Summary Care Record

Summary Care Records Action Plan

Wrafton House Surgery October 2014

Background

The Public Information Programme has been completed and lasted for 12 weeks in 2010. By March 2013 more than 24 million SCRs had been created across the UK. The introduction is being continued with SCRs containing essential information that could be necessary in an emergency.

Summary information now contains: patient medication, allergies, adverse drug reactions and additional information that may be requested by the patient, as well as patient’s name, address, date of birth and NHS number.

Benefits

Benefits to patients include:

Improved safety
Increased efficiency
Increased effectiveness
Better patient experience

More patient information can be found on the website: digital.nhs.uk/services/summary-care-records-scr

Summary Care Record Implementation Programme

The practice is contractually obliged to publish on the practice website and within the practice plans to:

Promote and offer the facility for patients to view online, export or print any summary information from their records relating to medications, allergies, adverse reactions and any other items agreed with the patient.
Upload information daily to the Summary Care Record
Use GP2GP transfer facility to transfer patient records

Promotion and Information for Patients

The Public Information Programme was completed and lasted a minimum of 12 weeks.

The practice will continue to provide information concerning Summary Care Records including:

Posters within the surgery informing patients about SCRs
Opt out forms for patients
To provide help with queries
Plans for new patients registrations

Patient Choice

Patients can choose whether or not to have an SCR
Patients can change their mind at any time by informing their GP practice
Patients can choose whether they want additional information added to their SCR
Patients can choose which additional information can be added to their SCR
Patients are asked for their permission every time healthcare staff need to view their record
Permission to view can be asked and granted for a group of healthcare staff e.g. an Emergency Department clinical team.
If a patient is unable to grant permission to view e.g. they are unconscious, a Clinician may choose to use emergency access to view the SCR if they believe it to be in the patient’s best interests.

Codes for patient preferences
Preference	Code 1	Code 2	What the code relates to
Implied consent for medication, allergies, and adverse reactions only	XaXbX	9Ndl	The SCR will only contain: medication, allergies and adverse reactions
Express consent for medication, allergies and adverse reactions	XaXbY	9Ndm	The SCR will only contain: medication, allergies and adverse reactions
Express consent for medication, allergies, adverse reactions, and additional information	XaXbZ	9Ndn	The SCR will contain; medication, allergies and adverse reactions plus any additional information
Express dissent	XaXj6	9Ndo

Security of the Summary Care Records

In order to maintain the security of the SCR security measures are in place to control access.

Technology security measures:

Secure NHS Network (N3)
Smartcards - are needed to view and update SCRs
Role Based Access Controls (RBAC) - ensures that only appropriate staff can view and create records
Legitimate Relationships – ensure that only healthcare staff involved in the patient’s care can view their record
Permission to View - gives patients control of access to their record at the point of care

Organisational security measures:

Legislation e.g. Data Protection Act
Caldicott Principles
Care Record Guarantee
Local Information Governance policies and procedures
Contractual measures e.g. confidentiality clauses in employment contracts
Training

Individual user based security measures:

Adherence to Smartcard usage policy
Existence of legitimate relationships
Asking for permission to view (where applicable)
NHS duty to patient confidentiality
Professional codes of conduct
Contractual requirements
Adherence to organisational security measures

What happens before we go live?

Within the practice there will be an SCR lead who will work with to ensure:

All of the appropriate technical checks are carried out
All of the staff within the practice are trained
All of the staff within the practice have received the information to enable them to deal with any queries patients may have about SCR
All staff are compliant with local best practice e.g. Patient Demographic (PDS) information management
The appropriate data quality standard is reached
The new patient process is operational

What happens when we go live?

There will be an “initial upload” of the three key core data items (allergies, adverse reactions & current medications) for each eligible patient who has not opted out of having an SCR

What happens after we go live?

Staff must follow all of the processes that were explained during the training e.g. using smartcards
If staff believe that the system is not working as it should be then they should follow normal escalation processes
Always ensure that there are patient packs with opt outs, on site to give to patients that register with the practice
Should practice staff receive a query that they cannot answer they should contact the Health Organisation

How are SCRs updated?

After the initial upload, SCRs are updated every time:

a change is made to the core data set
an additional data item is marked to be included or excluded from the patient’s SCR e.g. a diagnosis (This only results in an SCR update if the patient is set to explicit consent)

Updates are only made if the user is authenticated with their smartcard and the patient’s local demographic details are matched to the PDS

The SCR is date and time stamped so that anyone viewing the SCR knows the date and time it was last updated