The NHS Summary Care Record

1. The NHS Summary Care Record Supporting person centred coordinated care June 2016 v1.11

2. Current status • SCRs are an electronic record of key information from the patient’s GP practice • As a minimum contain medication, allergies and adverse reactions SCR created (55 million) SCR utilisation SCR creation 96% 3.2m of patients have had an SCRs accessed last year to support urgent and emergency episodes of care

3. SCR benefits Effectiveness Safety 29 49% minutes time saved per patient of patients guided toa more appropriate care pathway when SCR is used medication error identified when SCR is used (feedback from A&E clinical users) (feedback from ambulance clinical hub users) “While I use SCR relatively infrequently, on EVERY occasion it has directly informed, changed and better aided patient care … when we use it, it counts enormously and directly saves lives.” ED consultant Efficiency 40% of patients have a undertaking a medicines reconciliation (Journal of Medicines Optimisation-Dec 2015)

4. SCR benefits Supporting unscheduled care “The SCR is a secure and easy to use source of clinically important information that is readily available at times when you would otherwise be unable to obtain it. It is particularly helpful in an unscheduled care environment when this information is not otherwise available. Patients expect information about them to flow through the NHS and the SCR supports this. Every day of my working life the SCR is making my job easier and is improving the quality of care I can deliver to patients.” Dr Keith Grimes, Locality Medical Director and GP IC24, Ashford, Kent

5. SCR benefits Supporting older patients “Patients presenting as an emergency may have been unable to bring medication information with them, older patients in particular may be unable to recall all the medications they are taking. The SCR means we can gain information within minutes and ensures we can use the information to aid diagnosis and treatment, often facilitating a safe discharge from the Emergency Department. Without access to information in the SCR to aid management, patients can have an unnecessary admission to hospital” Dr Alison Cracknell Consultant Interface Geriatrician, St James’s University Hospital, Leeds

6. SCR benefits Supporting community and intermediate care "Sometimes when we get a new patient referred there is no information we can access. Previously this would mean that when we visited the patient they would often have struggled to recall all of the details that we need. This would be particularly frustrating for patients with communication difficulties. Now, at the time of arranging the visit, we can ask if we can look at their SCR. Having this information when we first see a patient speeds up the assessment and improves their experience of care as they are relieved to not have to answer countless questions about the same thing.” Louise Philips, Community Matron Maldon Integrated Care Team

7. SCRs with additional information Supporting person centred co-ordinated care • GP practices now have capability to enrich SCRs with a set of additional information - with patient consent • Includes individual coded items and associated free text as recorded in the GP record SCRs with additional information include: • Reason for medication • Significant medical history • (past and present) • Anticipatory care information • (such as information about the management of long term conditions) • Communication preferences • (as per the ISB-1605 national dataset) • End of life care information • (as per the ISB-1580 national dataset) • Immunisations

8. SCRs with additional information Supporting end of life care These are key extracts from an example SCR with additional information

9. SCRs with additional information Scenario 1: supporting end of life care Tom has lung cancer and the disease has progressed to a terminal phase. He has a life expectancy of a few months. Together with his wife Joan, Tom has made a competent decision to receive best supportive care and to die at home. • Palliative Care Team offer Tom the choice to have an enriched SCR at his review. • Tom agrees and his consent status is changed. • Important additional information from his GP record is now automatically included in his SCR. • One night Tom’s condition worsens, his breathing deteriorates and he coughs up blood. • Joan wants to support Tom’s wishes to receive care at home so calls NHS 111 for advice. • The call is transferred to the GP OOHs team. • A GP calls back and accesses Tom’s SCR. • Tom’s preferences can be seen and information about anticipatory medication. • A district nursing team is contacted and administers the medication relieving Tom’s symptoms.

10. SCRs with additional information Supporting end of life care “The Summary Care Record provides a great opportunity for everyone to have their views and preferences digitally recorded by their GP practice*, and viewed when necessary, during the final stages of their life. This can bring enormous peace of mind to these individuals and those close to them, and help professionals who are trying to deliver care in accordance with the individual’s needs and wishes.” Professor Bee Wee NHS England Director for End of Life Care * The SCR provides the end of life preferences entered in the GP practice system - complementing local Electronic Palliative Care Co-ordination systems (EPaCCS)

11. SCRs with additional information Supporting those with long term conditions These are key extracts from an example SCR with additional information

12. SCRs with additional information Scenario 2: supporting those with long term conditions Kate is a busy working mother of three children. She has type 1 diabetes, complicated by neuropathy, eye disease and early stages of kidney disease. The last thing she wants is to be admitted to hospital. • As a patient with multi-morbidity Kate was identified by her GP practice as someone who could benefit from an enriched SCR. • A note was added to Kate’s record to offer her the choice next time she presented. • When asked Kate provided her consent. • Kate is out shopping with a friend when she feels shaky and weak. • Kate’s friend drives her to the nearest A&E department. • By the time she arrives her speech is slurred. Staff identify that she is suffering a hypoglycaemia episode. • Kate’s SCR is accessed and contains information about her diabetes and contact details for her liaison nurse. • Kate’s insulin dose is adjusted and her liaison nurse confirms that this is not unusual and Kate does not need to be admitted.

13. SCRs with additional information Supporting those with long term conditions “Continuity of information is a vital contributor to continuity of care and better outcomes. The ability to enrich Summary Care Records beyond medications, allergies and bad reactions mean that more and more relevant information from the GP practice will be potentially available wherever a patient is receiving treatment in the NHS. This will improve safe, effective care and contribute to a positive experience for patients.” Dr Martin McShane NHS England Director for Long Term Conditions

14. SCRs with additional information Supporting those with learning disabilities These are key extracts from an example SCR with additional information

15. SCRs with additional information Scenario 3: supporting those with learning disabilities Lawrence is a middle aged man with a moderate learning disability. He has difficulty hearing, his speech can be difficult to understand and he gets anxious with people that he does not know. His sister is his next of kin and is very involved in his care. Six months later, he is brought to A&E with a carer. He has been refusing to eat for the last few days and clutching at his chest. Lawrence’s SCR is accessed which shows contact details for his sister. It also shows anti-inflammatory medication that he has received recently and that he has previously been treated for gastritis. Lawrence initially refuses blood tests but he is persuaded to have them by using local anaesthetic cream and a chat about football. He is found to be anaemic. An endoscopy is arranged which is supported by his sister. He is found to have a gastric ulcer. He is started on treatment and discharged home. Lawrence attends an annual health check at his GP practice. Key information from his healthcare passport, including his phobia of needles and his interest in football, is recorded in his GP record. In discussion with Lawrence and his sister, his GP makes a ‘best interests’ decision to create an enriched SCR.

16. SCRs with additional information Supporting those with learning disabilities “People with learning disabilities often have their behaviours misinterpreted as being part of their disability rather than their illness – something we call ‘diagnostic overshadowing’. The Summary Care Record helps enable reasonably-adjusted care and more accurate and timely diagnosis, which will make a very important contribution to the efforts to reduce premature and avoidable mortality.” Dr Dominic Slowie National Clinical Director for Learning Disability

17. SCRs with additional information Supporting older patients ‘When treating older patients, the Summary Care Record, enriched with additional information gathered during the process of Comprehensive Geriatric Assessment, or as part of the proactive care processes within the primary and community care setting, can be used to support decisions from the beginning of any new episode of care. This will increase the likelihood that complex conditions are accurately recognised and more appropriate treatment plans put in place. This will contribute to safer, more effective and efficient care for older people across the urgent care system, potentially avoiding the need for hospital admission or helping facilitate earlier and safer discharge’ The British Geriatrics Society

18. SCRs with additional information Supporting urgent and emergency care “Sharing data appropriately is central to the implementation of the "Keogh" review of urgent and emergency care. We know that when relevant information is available to healthcare professionals outcomes, safety and patient experience are all improved. The ability to create richer Summary Care Records provides an excellent opportunity to share additional information such as care plans, and we strongly encourage primary care teams to consider processes to seek the required consent from those patients that would benefit most.” Professor Jonathan Benger NHS England Director for Urgent Care

19. SCRs with additional information Supporting urgent and emergency care "The enhanced functionality to create enriched SCRs is simple. I can record information once and share it easily, which is fantastic! As an Out-of-Hours GP, I know the importance of making sure essential patient information can be accessed. Creating enriched SCRs empowers other people looking after my patients to be able to access accurate and detailed information – it reassures me that my patients will receive the best possible care whenever they need it.” Dr Mark Spring, GP Sandford Surgery, Dorset and Clinical Lead for Urgent Care Services

20. SCR and local information sharing The SCR, now and in the future, will: • Provide a nationwide data sharing solution – a foundation for access to a key set of common information that all care settings need to access • Complement local record sharing - complex care co-ordination will still occur at a local level using local systems • Provide a cost effective solution for settings that have lower digital maturity and where local solutions are not in place • Provide a cost effective opportunity for health communities to accelerate local record sharing by enriching SCRs with additional information

21. SCR and local information sharing "At the Hampshire Health Record, we are always looking to find ways of improving the efficiency, effectiveness, safety and completeness of the information we provide locally to clinical staff. We are very pleased to be working with the Summary Care Record to integrate patient information held nationally with the detailed information we hold from hospitals, community, mental health and social care providers locally. We believe this will give a more rounded, accurate and timely picture of the patient journey and improve patient care." Peter Cambouropoulos Programme Manager, Hampshire Health Record

22. Where next for the SCR? • Optimise the use of SCR, based on demand from care professionals to improve integration and extend the benefits to other settings • SCR Expert Advisory Committee ensures proposals to extend SCR use are subjected to consultation and analysis • SCR is a core part of the Paperless 2020 agenda within Domain D National Information Board - Domain D - Integrated Care We will better inform clinical decision making across all health and care settings by enabling and enhancing the flow of patient information

23. Web: www.hscic.gov.uk/scr Email: scr.comms@hscic.gov.uk Twitter: @NHSSCR Sign up to the SCR bulletin: http://systems.hscic.gov.uk/scr/signup