Additional information in SCR

Summary

Guidance for GPs to use SCR to make more information available across care settings.

Benefits of using additional information in SCR

When a patient consents to including additional information in their SCR, the GP can add it simply by changing the consent status on the clinical system. This means more information will be 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, cost-effective way to:

improve the flow of information across the health and care system
increase safety and efficiency
improve care
respond to particular challenges such as winter pressures

It's particularly useful for people with complex or long term conditions, or patients reaching end of life.

GP guidance on including additional information in the SCR

GPs can include additional information by changing the patient's consent status on the clinical system used in the practice, to 'Express consent for medication, allergies, adverse reactions and additional information'. (This functionality was included in release SCRv2.1 of SCR, which is available on Emis Web, TPP Syst mOne and InPractice Vision.) Staff need activity B0020 on their smartcard to do this. It adds read code 9Ndn or CTV3 code XaXbZ to the record. Once consent status is changed, coded items and the supporting free text will be added. This will include:

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

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. These documents are for reference only, and full downloads of the GP Summary Code List releases are available on the Technology Reference Data Update Distribution site: https://isd.hscic.gov.uk/trud3/user/guest/group/0/pack/1/subpack/141/releases.

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.

Patient consent to include additional information in the SCR

Additional information can only be included with the patient's consent, unless they don't have capacity to consent. Resources to help explain SCR and additional information to patients are available.

Patients who can't consent

GPs must always act in the best interest of their patients. This might mean that additional information should be added to the SCR of a patient who lacks capacity to consent. GP practices and clinicians should follow existing guidance (such as General Medical Council guidance) and their usual processes for gaining consent and making best interest decisions on behalf of patients who can't consent. Every effort should be made to talk to all patients and help them understand their choices. This Easy read leaflet on SCR and additional information can help.

Carers of patients who are vulnerable or might have difficulty understanding their SCR choices can be involved in the discussion. Any patient preferences expressed in the past should be taken into account. Parents can help their children come to a decision if they think adding information to their SCR would improve their care. If someone has a Health and Welfare Lasting Power of Attorney that grants them the necessary powers and is registered with the Office of the Public Guardian, then they can legally give the consent on behalf of a person who lacks capacity, as long as they are acting in the patient's best interests.

The GP can make a decision in the best interest of the patient if they can't give informed consent. If this means that additional information is included without patient consent, they should record how the decision was made, including why they decided the patient lacks capacity, in the free text box when the SCR consent status is changed.

Patient groups who benefit most from including additional information in their SCR

Health and care staff should identify patients who would particularly benefit from additional information and encourage them to add to their SCRs. Such patient groups include:

patients planning for end of life, who can use SCRs to share information about their preferences, Lasting Power of Attorney and advance decisions
frail patients and those on the 'Avoiding Unplanned Admissions' (AUA) register, 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 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

Encouraging patients to include additional information in their SCR

To encourage uptake practices can:

discuss additional information during routine review appointments, proactive care planning, palliative care planning and flu clinics
make additional information consent a part of new patient registration
encourage everyone involved in patient care to discuss the benefits of additional information, including palliative care team staff and care home staff - (consider how consent will be communicated back to the GP practice)
run reports to identify patients in vulnerable groups
add prompts to the records of patients that have been identified so that staff will discuss consent the next time the patient comes in
consider displaying posters, putting notes on prescriptions, using SMS messages, putting information on practice websites, and including leaflets in letters and having them available while patients are waiting to be seen (See Resources for sample posters and leaflets)
add the the consent code for additional information (read code 9Ndn or CTV3 code XaXbZ) to relevant clinical templates such as EPaCCS, annual health check, Avoiding Unplanned Admissions or Long Term Conditions review templates

Expert views on the benefits of additional information in Summary Care Records

Dr Martin McShane, 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.'

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