SCRs have friends in the north

Since SmartHealthcare.com examined the use of Summary Care Records (SCRs) in Bury and Bolton in January 2009, the rollout of the the system – designed to ensure that essential patient details are available for out-of-hours and emergency treatment – has continued apace. The north of England continues to host many of the early users, although the system is now being extended to patients in London. NHS Tees has just begun a mass mailing to all patients in its region over the aged of 15 years and 9 months, with details of the SCR programme and how to opt out. Carl Parker, chairman of the Professional Executive Committee for NHS Stockton and NHS Hartlepool, is very upbeat about the scheme, which should be operational this coming summer in the NHS Tees region. "Errors can occur where patients move from one service to another, particularly when general practice is closed or the patient is unable to communicate due to severe illness or trauma," he says, adding that the SCR will help eliminate this. NHS Bolton, which was one of the first primary care trusts to start introducing SCRs, had two of the three GP platforms enabled for access in early 2009. Since then, a project manager has joined to develop the scheme and a DVD produced – involving pupils form a local school – to promote the programme to interested parties. According to spokesperson Claire Wightman, approximately half of all NHS patients in the trust's area now have their SCRs uploaded to Connecting for Health's national data spine. This equates to 21 Bolton GP practices having created more than 130,000 records, with further practices expected to confirm and come online over the next year. At the other end of the SCR connection – the clinical side – Wightman says that the records are now accessible by several teams within the PCT and at the Royal Bolton Hospital. "Now that so many records have been uploaded, clinicians who are accessing the system to read the SCRs are finding the system extremely useful," says Wightman. Darren Mansfield, NHS Bolton's clinical lead for urgent care and patient safety, is equally upbeat about the scheme. "The doctors working in out of hours care have seen real benefits through using SCR in their patient consultations," he says. "SCR is enabling out of hours care to be delivered more safely and effectively. Further plans are in place for the next 12 months to allow other clinical departments in both primary care and acute care settings to begin using the SCR application," he adds. Recording wishes Wightman adds that considerable work has recently been undertaken on patient's end of life details and care wishes using SCRs. This, she told SmartHealthcare.com, has ensured that many palliative care patients have experienced a more dignified death than they may have experienced had the out-of-hours service not had access to their SCR. "An example of which was when Petrina Wood recently lost her mother Olive Mitchell due to cancer. As Olive had her end of life details on her SCR, the out of hours service were informed of her wishes and therefore were able to contact her GP who was able to issue the death certificate immediately," she says. The good news about this, she explained, is that this avoided the need for the police to become involved. Petrina Wood added: "The information within the Summary Care Record meant that my Mum's death was treated in a dignified and respectful manner. If the out of hours service had not had access to the end of life information, it would have made the already painful experience of her death more traumatic for me and my family." Across at NHS Bury, the primary care trust had planned to have around 140,000 SCRs online by spring of last year, with the data accessible to Fairfield Hospital's A&E department, the town's walk-in centre and the GP doctors on call service. These targets were achieved and, in November last year, the trust went live with the Lorenzo electronic health record system from iSoft. Lorenzo now supports approach 600 community-based clinical and administrative users working across two wards and 1,200 clinics in the trust's area. In parallel with the switch-on of the system on 3 November 2009, NHS Bury sent a letter to all of its adult patients formally requesting permission for the trust to allow staff access to the patients' SCRs. The letter included specific example, such as "If the healthcare worker treating you is not able to ask for your permission – for example if you were unconscious or unable to answer questions – they can access your record in your best interests." In the letter, Stephen Mills, NHS Bury's chief executive, said that the trust believes that SCRs "will improve the quality and safety of your care," noting that, if the patient did not respond to the letter by 7 December 2009, an SCR would be created automatically. So, have SCRs been a success? Judging from the rollouts in Bolton and Bury PCTs, most definitely, and in the case of NHS Tees, things are also looking good. Nationally, however, the situation is less rosy. There is considerable opposition from privacy groups such as NO2ID and a number of lobbying groups seem unhappy with the government being able to shuttle patient records around PCTs electronically. Given the ultimate aim of the CfH programme is to have SCRs available to emergency and out of hours staff nationally, this opposition could prove a stumbling block. The Conservative Party has discussed alternative approaches, and the Liberal Democrats want to scrap the records altogether. As the case of the Bolton patient and her daughter above clearly illustrates, however, SCRs can make a considerable difference to terminally ill patients' experience of the NHS – something which politicians may wish to take into account.