Additional Information in SCR

The change to include Additional Information in a patient’s SCR will enable health and care professionals to have better medical information about the patient they are treating at the point of care. This change will apply for the duration of the coronavirus (COVID-19) pandemic only. Unless alternative arrangements have been put in place before the end of the emergency period, this change will be reversed.

Patients can be reassured that if they have previously opted-out of having a Summary Care Record or declined to provide consent to share their Additional Information,their preference will continue to be respected and applied.

We ran a user research project to understand users' experiences with Summary Care Records (SCR) and the information they provide, particularly focusing on the inclusion of Additional Information by default.

Read the report on Additional Information.

By including Additional Information in a patient's SCR, more information is available to health and care staff viewing the SCR. It will then be automatically updated when the GP record is updated. This is a quick and effective way to:

• improve the flow of information across the health and care system
• increase safety and efficiency
• improve care

SCR Additional Information is particularly useful for people with complex or long term conditions, or patients reaching end of life.

A change has been made to the way Summary Care Records are made available. Where a patient has not previously expressed a preference with regard to their Summary Care Record, both the core and Additional Information will be included in a patient’s SCR by default.  

In practical terms, the only thing that will change is that those patients whose current SCR consent preference is set to 'Implied consent for Core Summary Care Record Dataset upload' will have a Summary Care Record with Additional Information uploaded to the NHS Spine. All the remaining SCR consent preference options will continue to function as previously. When the Additional Information is uploaded for a patient, your GP IT system will automatically make an auditable entry in the patient’s GP record. Get more information on this change on the NHSX website.

Additional Information includes:

• significant medical history (past and present)
• reason for medication
• anticipatory care information (such as information about the management of long term conditions) 
• end of life care information (from the SCCI1580 national dataset) 
• immunisations.

There will also be a temporary change made to Summary Care Record Additional Information to include COVID-19 specific codes in relation to suspected, confirmed and other COVID-19 related information. This will be surfaced within the significant medical history of the record.

This information is identified within the system through the codes for significant medical history (known as active problems and significant past problems, local summary and active problems, or priority 1 items and active problems, depending on which clinical system is being used) or those included in the NHS Digital SCR inclusion dataset overview. (To see the complete list of codes currently in the inclusion set used by GP suppliers implementing SCR v2.1, download the NHS Digital SCR inclusion dataset).

Specific sensitive information like fertility treatments, sexually transmitted infections, pregnancy terminations and gender reassignment will not be automatically included when the information is added. Sensitive information is excluded through the RCGP sensitive dataset.  Full downloads of the GP Summary Code List releases (Generalpracticesummarydatasharingexclusionforassistedfertilisation, Generalpracticesummarydatasharingexclusionforgenderrelatedissues, Generalpracticesummarydatasharingexclusionforsexuallytransmitteddisease and Generalpracticesummarydatasharingexclusionforterminationofpregnancy) are available on the Technology Reference Data Update Distribution site. 

Other items, including sensitive items that the patient would like to be included, can be manually added to the record. The patient can view a preview before they consent, and items can be added or removed.

View an example SCR with Additional Information created by TPP SystmOne

View an example SCR with Additional Information created by Emis

Identification and management of patients with frailty

From 1 July 2017, the General Medical Services (GMS) contract requires GPs to identify patients with moderate or severe frailty, and promote the inclusion of Additional Information in the SCRs of those with severe frailty by seeking their consent to add it. NHS Digital have sent a resource pack, Supporting Guidance for promoting enriched Summary Care Records for patients with frailty, to CCGs, to be distributed to GP practices, containing support and guidance on their new duties and how to include Additional Information in SCRs.

Read NHS England guidance on the requirements to support frailty in the GMS contract 2017-18. 

Patients who have opted-out of having a Summary Care Record or chosen to have a core Summary Care Record only by declining to provide consent for Additional Information to be shared will continue to have their preferences respected.

Patients can continue to express an SCR consent preference and they can change their mind at any time. Any changes to a patient’s SCR preference made during the coronavirus (COVID-19) pandemic will still continue beyond the end of the emergency period. Patients should inform their GP practice of their choice or complete the SCR patient consent preference form and return to the GP practice.   

Care priorities are focused on efforts to respond to the pandemic. Therefore, it is understood that it may take General Practices longer to respond to requests for preference changes on data sharing. They should however still be processed as soon as possible to uphold patients’ rights. 

GP practices can continue to use the opportunity of new patient registration to obtain a patient’s SCR consent preference. 

If patients do contact the practice you may change their preferences exactly as you would do at the moment. However, it is important that patients who choose to opt out from having an SCR are able to make a well-informed choice and understand the consequences of that choice in the event they require urgent treatment.

Patient groups who benefit most from including Additional Information in their SCR include:

• frail patients who can use SCR to give out of hours or emergency health care staff more complete information, making unwanted admission less likely
• patients with long term conditions
• patients eligible for flu vaccinations
• those with dementia or learning disabilities
• patients planning for end of life, who can use SCRs to share information about their preferences, Lasting Power of Attorney and advance decisions
• patients with physical, sensory or other disabilities, who can benefit from recording any specific needs, for example communication needs, so that health and care staff can make reasonable adjustments
• non-English speakers
• patients with carers whose details they want to share or who have appointed someone to have Health and Welfare Lasting Power of Attorney
• patients with specific care preferences

Dr Martin McShane, former NHS England Director for 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.'

The British Geriatrics Society

'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 episodes 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.'

Dr Mark Spring, GP at Sandford Surgery in Dorset and clinical lead for Urgent Care Services, a GP Out of Hours service

'Creating SCRs with Additional Information 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.'

case_study_on_Additional_Information

System Quick Guides

EMIS Quick Guide

TPP SystmOne Quick Guide

System Viewing Guides

Viewing SCRs in EMIS Web

Viewing SCRs in TPP SystmOne