Currently, most patients have an SCR containing the ‘core’ dataset SCR (medication, allergies and adverse reactions as a minimum). SCRs can also contain Additional Information over and above the core dataset where patients provide their explicit consent for this to happen. 

There are a number of differences in the way that information is recorded between the different GP systems and the different GP system supplier implementations. There are also differences due to local data quality, recording practices and patient preferences. As a result, the content of SCRs with Additional Information will vary from one record to another but will follow a broadly consistent presentation format. However, a consequence of this is that a small number of patient’s SCRs will not include major past problems and other SCRs will not include all instances related to a specific code.

SCR content is limited to information held in GP systems but may include information from shared records. Therefore, the SCR Additional Information may include relevant content recorded by other organisations and shared with the GP practice.

The data included in the SCR consists of coded items from the GP system together with any supporting free text. Some of the primary care terminology may not be familiar to emergency and other secondary care clinicians. There is no standard for the recording of supporting free text and its quality will vary, but when present in the SCR it generally provides additional useful detail to supplement the coded information. This may also include information that may be considered sensitive or relate to unnecessary third party information – see Summary Care Record exclusion set below.

The SCR with Additional Information is generally larger - typically 2-3 times the size of the core SCR (3-16 pages).

The SCR with Additional Information follows the existing SCR format with the core dataset of the record containing medications, allergies and adverse reactions remaining at the top of the SCR. When Additional Information has been added, 'Reason for Medication' will appear against relevant medication if this has been recorded by the GP practice.

Additional Information will appear below the core SCR, grouped under the following Care Record Element (CRE) headings:

• Risks to Patients
• Administrative Procedures
• Risks to Care Professional or Third Party
• Provision of Advice and Information to Patients and Carers
• Diagnoses
• Personal Preferences
• Problems and Issues
• Services, Care Professional and Carers
• Clinical Observations and Findings
• Care Professional Documentation
• Treatments
• Patient/Carer Correspondence
• Investigations
• Third Party Correspondence
• Investigation Results
• Social and Personal Circumstances
• Family History
• Lifestyle
• Care Events

The headings are determined by the UK Terminology Centre (UKTC) and are a mechanism to group SCR items within individual patient records. A heading will only appear in an individual SCR if there is relevant information available from the patients GP record for inclusion under that heading. Some headings are only likely to be used in limited circumstances. For example, ‘Third Party Correspondence’ will not generally be present as this information cannot currently be attached to the SCR – although the existence of correspondence in the GP record could be signposted. When headings are shown, they always appear in the order above.

There is no specific ‘End of Life’ heading but End of Life care information will appear under relevant headings. For example, information about resuscitation status will always appear under 'Personal Preferences' and diagnoses will appear under 'Diagnoses'.

The quality and completeness of the Additional Information included in an SCR is dependent on factors such as the underlying clinical record, data quality and confidentiality issues. SCR viewers should be aware that the SCR may not be complete and should be seen as an additional clinical tool to support current practices.

Items defined in the Royal College of GP’s (RCGP) sensitive datasets which specifically relate to in-vitro fertilisation, sexually transmitted diseases, terminations of pregnancy and gender re-assignment are automatically excluded from Additional Information, but can be manually added by the patient’s GP practice, if the patient wishes.

There may be other items deemed as sensitive which may have been included as codes or referenced in free text, such as details of abuse or unnecessary information related to third parties. Viewers are reminded to treat the SCR information with the same sensitivity as any other clinical records and to take steps to avoid inappropriate disclosure when discussing information with patients, family and carers.

When an item is excluded from SCR Additional Information because it is in the RCGP sensitive dataset, a message is included in the SCR. A general message is included at the top of the SCR indicating that one or more items have been withheld from the SCR.

Figure 3: Viewing Additional Information below the core SCR

There are a number of known causes of duplication and repetition within the SCR with Additional Information. These include duplication of codes from the underlying system, data quality issues, inclusion of repeated vaccinations or different instances of similar information from shared records. Means for filtering these out are being considered.

SCRs may contain auto generated text defining problem detail from the GP system. Examples include Significant Active, Significant Past, Minor Active, Minor Past, End Date, Problem; New – see Fig. 2.

Problems and Issues is a special section that may contain the patient’s active problems, where they have been identified as such in the GP system. Some systems may also include significant past or inactive problems. Any items that appear under this heading will also appear under their respective defined headings as well. For example, heart failure in Fig. 3. appears in 'Diagnoses' and also 'Problems and Issues'.

Immunisations/vaccinations currently appear under 'Treatments'. The SCR is sourced from the patient’s GP record only and it may not include details of the patient’s immunisations administered outside of the GP practice, unless the practice has manually entered these items into their GP system or the information is available as part of a wider shared record from another organisation.

'Clinical Observations and Findings' may include some observation values – such as blood pressure – but only if:

• the GP system adds them systematically (which not all do)
• the GP practice marks the items for inclusion
• they were recorded in a relevant section of the GP record for inclusion in SCR

'Investigations' and 'Investigation Results' only contain items manually added by the GP practice or those items recorded in a relevant section of the GP record for inclusion in SCR.

GP systems use different versions of codes to record clinical information. Some codes may include terminology unfamiliar to non-primary care SCR viewers. Examples of these include:

• [D]= codes for working diagnoses when a specific diagnosis is not yet ascertained
• [M]= related to morphology of neoplasms
• [EC]= Classified elsewhere in a code, usually referring to an underlying cause of a particular disorder
• [NEC]= not elsewhere classified
• [HFQ]= however further classified
• [OS]= otherwise specified - only used when a definitive code is not available     
• [NOS]= not otherwise specified - only used when a definitive code is not available
• [SO]= Site of
• [V]= Supplementary factors influencing health status, but not including illness
• [X][Q] relate to cross-reference and qualifier information - not important for viewing
• A few examples of other clinical notation that may also be encountered include: 
• O/E = On examination
• C/O = Complaining of
• H/O = History of
• P/H = Personal history of
• F/H = Family history of
• CXR =  Chest x-ray
• NAD = No abnormality detected

Figure 4: Viewing Additional Information below the core SCR

The SCR examples shown in this guidance are screenshots of the Summary Care Record application (SCRa). There are some presentation differences between SCRa and printouts.

Further information can be found via the SCR Additional Information web page

For help with implementation or further questions please contact liveservices.operations@nhs.net

Where recorded in the GP record, the single most recent instance of the three COVID-19 risk category codes is included in SCR Additional Information. These codes will appear on the SCR under the heading ‘Risks to Patient.’

These codes relate to a separate programme of work that has been undertaken to identify a cohort of patients who may benefit from ‘Shielding’. These patients have been advised to not leave their home and minimise contact with other members of their household and will be offered access to home shielding support. There is a National Shielded Patient List (SPL) which is created and maintained by NHS Digital on behalf of the NHS. The SPL is reviewed regularly and updated to improve accuracy according to the Chief Medical Officer (CMO) criteria.

A group of high risk patients was initially identified from centrally available data and these patient’s then had the code ‘High risk category for developing complication from COVID-19 infection’ added to their GP record. Following this, general practices have reviewed this group to identify those patients who have been recorded as ‘High risk category for developing complication from COVID-19 infection’ but who do not actually meet the CMO criteria. Those patients found not to meet the CMO criteria had an additional code added to indicate either the Moderate or Low risk category.

Data is regularly extracted from GP records and where there are changes to the patients’ latest risk category code either from or to ‘High risk category for developing complication from COVID-19 infection’ this is synchronised to the SPL database.

A flag has been created on SCRa that will identify patients currently on the SPL. However, SCR content reflecting vulnerability to COVID-19 infection complications may not always align with the SPL, due to synchronisation issues and different data sources.

The risk category codes for developing complications from COVID-19 infection may support patient management but should not be used in isolation as an assessment of risk. Patient management decisions should always be made drawing from the widest range of available information sources. These might include the patient and their carers, currently available evidence and information about co-morbidities available from other sources including the rest of the SCR.

Separate guidance is available about how information about patients who are on the SPL is made available in SCRa and SCR 1-Click.

COVID-19 message box in SCRa, SCR 1-Click and SCRa Private Beta

Five of the commonly used codes for suspected and confirmed COVID-19 cases are signposted by a yellow message box when viewing the SCR screen on SCRa and SCR 1-Click and a yellow banner when viewing SCRa Private Beta.

SCRa and SCR 1-Click yellow message box:

Four of these terms relate to whether the patient has a diagnosis of confirmed COVID-19 based on laboratory test results or clinical diagnostic criteria. The fifth term relates to whether the patient has suspected COVID-19, which will include assessments by NHS 111 telephone service.

The message box is intended to draw attention to specific COVID-19 information in the SCR but not to distract from other important information such as allergies and significant past medical history. 

Negative test results, risk category codes and other COVID-19 related information may be present on a patient’s SCR, however the yellow message box will not be displayed to signpost to this information.

Patients will be aware of their test results in advance of their GP being notified. It will take time for the data to flow through to the GP record and the SCR. There may be occasions where the GP record and the SCR are not updated with the COVID-19 results received by individuals, for example, where it was not possible to ascertain the NHS number from the information provided to the test centre.