Dr Gillian BraunoldDr Gillian Braunold explains how pragmatism and common sense are the touchstone of the summary care record early adopters, which are already shaping policy for future roll-out.

By Dr Gillian Braunold, National Clinical Lead for GPs, NHS Connecting for Health

On 14 March we kicked off the initial stage of the introduction of the NHS Care Records Service with the announcement of the first ‘early adopter’ primary care trust. The announcement that Bolton PCT would be the first location in England to introduce the Summary Care Record (SCR) was the result of years of intense work and debate. However, the task now is to make this a reality for patients and clinical staff, a process that will inevitably create further discussion and dialogue.

An intense amount of activity has been going on over the last few months aimed at resolving a number of important questions such as what the summary record should include, how we should manage issues of consent and security as well as how we should deal with sensitive patient information.

This early adopter phase will give us the opportunity to discuss these important issues with patients themselves, often a group forgotten in much of this debate. It will also be a real opportunity to test out some of our assumptions in a careful and controlled way before we embark on introducing the SCR to all PCTs across England.

Common sense and pragmatism are at the heart of our approach. Early adopter PCTs have been regular and frequent participants in the planning stages of our work and regularly attend our internal Implementation Board meetings. We believe that this inclusive approach is one way in which we can make sure that we stay grounded in reality when making decisions.

With any national transformation project you need this element of pragmatism. My personal feeling is that this early adopter programme is less about technology and is more a question of cultural change – a different and more modern way of working.

Clearly, addressing issues around consent has been central to preparations for the early adopter phase. We have GPs who are happy to share records but they are concerned about the issue of consent and they are unsure how their patients will take to it. They are worried that conversations with patients about consent will be time consuming or may simply become formulaic.

The key is to explore a variety of different mechanisms in order to raise awareness amongst the local population to try to satisfy GPs that patients really are making an informed choice. Therefore, we have sent out letters directly to all adult patients in Bolton PCT, information booths staffed either by trained members of the PCT or NHS Connecting for Health have been put in place and a special NHS Care Records information line is available as a further source of information. This initial phase is for testing what methods work best in different areas and amongst different socio-economic groups.

Even the seemingly simple things can benefit from being prepared. I now know about the Royal Mail’s junk mail rule. This dictates that if there are more than three items of junk mail going to any house in a week then the Royal Mail disposes of it. As a result of this we ensured that all letters to patients were addressed and sent in an envelope as opposed to being a leaflet dropped through the letter box.

In addition, the Information Commissioner advised us that he wanted a leaflet to go to every adult, not simply every household, as it would be a more effective way of reaching more patients. Similarly, Bolton PCT challenged the assumption that an adult was anyone over the age of 18 years highlighting that large numbers of people in their community were aged between 16–18 years and living away from home. We took this recommendation to the Information Commissioner who agreed that for the Early Adopter programme an adult should be anyone 16 years or over.

With Healthspace being the way that patients will be able to view their SCR this subsequently meant that we had to seek agreement from the Healthspace board that we could change the restriction on access to the site from 18 year olds to those over 16. These are all things we can anticipate when the next early adopter PCT comes on board.

Another key issue was how to allow patients to express their dissent in a way that will not adversely impact on the workload of busy GP practices. We have taken on board suggestions from practice managers in the early adopter PCTs that if a patient is adamant that they do not want an SCR and that they do not want to see a GP to discuss it, then they have an option on their forms which they send back to their practice which states that the patient has chosen not to discuss it with the GP. Again this demonstrates how the early adopter sites have influenced what happens nationally underlining the important role played by those sites going through this experience.

A sensible approach can also be seen in the way we have addressed the issue of editing out sensitive information relating to prescriptions. The feedback from GPs on the ground highlighted that, pending the introduction of sealed envelopes (the facility a patient can use to protect sensitive information on their SCR); they were worried about having access to an only partial prescription record. Based on this feedback we recommended that, during the early adopter phase, patients concerned about sensitive prescriptions should be encouraged to choose the not share option. They could then share explicitly by giving consent only on those occasions when they want to share as opposed to having a partial prescription record. As a result in the early adopter programme patients will be able to take out sensitive history items but the prescription record will be total, either shared or not shared.

The ‘go-live’ of the early adopter sites is simply the start of a new phase in healthcare. Although the independent evaluation is an important part of our learning process, it is also crucial that we put in place an early adopter programme that allows us to benefit from learning as we go, not just after a set period in time.

I am very proud of my GP colleagues in these first practices. For some looking on it may seem an unenviable position to be in. However, these GPs are keen to make sure that what is put in place is right and they are happy to do that for the wider benefit of other professional colleagues. They want to make sure that when the time comes we all have the opportunity to adopt a system with the benefit of hindsight and experience

My role is to respond to the feedback of GPs and practices so that the design and process of this project can be adapted. Undoubtedly, the learning we gain from the comments and concerns of clinicians and their patients in these sites will help ensure the successful implementation of the SCR.

To find out more about the SCR early adopter programme contact: gplead@nhs.net