The gap between the concept of the NHS Summary Care Record and the reality of implementing it will continue to be the focus of its evaluation programme.

Patricia Greenhalgh, professor of primary care at University College London, which was commissioned to evaluate the SCR early adopters, told yesterday’s Healthcare Interoperability conference that the evaluation programme was looking at the technical assumptions versus the clinical realities.

She said the reality of using the SCR in a busy walk-in centre in a deprived area – where the SCR could take 25 seconds to load and had be used by nurses unfamiliar with technology – was very different to the concept behind it.

She stressed that on the ground, it might understandable that a nurse might choose not to access the SCR, which was intended to give clinicians access to basic information about a patient, including any allergies they suffered and a list of their current medications. “This is not just a stubborn response by a stupid member of staff,” she said.

Professor Greenhalgh’s initial report, published in May, concluded that the consent model for the SCR should be reviewed and led to NHS Connecting for Health implementing a ‘consent to view’ system this September.

Professor Greenhalgh and her team are continuing to look at the early adopters and will evaluate any ‘fast follower’ primary care trusts. They are also to study the use of the HealthSpace patient portal in a further two year evaluation that is due to report in 2010.

She told Healthcare Interoperability that her team were looking at standard operating procedures versus the essential workarounds that staff adopt. She added: “We will be looking at why there are workarounds and what are people having to do.”

Professor Greenhalgh conducted an ethnograpic study of the early adopters. At the conference, she argued that NHS Connecting for Health’s PRINCE 2 management approach was “definitely unfit for purpose” and that there was a huge cultural style gap between those different parties working on the SCR project.