Robbie Turner, director of the Royal Pharmaceutical Society has recently called for urgent pharmacist involvement in Sustainability and Transformation Plans.
Having analysed the digital requirements of all 44 STPs (fuelled by several cups of strong coffee) I second his call. Every single plan talks about transforming patient care in their communities and improving communication between health and care providers using a form of electronic shared care record.
For those of you who haven’t heard, I’ll shout it out – community pharmacies are already doing it!
That’s right - following the requisite online training and assessment from NHS England, approved Community Pharmacists - armed with Smartcards - are empowering patient care and reducing GP appointments in their localities by accessing the national Summary Care Record (SCR).
The SCR is an electronic summary of key clinical information (including medicines, allergies and adverse reactions) relating to a patient, extracted by NHS Digital from the GP record.
Last October, Harpreet Shergill, NHS Digital's lead for rolling out SCR across community pharmacy and a pharmacist in his own right, said that it enabled his pharmacy to sort, ‘92% of cases with patients on-site, without having to direct them back to their GP.’ He added that accessing SCR was the ‘biggest single change in pharmacy in the last 10 years’ – with early data showing some pharmacies access the system up to 70 times a week.
Further endorsement came from Dr Neil Paul, GP Partner at Sandbach GPs, who recently argued the case for SCR versus the limitations of his local Cheshire Care Record (CCR). As he pointed out, patients attending A&E from outside of the CCR boundary do not benefit from local record sharing:
‘One of the biggest clinical drivers I have ever heard was from a consultant psychiatrist who was dealing with severely mentally ill patients. She bemoaned her inability to see patients’ live prescribing data or see what they were on or at what dose. She felt she was being asked to make risk judgements that could kill the patient – and perhaps her career – on the basis of incomplete data.’
So with these ringing commendations of SCR enabled pharmacy as a means to relieve the burden on GPs, why isn’t uptake soaring?
Could it be a usability issue? The majority of pharmacists accessing SCR currently use a web portal provided by NHS Digital called the SCR application (SCRa). However its standalone nature means that patient data has to be manually transcribed into the pharmacy Patient Medication Record (PMR) if a record is to be kept, increasing administration time and potentially clinical risk. You’re faced with more Windows than a double glazing showroom.
Dr Ben Brown, a GP and Wellcome Trust doctoral fellow in health informatics was certainly unimpressed:
“There was little support from clinicians for this technology, because it had a clunky interface and lacked the detailed patient information needed to be ‘actionable’. Furthermore, it was widely deployed with relatively little user testing.”
Clunky! Surely then, there is a case for fully-integrated SCR?
By integrating local systems with the SCR the number of clicks is dramatically reduced and the look-up can be built into existing workflows. The tricky issue of consent (required for each and every view) can be more easily captured and managed and the user can make an informed decision with the reassurance of a full audit trail.
Pharmacists are spared the arduous task of manually entering data into another system – freeing up valuable time to talk with patients.
Furthermore, the rise of the Summary Care Record Spine Mini Service has reduced the burden on PMR suppliers who can now shortcut the arduous NHS Digital Common Assurance Process and gain access in a matter of weeks.
It seems we are faced with a ‘chicken or egg’ situation. With many pharmacy chains contracted to large proprietary PMR providers, the decision to adopt SCR in its integrated form is in the hands of the system suppliers. These are unlikely to make the investment in integration of SCR with their systems without market pressure from their customers, who remain unconvinced by the ‘clunky’ SCRa solution?
Could the impending STP shakedown be what is needed to break this stalemate and get PMR suppliers and Pharmacists to talk to each other?
To read more about our award-winning SCR Spine Mini Service click here….