Introduction to the Summary Care Record (SCR)

1. Introduction to theSummary Care Record (SCR) Core Module SCR Concept Training Core Module Self Run v1 31-03-11

2. Instructions • This presentation is timed and will run automatically • There are shortcuts available to help you navigate through this presentation should you choose to use them • The contents section will allow you to jump to the relevant section by clicking on that topic • The home buttons located in the bottom left hand corner of some screens will return you to the contents screen

3. Contents Introduction to the SCR Content of the SCR Informing Patients Patient Choice, Consent and Security Creating SCRs Viewing SCRs Further Information

4. What is the SCR? • The SCR is: • An electronic patient summary containing key clinical information • Accessible by authorised healthcare staff treating patients in urgent or emergency care settings • Optional - a patient can choose to have or not have an SCR • Only accessible with permission from the patient (except for exceptional circumstances e.g. emergency access if the patient is unconscious) • Viewable by patients through HealthSpace Home

5. Purpose of the Summary Care Record • To improve the safety and quality of patient care by providing key clinical information to healthcare staff in urgent and emergency situations. • For example, when a patient needs care at an Emergency Department or Out of Hours service Home

6. Benefits of Summary Care Records • Benefits of the SCR include: • Improved patient safety • reducing the risk of prescribing errors and adverse reactions to prescribed medication • Improved efficiency and effectiveness • reducing time, effort and resource required to share information across different NHS organisations • Improved quality of patient care • more timely/informed clinical decisions in urgent and emergency care • enabling the most appropriate care to be delivered in the most appropriate setting Home

7. Content of the SCR

8. SCR Content – Core Data • The SCR is generated with clinical information provided by the patient’s registered GP practice • The SCR consists of the following core data items: • Allergies • Adverse Reactions • Medication (Repeat, Acute and Discontinued Repeats) • When a GP practice is live with SCR any changes made to these core data items will be updated in the SCR automatically Home

9. SCR Content – Additional Information • Additional clinical information over and above the core data items can be added to the SCR where a patient and their GP agree • Examples of information that can be added to the SCR include: • Significant diagnoses • Care plan information (e.g. end of life, long term conditions) • Any other information that is considered relevant by the patient or GP • Patients are in control of any additional information that is added to the SCR and are required to give their explicit consent Home

10. SCR content • GP Summary Update • Containing: • Core Data or • Core Data & • Additional Information • GP Summary containing: • Medication • Allergies • Adverse reactions GP Practice Home

11. Informing Patients

12. Public Information Programme • The Public Information Programme (PIP) is an information campaign co-ordinated by the PCT to inform patients, the public and NHS staff about the SCR and the choices available. The PIP lasts a minimum of 12 weeks • Key elements of the PIP are: • Patient information pack • Local promotion – leaflets and posters in NHS sites and other public buildings, awareness events etc • Local media – local print and radio • Targeting of hard to reach groups specific to the local area • Summary Care Record Information Line and Website Home

13. Patient Information Pack • A patient information pack is sent to every person in England who is aged 16 or over and registered with a GP Practice • The patient information pack contains: • a letter from the PCT • patient summary leaflet – a leaflet for patients explaining Summary Care Records • freepost opt-out form Home

14. PIP Process PCT Let your GP Practice know your decision to opt out (complete and return the opt out form) and they will opt you out in their system, ensuring an SCR is not created for you. Don’t do anything and one will be created for you! Your name Address Address Postcode The creation of SCRs will only take place when a practice and their PCT agree that patients have been informed and enabled to opt out should they wish. Yes – I want a Summary Care Record No - I don’t want a Summary Care Record I’ve considered my options. Decision made Patient Home

15. Patient Choice

16. Patient Choice • Creation of an SCR • Patients can choose whether or not to have an SCR • Patients can change their mind at any time by informing their GP practice • Content of the SCR • Patients can choose if they want additional information added to their SCR • Patients can choose which additional information they want adding to their SCR Home

17. Patient Choice - continued • Viewing an SCR • Patients are asked for their permission every time healthcare staff need to view their record • Permission to view can be asked and granted for a group of healthcare staff e.g. an Emergency Department clinical team • If a patient is unable to grant permission to view e.g. they are unconscious, a clinician may choose to use emergency access to view the SCR if they believe it to be in the patient’s best interests Home

18. Viewing the Record: Can I/we look at your Summary Care Record? When you present for care, you will be asked* if your record can be viewed. Creating the Record:Do you want a Summary Care Record? YES NO Do nothing and a record will be created for you. Inform your GP Practice of your choice and no record will be created. *In an emergency where you are unable to be asked, or certain medical/legal circumstances (such as Court Order) the clinicians involved in your care may access the record without asking. All such actions will be recorded for investigation.

19. Security of the SCR

20. Security of the SCR • In order to maintain the security of the SCR security measures are in place to control access • These can be grouped into three categories: • Technology – controls embedded in the systems • Organisational – controls embedded in the NHS • Individual user – appropriate staff conduct Home

21. Technology Security Measures • Secure NHS Network (N3) • Smartcards - are needed to view and update SCRs • Role Based Access Controls (RBAC) - ensures that only appropriate staff can view and create records • Legitimate Relationships – ensure that only healthcare staff involved in the patient’s care can view their record • Permission to View - gives patients control of access to their record at the point of care • Every action that a user takes is audited Home

22. Organisational Security Measures • Legislation e.g. Data Protection Act • Caldicott Principles • Care Record Guarentee • Local Information Governance policies and procedures • Contractual measures e.g. confidentiality clauses in employment contracts • Training Existing organisational security measures apply to the access of SCRs Home

23. Individual user based Security Measures • Adherence to Smartcard usage policy • Existence of legitimate relationships • Asking for permission to view (where applicable) • NHS duty to patient confidentiality • Professional codes of conduct • Contractual requirements • Adherence to organisational security measures Home

24. Security Measures Organisational measures Contracts Policies Procedures Legislation Training Individual behaviours Smartcard Usage Confidentiality Professional standards Contracts Permission to View Policies Technology measures Legitimate Relationships Permission to View RBAC Smartcards Home

25. Creating an SCR

26. Do nothing and a record will be created for you. Creating an SCR Patients can express a choice as to whether they wish to have an SCR created YES NO Inform your GP Practice of your choice and no record will be created.

27. Yes • Following the Public Information Programme, where a patient has decided that they want an SCR and have not opted out, a record will be created containing a GP summary with the patient’s core clinical details of medication, allergies and adverse reactions. Home

28. Yes (additional information) • Once a patient has an SCR, additional information can be added to the SCR only with the explicit consent of the patient • A discussion will take place between the patient and the practice before any additional information is added Home

29. No (patient informs GP Practice) • Patient has decided they do NOT want an SCR to be created and has returned an opt out form to their practice • A patient can change their mind at any time Home

30. Viewing an SCR

31. Viewing an SCR • The SCR can be viewed by authorised healthcare staff in urgent and emergency care settings • In order to a view an SCR, a clinician must: • Use an NHS computer • Use their NHS Smartcard with their passcode • Have the appropriate Role Based Access Control (RBAC) • Have a legitimate relationship with a patient • Ask a patient for their permission to view their record Home

32. When you present for care, you will be asked if your record can be viewed. Permission to View Can I/we look at your Summary Care Record?

33. Permission to View Principles • Patients are asked every time their record is accessed • Designed to allow a flexible approach to asking permission e.g. clinicians or administrative staff may request permission individually or on behalf of a clinical team • If a patient is unable to grant permission to view e.g. they are unconscious, a clinician can use emergency access to view the SCR if they believe it to be in the patient’s best interests Home

34. Viewing an SCR An SCR can be viewed in the following ways: • Summary Care Record Application (SCRa) – a stand alone web based application • Through integration with their existing clinical system, for example the Adastra Out of hours system • Patients are able to view their own SCR via HealthSpace Home

35. Viewing the SCR May we view your SCR? YES NO With the patient’s permission to view the healthcare staff member will be able to view the contents of the SCR Emergency Care SUMMARY CARE RECORD If a patient says NO their SCR should not be accessed Healthcare staff Patient Home

36. What does it look like? Time and date is clearly visible indicating when the GP Practice last sent this summary Medication, Allergies and Adverse reactions Additional Information: End of life care information added Home

37. Summary - SCR Permission to View granted Your name Address Address Postcode • GP Summary Update • Containing: • Core Data or • Core Data & • Additional Information • GP Summary Update • Containing: • Core Data or • Core Data & • Additional Information Emergency Care GP Practice Min 12 weeks to decide Patient Home

38. Further Information

39. More Information • Information on the SCR www.connectingforhealth.nhs.uk/systemsandservices/scr • SCR Training Information www.connectingforhealth.nhs.uk/systemsandservices/scr/staff/impguidpm/training • HealthSpace www.healthspace.nhs.uk • Frequently Asked Questions www.connectingforhealth.nhs.uk/systemsandservices/scr/staff/faqs • PCT for all local information on plans to introduce the SCR Home