier by having immediate access to the key information from their GP record that is contained in the SCR!
Enriching the SCRs with relevant additional information from the GP record should be introduced as part of the routine care of older patients and could, for instance, be incorporated into the annual health check for older people. Health communities, through their CCGs, could agree a mechanism whereby this could be introduced.
The NHS Standard Contract for 2015/16 (mandated by NHS England for use by commissioners for all healthcare service contracts other than in primary care) states that service providers ‘must ensure that all staff involved in the provision of urgent, emergency and unplanned care can view key service user clinical information from GP records, whether via the Summary Care Records Service or a locally integrated electronic record system supplemented by the Summary Care Records Service’ (NHS England 2015). Has your organisation made SCR viewing available to you?
There need not be any significant capital cost to an organisation in enabling SCR viewing for its staff, because access to the SCR can be through the nationally available, web-based SCR application and the programme is centrally funded. There are no licensing costs on introduction and no recurrent licensing costs. There will be some incidental costs in establishing the registration authority function to print and distribute smartcards, but staff require only a small amount of training. The Health and Social Care Information Centre (HSCIC) programme has people working across the country who can help with implementation.
Image credit: Mark Crossfield via flickr