Starting gun fired for Summary Care Record roll-out

The government’s ambitious plan for a national system of electronic summary care patient records (SCR) will begin trials tomorrow at two GP practices in Bolton, in the north-west of England.

Approximately 14,500 patients will have a summary of the GP record, containing details of name, address, medication history, serious illnesses and allergies, uploaded to a national database unless they choose to opt-out during after an eight week consultation period beginning today. Letters and leaflets explaining the programme will go out in the next few weeks.

By July, eight weeks after the end of the consultation phase, Bolton’s out-of-hours provider and A+E department will be able to view the summary record.

Professor Mike Pringle one of the two clinical leads behind the project told E-Health Insider: "This is the starting gun for the early adopter programme for the Summary Care Record." He said he expects a total of seven PCTs to be involved in the programme by the end of the year.

The first two practices are Keardley Medical Centre and the Kirby, Page, and McMillen practice, Bradshaw Brow.  The first of the practices use InPractice Systems GP software, while the second uses iSoft GP software.  Other practices, initially from Bolton PCT, will follow over the next few months.

Dr Liaqat Natha from Kearsley Medical Centre, said: "There are huge potential benefits from making patient records available to all staff caring for them, through the secure NHS network."

The creation of the summary care record, which will be accessible to authorised clinicians working in A+E departments, and GP out-of-hours providers, is intended to be of value particularly as an emergency care record. A similar project is already being rolled out by NHS Scotland, while a summary care record project has been running in Hampshire and Isle of Wight for some time.

The DH says the national database of summary patient records will provide the basis for safer treatment in all care settings, reduce duplication and lost records, saving time and money.

Patients will be able to choose whether they wish a summary record to be created for them, whether they want it to be shared, and be able to change their mind at any time. Individuals will also be able to securely view their record online.

As the SCR develops it will also record details of each patient’s encounters with different parts of the NHS, providing different clinicians treating them, including their GP, with a complete overview of care they have received.

Connecting for Health, the NHS IT agency responsible for the project, stresses that this summary record will not replace the detailed patient medical records held by GPs and hospitals – which will remain the medico-legal record. CfH says that the electronic record will enjoy higher levels of security than online banking.

Professor Pringle stressed that the subsequent roll-out programme would be based on the experience at the first pilot sites. "The evaluation team will be there throughout the early adopter phase."

Professor Pringle told EHI there were now no deadlines for the full roll-out of the project. Guidance issued to all strategic health authorities last month said that following the ‘early adopter phase’ now underway there should be a full roll-out across England of the SCR by the end of 2008.

"The end of 2008 is not a target. There is no target for this," said Prof. Pringle. "By the end of the year we expect to get a pace that is sustainable. We are not going to rush it."

With the patient consultation beginning today in a blaze of local and national publicity, patients will have eight weeks to decide whether they want their record loaded onto the database, plus whether they want their summary record to then be available to suitably authorised clinicians. Unless patients of the two initial practices choose to opt-out by the end of the consultation period, a summary record for them will be  created automatically.

"Our advice to patients is that you decide whether there is a summary record and you decide whether that summary record is shared," said Dr Braunold. She said that once they had decided they were happy to have a summary record created and uploaded to the national database they can at any time decide who and when it is shared with the functionality acting as "a consent to view button". Sealed envelopes will not form part of the early adopter phase.

Asked how many patients CfH thought would opt out Professor Pringle said: "Based on the experience of Scotland and Hampshire and Isle of Wight we expect very few will want to opt out."

Once the first two practices have loaded up records, other practices from Bolton PCT will follow in their footsteps. Initially the summary record will be available to clinicians working for the local out-of-hours provider, with the local A+E department to follow.

CfH’s other GP clinical lead, Dr Gillian Braunold, told EHI that in the near future patients will be able to access their summary record using the online patient portal HealthSpace. "We won’t do it with the first two practices but soon afterwards."

Patients will have to securely register to use HealthSpace, and provide a form of ID. They will then get an entrance card, which has a 5×5 grid of numbers on it and PIN number by post. To access their summary record they will have to provide a grid reference from the entrance card and their PIN.

Dr Braunold stressed that the experience of the early first two adopter sites would be carefully monitored and inform future roll-out plans. "We’re doing this very slowly and carefully, so we can be fleet of foot."

She added: "I’m very proud of my colleagues in the first two practices going live who are also taking on the pain of going through all the business processes involved. This is about changing the way people work"