Summary care record delayed and abridged

The content of the summary record uploaded to the spine will be cut back to include just allergy and prescription information initially, Connecting for Health (CfH) has decided.

The decision to significantly abridge the initial content of the record has been made to allay GPs’ concerns over the accuracy of their records. It could also address demands from GPs’ leading representative bodies that patients should be allowed to ‘opt in’ to the record rather than the summary record operating on an ‘opt out’ basis as proposed by CfH.

Dr Gillian Braunold, one of CfH’s national clinical leads for general practice, said major diagnoses and major procedures will no longer be included in the initial upload to the spine, a change in policy from proposals issued by CfH in the autumn.

She told EHI Primary Care: “We feel it is sensible to limit the initial record to just prescriptions and allergies because we want to make sure each set of records is fully correct. The profession felt strongly that although globally a practice might feel its records were good it was important to look at each set of records before they went up.”

The proposal now is that allergies and prescriptions items will be uploaded as free text initially on an opt-out basis following local publicity campaigns about the NHS Care Records Service (NCRS). Additional information, such as major diagnoses and procedures, can then be loaded as a coded summary once patient consent has been received.

CfH will not proscribe how or when GPs’ need to obtain that consent or what exactly the summary should include, both of which will be left for practices to discuss with their patients although the agency has been talking to GP system suppliers about creating a ‘spine view’ from patient records which practices could use as a basis for discussion with patients.

Dr Braunold added: “You can’t tell doctors what to do and we have had a long debate about how best this would work. The idea is that it will be a clinician’s decision to refresh the record and upload the coded summary when they feel it appropriate. The patient and the doctor should be able to customise the summary.”

Dr Braunold said seeking consent before information other than prescriptions and allergy data was uploaded would also negate the need for a blanket exclusion of ‘sensitive’ information such as data on mental health and sexual health which had been in the original propsoals.

She said that in her own practice she envisaged inviting patients to check their summary record via reception and approve it for upload once the local publicity campaign about the NCRS upload had begun. Those with concerns would be invited to see the doctor.

She added: “People will be having these conversations during the work up to the upload and jointly with the patient in the room as summaries are updated all the time.”

Dr Braunold said she was also keen to make sure that housebound patients and those in nursing homes were included as they would be the group of patients most likely to benefit from the summary record.

As well as the content of the initial upload the timetable for rolling out the summary record has moved from an original proposal that pilots would begin from August this year.

Summaries of records from a small number of practices will be uploaded to the spine as a pilot sometime later this year or early next year. Dr Braunold said the pilot would be properly evaluated before wider rollout begins, probably late in 2007 or in 2008.

She added: “We feel it is very important that we are going to pilot it in one or two areas of the country so that we can find out about how role based access works, the consent system and how much workload it creates for practices and then act on the lessons we learn.”

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