Summary Care Record (SCR)

Programme Overview:

The NHS in England is using an electronic record, the Summary Care Record (SCR) to support patient care.

The Summary Care Record is a copy of key information from the patients GP record. It provides authorised healthcare staff with faster, secure access to essential information about the patient when the patient needs unplanned care or when their GP practice is closed.

The Summary Care Record contains important information about any medicines patients are taking, any allergies they suffer from and any bad reactions to medicines that they have previously experienced.

Nationally, over 96% of patients in England have an SCR. That’s 55 million people! Some 2.5 million records were viewed in the last year to support urgent and emergency episodes of care.

SCR is just one of the steps towards achieving a paper free NHS by 2020

What are the benefits of the Summary Care Record?

The Summary Care Record is a copy of key information from your GP record. It provides authorised care professionals with faster, secure access to essential information about you when you need care.
Summary Care Records improve the safety and quality of your care.

Benefits to patients

There are a number of reasons why sharing key healthcare information from your GP practice with others responsible for your care is important:

Improving Your Experience of Care – reducing the need for you to remember or repeat your medication information particularly if you have difficulties communicating
Improving the Safety of Your Care – resulting in safer prescribing by providing timely access to accurate information – for example making sure a new drug does not affect how another one works
Improving the Effectiveness of Your Care – by giving healthcare staff relevant information to make appropriate decisions about your care
Improving the Efficiency of Your Care – reducing the time, effort and resources required to obtain this key information from your GP practice.

Benefits to Healthcare Professionals

Improved Safety

Reduced prescribing errors.
Provision of key medical information allows clinicians to make informed decisions.

Increased efficiency

Reduced time, effort and resources needed to obtain medication information directly from the patient’s GP surgery. Time saved through phoning, faxing and responding to queries can be reinvested in direct patient care.
Significantly reduced time taken by hospital pharmacists to reconcile medication.

More Effective Care

Provides access to essential medical information out of hours (OOHs) and on weekends (when GP practices aren’t open).
Supports the delivery of appropriate care to patients. For example – enabling GPs in OOHs services to treat patients, without having to refer them back to their usual GP.
Invaluable when a patient cannot give information (e.g. if they are unconscious), or when they are taken ill away from home and are unable to see their own GP.
Gives those with long-term conditions confidence that if needed, their key medical information is available wherever they travel in England.

Who uses the Summary Care Record?

Allowing authorised healthcare staff to have access to this information will improve decision making by doctors and other healthcare professionals and has prevented mistakes being made when patients are being cared for in an emergency or when their GP practice is closed. The Summary Care Record also includes name, address, date of birth and uses the NHS Number as the unique identifier.

Who can access the SCR?

Healthcare staff will have access to this information, so that they can provide safer care, whenever or wherever the patient needs it, anywhere in England, however healthcare staff who have access to your Summary Care Record:

need to be directly involved in caring for you
need to have an NHS Smartcard and appropriate RA roles
will only see the information they need to do their job
will have their details recorded every time they look at your record

Healthcare staff will ask for the patient’s permission every time they need to look at the Summary Care Record. If they cannot ask (for example if the patient is unconscious or otherwise unable to communicate), healthcare staff may look at the record without asking, because they consider that this is in the patient’s best interest. If they have to do this, this decision will be recorded and checked to ensure that the access was appropriate.

The patient can choose to have a Summary Care Record or they can choose to opt out. If they choose to have a Summary Care Record and are registered with a GP practice, a Summary Care Record is created on initial upload. If a patient chooses to opt out of having a Summary Care Record and do not want a SCR, they need to let their GP practice know by filling in and returning an opt-out form. Opt-out forms can be downloaded from the NHS Digital website or from the GP practice. The patient can change their mind at any time by informing their GP practice and either filling in an opt-out form or asking the GP practice to create a Summary Care Record.

Where is the SCR used?

Hospital pharmacies – when reconciling medicines for new admissions.
GP out-of-hours services – when treating patients with whom they are unfamiliar.
GPs – when temporary residents, such as holiday-makers, visit their practice.
Accident and emergency clinicians – when treating emergency patients.
Clinical staff in hospital wards – when admitting new patients.
Ambulance staff – checking patient details when responding to calls.
Staff at walk-in centres and minor injuries units – when caring for patients who present for treatment
Multidisciplinary teams – when providing community and intermediate care services.

What is ‘Additional Information’?

With the release of SCR version 2.1 the patient’s SCR can also be enriched with additional information beyond the core dataset (medications, adverse reactions and allergies), where patients provide their explicit consent for this to happen.

What additional information is included?

Reason for Medication (displayed alongside the relevant core medication item)
Significant medical history (past and present)
Significant procedures (past and present)
Anticipatory care information e.g. concerning management of long term conditions
Communication preferences – as per the SCCI1605 dataset
End of life care information – as per the SCCI1580 dataset
Immunisations

What is the additional information for?

Long term health conditions such as asthma, diabetes, heart problems or rare medical conditions.
Relevant medical history – clinical procedures that you have had, why you need a particular medicine, the care you are currently receiving and clinical advice to support your future care.
Healthcare needs and personal preferences – you may have particular communication needs, a long term condition that needs to be managed in a particular way, or you may have made legal decisions or have preferences about your care that you would like to be known.
Immunisations – details of previous vaccinations, such as tetanus and routine childhood jabs.
Please note: specific sensitive information such as any fertility treatments, sexually transmitted infections, pregnancy terminations or gender reassignment will not be included, unless you specifically ask for any of these items to be included

What are the consent requirements?

All patients should be appropriately informed and supported to come to a decision as to whether they would like additional information to be added to their SCR.
Information should be provided in a way and format that individual patients can understand
There are resources available to support discussions with patients to seek their informed consent.

What are the benefits for GP practice of SCR 2.1?

Reduced effort – The new functionality makes it quick and easy to create a relevant summary, even for patients with multiple complex conditions.
Simplicity – Once the patient’s SCR consent code is set to “Express consent for core and additional Summary Care Record dataset upload”, then the additional information is included in the SCR and this summary is automatically updated over time as the patient’s GP record is updated.
Flexibility – GPs working to coordinate care for patients with multiple complex conditions and reduce unplanned admissions can be reassured that clinicians who are also treating their most vulnerable patients can access key clinical information and patient preferences to treat their patients.
Reassurance – Sensitive coded items (as per the agreed RCGP sensitive exclusion dataset) are automatically excluded. Items can be manually included to support specific individual patient circumstances and preferences, and this includes those sensitive items automatically excluded.

Why would GP practices want to do this?

The NHS ambition is to embrace technology as part of its drive to offer modern, convenient and responsive services to patients, their families and carers. GP practices are leading the way. Today, the majority of GP practices already offer these services.

By when?

2016/17 GMS Contract Requirement:

NHS England and GPC will jointly consider ways in which practices can be resourced to offer patients the opportunity to add additional information to their Summary Care Record (SCR). It is recognised that particular groups of patients, for example those likely to present in unplanned, urgent or emergency care, may benefit from the availability of additional information within the SCR. It is agreed that practices will require additional support to undertake this work, in recognition of the additional workload.

Visit the NHS Digital SCR Library

The link below will take you to the NHS Digital SCR library where you will find information and resources to support your practice with SCR.

View Page

What help can I get with SCR?

Our team are on hand to help with any questions you may have about SCR and Additional Information.

Questions & Answers

In SystmOne, SCR Updates in Workflow some of the updates are not updating and staying in the list reason Consent Diffrences Not Resolved

This is a known problem with GP2GP patients when the degraded data is received into the GP clinical system.

1. Look through all read coded entried to find Transfer-degraded record entry (XaLGM)
2.Right click the entry
3.Amend Read Code to XaXbX – Implied consent for Core Summary Care Record dataset Upload
4.Click Ok
5. Message box appears – Click ok
6.Save Record

The SCR will now sucessfully be uploaded automatically

If a patient has agreed to their enhanced information to be uploaded – can this be viewed by the pharmacies? And if so what type of audit trail is there?

If a patient has given consent to the GP for their enhanced information to be uploaded to their SCR then this information is available to seen by pharmacies and all other authorised staff. The pharmacies needs to ask for permission to view their SCR. If the patient says ‘yes’ the pharmacists needs to record the consent before actually going it to the patient’s SCR. They also need to record the consent given in their PMR system. The consent from the patient can be given verbally or written depending on the pharmacy agreement.
Each pharmacy needs to have a privacy officer in place. The privacy officers main role is to audit all SCR access made in each pharmacy ensuring that patient consent was requested, given and recorded. Also that there was a legitimate reason to check their SCR. So the privacy officer role is the audit trail for all SCR accesses made within their pharmacy. All SCR users and privacy officers all need to use their own smartcards, this acts as another audit trail. If any patient is concerned about any unauthorised access to their SCR, they can go into a pharmacy and asked who has viewed their SCR in the last year within that specific pharmacy. It will be the privacy officer responsibility to check and provide the information to the patient.

Query from Cambridge Community Services MDT Team. When we update the patient record in SystmOne Community - will this information get uploaded into the Enriched Summary Care Record

No – Only the information held with the GP Clinical System (System One, Emis & Vision) will be uploaded. The upload will come directly from the GP clinical system only.

Does a read code exist for MDT Patients so that they can be identified as such at the Enhanced Summary Care Viewer end.

Response from MDT Team –

There is not a read code specific to MDT Patients.

The read codes that GP’s use for our type of patients would be the one that is used for the DES or Unplanned admissions patients cohort.

This is around 2% of the practice population that are under risk of avoidable admissions to hospital.

The GP’s get paid for doing care plans for these patients.

These patients can be on both the GP DES caseload and our MDT caseload but not always.

Can free text be included within the Enhanced Summary Care record to be uploaded?

Yes, any free text associated with the included read codes is automatically included.

Can the Enhanced Summary Care record include care plans?

No, the information in the enhanced SCR will indicate that there is a care plan present, but will not be able to display the actual care plan.