National Programme for IT – NHS Care Records Service (2)
August 2007
- Background
- BMA Conference Policy on the Summary Care Record
- Early Adopter Programme - Progress to date
- Public Information Programme
- Consent model
- Summary Care Record Content
- Healthspace
- The Independent Evaluation
- Further Information
Background
The NHS CRS will enable the sharing of electronic patient records across the NHS. Go here for detailed guidance on the NHS CRS. The Summary Care Record is one part of the NHS CRS. It will provide a summary of key health information to support unscheduled care and will be accessed anywhere in England by NHS staff who are directly providing care to a patient.
BMA Conference Policy on the Summary Care Record
At the Annual Representatives Meeting (ARM) 2007 it was resolved that BMA members should not cooperate with the proposed centralised storage of all medical records due to concerns about security and confidentiality. At the Local Medical Committee Conference 2007, GPs resolved that lessons must be learnt from early NHS CRS adopter sites.
The BMA accepts that some GPs are, or are soon to be, involved in the early adopter programme and this will provide an opportunity to explore the practical as well as theoretical issues surrounding consent, confidentiality and of implementing a summary care record. The BMA understands that GPs in the Early Adopter PCT areas may wish to continue to be involved. Not all of the early adopter PCTs have been announced and we will update this guidance as soon as the 6 PCT areas are made public so that you know if you are involved or not.
GPs not involved in the early adopter process should await the outcomes of the evaluation of the Early Adopter Programme. If patients express their concerns and request their clinical data is not uploaded this can be recorded in their individual record as an appropriate Read code (see reference 1). Go here for NHS CfH guidance on managing requests for no summary care record. If patients request a SCR, they should be informed that it is only possible for a SCR to be created in the Early Adopter PCT areas, at this stage.
An independent evaluation of the Early Adopter Programme is in progress and the BMA has representation on the advisory committee. The BMA has written to Ben Bradshaw, Minister for Health, to recommend that there should be no roll out of the Summary Care Record, beyond the Early Adopter PCT sites, until the independent review has been completed and ways forward have been agreed.
Early Adopter Programme – Progress to date
The Early Adopter Programme is intended to cover six PCT areas. GP practices in the Bolton and Bury PCT areas have started uploading Summary Care Records following a public information programme. Dorset PCT has started the public information programme and South Birmingham PCT has recently been announced as the fourth PCT area. The remaining two areas will be announced over the next few months.
Public Information Programme
Local Public Information Programmes were started in Bury and Bolton. Information was sent to every member of the public over the age of, or soon to reach, 16 years. The local media was used to raise awareness. Roadshows and information booths were also launched. The PCTs are also working with schools to raise awareness so those who are under 16 but Fraser competent can make decisions about how their records are shared. The effectiveness of the public information programme will be evaluated by the independent team. The BMA is in the process of finding out more about the evaluation process of the public information programme.
We have recommended that NHS CfH continues to work with the BMA, Medical Defence Unions and patient organisations to agree the final public information programme material once the findings of the evaluation are known.
Consent Model
Following the recommendations of the Ministerial Taskforce report, patients have 16 weeks from the start of the public information campaign to contact their practice with their sharing preferences. Patients are offered three choices:
Green - Summary Care Record is shared with those providing direct care to the patient
Amber - Summary Care Record is created and stored centrally but not shared unless the patient gives their explicit consent or access is required by a court order or statute
Red - A blank Summary Care Record is created.
To date only a small percentage 0.32% of patients have opted out in the early adopter areas. The BMA will monitor the situation and evaluate progress. The BMA has received assurances from the Department of Health and the Information Commissioner that uploading information on an implied consent basis meets the requirements of the Data Protection Act. In response to LMC policy 2007, we will be seeking further clarification.
Summary Care Record Content
After the 16 week period a Summary Care Record is created unless patients have contacted the practice to state their preferences. Initially the Summary Care Record will only contain medications, adverse reactions and allergies. Work is being undertaken with the Early Adopters to establish how further clinical data such as major diagnoses should be added to the record. The Royal College of GPs is developing standards to support GPs in their summary maintenance and its input into the content of the Summary Care Record.
Healthspace
Healthspace is an online personal area. Patients in the early adopter areas can access their Summary Care Record via an advanced Healthspace account offering additional security. Patients wishing to view their Summary Care Record via Healthspace will need to register, which involves filling in an application form and an interview with a registration agent.
The Independent Evaluation
The Independent Evaluation is being conducted by University College London. It is expected that all significant findings will have been reported by May 2008. The BMA is represented on the External Advisory Group for the independent evaluation and the Advisory Group for the Summary Care Record, which considers regular updates from the evaluation team.
Further information
Go here to find information on NHS CfH. If you would like to contact the BMA about NHS IT issues please email: info.nhs-it@bma.org.uk
References
- 93C3 as a Read code can be used to record patients who have requested that their information is not uploaded. This presence of this code in GP clinical systems will prevent the upload and may be a useful way to search for patients with concerns. 93C2 can be used to indicate patients who have stated that they are happy for their record to be shared.