This is a positive first step to what we hope will be full read and write access to patient records
A Proof of Concept (PoC) trial gave 140 pharmacies in England access to the Summary Care Record (SCR) from September 2014 to March 2015, with a follow-up report from the Health & Social Care Information Centre (HSCIC) claiming that pharmacists involved in the pilot were – among other outcomes – able to improve effectiveness, efficiency, safety and patient care with a reduction in the number of avoidable medicines errors and in the necessity of GP visits.
NHS England has subsequently commissioned HSCIC to support all community pharmacies in England to implement access to the SCR, and the government has pledged up to £7.5 million to give community pharmacists the (as yet unspecified) training and tools they need to access a patient’s SCR. PSNC is working with NHS England, HSCIC and the other national pharmacy bodies to finalise the arrangements for the roll-out, with completion expected by autumn 2017.
However, the initiative has recently attracted negative media coverage, stemming from an article in The Daily Telegraph. So, are pharmacists sure that this is what they want to happen?
More than 96 per cent of the population have an SCR and it is already being successfully used in settings across the NHS, such as A&E departments, hospital pharmacies, NHS 111, GP out-of-hours services and walk-in centres.
The PoC trial found that SCR access in community pharmacies delivered benefits to patients, pharmacy and general practice, including the pharmacist avoiding the need to signpost the patient to other NHS care settings in 92 per cent of encounters where SCR was accessed; 85 per cent of pharmacists agreed that SCR reduced the need for them to contact the patient's GP and that the risk of a prescribing error was avoided in 18 per cent of encounters.
The recent news of SCR access throughout England has had widespread support from pharmacy groups. In a joint statement, the RPS, Pharmacy Voice and PSNC said: “We welcome and fully support the deployment of access to the Summary Care Record to all community pharmacies in England,” with Professor Rob Darracott, chief executive of Pharmacy Voice, adding: “This is a positive first step to what we hope will be full read and write access to patient records, enabling pharmacy teams to provide better patient care and a more consistent primary care service to patients.”
Others agree that the scheme should continue to develop.
For Graham Phillips, pharmacy superintendent and owner of Manor Pharmacy Group, write access is crucial. “Frankly, some in the NHS hierarchy are blindly prejudiced against us," he says. "We are all too often not considered in the context of what we could do as the third largest health profession, where we can add value, and the IT solutions we need to support that. So while read-only SCR access is a great start, it’s not enough.
“We need write access, too, because in order to demonstrate health outcomes for people, we need to be able to record what we do and share the outcomes with GPs and the NHS. Ninety-five per cent of care is self-care and that’s where we have a massive part to play. Focusing solely on the other 5 per cent (which is what the rest of the NHS sees) is simply looking down the wrong end of the telescope.”
Mr Phillips is unfazed by potential obstacles, such as extra training, that may be needed. “How hard can it be for us to operate a computer?” he says, but points out that there might be a more pressing barrier to attend to. “What was interesting from the initial trials was that some pharmacists used SCR access a lot and some didn’t use it at all. We need to find out why those who didn’t didn’t, and really share and identify best practice.”
From speaking to Numark members who were involved in the trial, Andy Charlesworth, Numark’s IT services manager, has had similar feedback. “We found that not all of them had accessed it,” he says, “because they found it hard to break the habit of just picking up the phone to the GP surgery. However, they had found it useful when locums were covering, on Saturday mornings when the surgery was closed, and particularly in emergency supply situations.”
However, he warns that once practices “wake up to the fact we have access to the SCR, they aren’t going to be too impressed if we’re phoning all the time and interrupting them when we could have easily found the answer out ourselves".
For Rekha Shah, chief executive officer at Pharmacy London, a consortium of LPCs working together on matters affecting pharmacies across the capital, any reduction in the time it takes to solve a query is also a great outcome for the patient.
“In my pharmacy practice I can be waiting up to two days for a GP practice to respond to queries – and that’s after multiple attempts by me to contact them," she says. "Often that makes for quite a difficult experience, because patients don’t realise we can’t just pick up the phone and talk to the GP directly in the event of a query. If I have direct access to the patient’s key information via the SCR, that enables me to solve a query myself, and it’s better for the patient.”
That’s all well and good, but for Ms Shah it’s still not enough. “There is a lot of information that is not available on the SCR because it only covers key data about allergies, the medicines people are on, test results and so on. I’m involved in developing a vaccination service in London, but immunisation information is not on the SCR – although it could be if advanced care records were agreed. That means that once I’ve immunised someone, I could write this information into the record myself (via read and write access), which would solve so many problems, such as GPs not receiving information in a timely way or not uploading it into the patient record.”
For those worried about the increased cost (in terms of staff and training, etc) associated with using the SCR, Ms Shah says: “It is my understanding that there will be a fee paid to pharmacists through the drug tariff as recognition of a little extra workload. However, it’s down to the negotiating bodies to get the right level of payments set for this.”
Some have other concerns. “It’s definitely a step in the right direction, but has anyone thought through the unintended consequences of such a move, especially as the pilots were around unplanned care and emergency, not everyday access like we need in pharmacy?” says Sultan "Sid" Dajani, RPS spokesperson and treasurer, and owner and pharmacist superintendent at Wainwrights Chemists in Hampshire.
“For example, if we access the records and we miss something or misinterpret something, we are therefore liable. Where do we stand? Do we have to access everybody’s file every time we see them, even for OTC medicines, MURs or the New Medicines Service? If we get read and write access, how is the audit trail going to work? Can technicians access it? How will that be monitored? Will we have access to hospital discharge records, which are very important too? How often is the GP record updated? Is the SCR real time or is there an overnight update, which may mean information is not updated when we access it? I don’t think the legal aspect of confidentiality, consent and liability has been properly addressed.
“That’s not to say that I think it’s moving too fast, rather that things aren’t moving in tandem. The responsibility is across the board but the RPS should be leading on this through the IM&T Group, along with the PMR software and contract organisations (NPA and Pharmacy Voice) and the HSCIS. I’m sure somebody somewhere has the answers to all the elephant traps I can see.”
Despite the holes that pharmacists are pointing out, it seems they would still rather have the start of SCR access than nothing at all. Mr Dajani points out that, although he sees “a real danger – if this fails we are going to get the blame”, he hopes that “my fears are unfounded and it succeeds quickly, which is why I’m cautiously optimistic".
Ms Shah is more confident, believing that pharmacists “adapt really well to new developments. At the end of the day, we are clinicians; we want to be involved in primary care, and what better way than with access to the SCR?”
Mr Charlesworth is looking forward to write access, but stresses that there is a need to “build confidence with GPs and, as such, it will be a one-step-at-a-time approach".
For Mr Phillips, that day can’t come soon enough. “In any sensible world, this would have been joined up from the very start with no debate about it'" he says. "Instead, pharmacy is an afterthought once again, which is ridiculous. It’s time for my profession to grow up, and for the NHS to respect us at long last.”
The NPA pharmacy services team has produced a factsheet “Summary Care Record (SCR): community pharmacy access” with information including an illustration of what the SCR looks like, when to access the SCR and other relevant information.