1. Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

2. This presentation is timed and will run automatically There are shortcuts available to help you navigate through this presentation should you choose to use them The contents section will allow you to jump to the relevant section by clicking on that topic The home buttons located in the bottom left hand corner of some screens will return you to the contents screen Instructions

3. Contents Practice Activities How the SCR looks Creating the SCR Informing Patients Recording Consent Model Content of SCR Further Information Introduction

4. The GP module will build on information previously covered in the Core module The module is designed for all GP practice staff in practices implementing SCR The module is intended as a precursor to implementation of the SCR Home

5. Min 12 weeks to decide GP Practice Patient Summary - SCR Home Emergency Care Your name Address Postcode Permission to View granted GP Summary Update Containing: Core Data or Core Data & Additional Information GP Summary Update Containing: Core Data or Core Data & Additional Information

6. SCR Consent Model

7. Creating the Record: Do you want a Summary Care Record? *In an emergency where you are unable to be asked, or certain medical/legal circumstances (such as Court Order) the clinicians involved in your care may access the record without asking. All such actions will be recorded for investigation. Do nothing and a record will be created for you. Inform your GP Practice of your choice and no record will be created.YESNO Viewing the Record: Can I/we look at your Summary Care Record? When you present for care, you will be asked* if your record can be viewed. Home

8. Informed implied consent: Do you want to have a Summary Care Record?YESNO Do nothing and a record will be created for you. Inform your GP Practice of your choice and no record will be created. Home

9. Following the Public Information Programme, where a patient has decided that they want an SCR and have not opted out, a record will be created containing a GP summary with the patient’s core clinical details of medication, allergies and adverse reactions. Yes Home

10. Once a patient has an SCR, additional information can be added to the SCR only with the explicit consent of the patient A discussion will need to take place between the patient and the practice before any additional information is added Yes (additional information)

11. Home Patient has decided they do NOT want an SCR to be created and has returned an opt out form to their practice A patient can change their mind at any time No (patient informs GP Practice)

12. Content of the SCR

13. The SCR is generated with clinical information provided by the patient’s registered GP practice The SCR consists of the following core data items: 1.Allergies 2.Adverse Reactions 3.Medication (Repeat, Acute and Discontinued Repeats) When a GP practice is live with SCR any changes made to these core data items will be updated in the SCR automatically SCR Content – Core Data Home

14. Additional clinical information over and above the core data items can be added to the SCR where a patient and their GP agree Examples of information that can be added to the SCR include: – Significant diagnoses – Care plan information (e.g. end of life, long term conditions) – Any other information that is considered relevant by the patient or GP to support the patient in an urgent or emergency care situation Patients are in control of any additional information that is added to the SCR and are required to give their explicit consent SCR Content – Additional Information Home

15. The Public Information Programme (PIP) in GP Practices

16. PIP in GP Practices In addition to the patient information pack sent to all patients over 16 years of age registered with a GP and to ensure that patients are adequately informed about SCR, the PCT should support practices to: Inform patients that the SCR is available Make posters available Make opt out forms available Be able to answer patient queries Home

17. Recording SCR Consent

18. Recording Consent Consent preferences can be recorded in two ways: 1.By adding the relevant code manually to a patient’s record 2.By using the GP practice systems’ SCR consent management screens. This option becomes available when your IT system has been upgraded for SCR In each case, only the latest value will be referenced to control the flow of information to the SCR Home

19. Codes for patient preferences Consent Preference Code* Action Read 2CTV3 Implied Consent to the SCR No Code Implied consent to allow core information of Medication, Allergies and Adverse reactions to be added to the SCR The patient wants to have a Summary Care Record (explicit consent) 93C2XaKRx “Consent given for upload to national shared electronic record” - Allows additional information to be sent to the SCR. The patient does not want to have a Summary Care Record (opt out) 93C3XaKRy “Refused consent for upload to national shared electronic record” - Sends a blank summary to the SCR (Patient opted out). Home * During 2011 new Read and CTV3 codes will be available for the recording of patient consent preferences. Guidance for GP practices will be released when codes become functional.

20. Changing Consent after Opting Out Once a patient has opted out they are able to opt back in to the SCR at any time To do this the setting of explicit consent will need to be applied. This means that reason for medication could automatically be displayed alongside core data. Any additional items will only be sent manually by the GP Practice in agreement with the patient A conversation should take place with the patient to agree which items are to be included If the patient is unhappy with being set to explicit consent, they should remain opted out at this time Home * During 2011 new Read and CTV3 codes will be available for the recording of patient consent preferences. Guidance for GP practices will be released when codes become functional.

21. Changing Consent after Explicit Consent If a patient had previously explicitly consented to having an SCR, they are able to opt out by applying the correct code If the patient wishes to revert back to core only the practice is able to remove any additional data that has been added Reason for medication may continue to be added to the SCR if present in the GP record Patients should be made aware of this through conversation with the GP If the patient is not happy with explicit consent remaining on their record, they should be opted out at this time Home * During 2011 new Read and CTV3 codes will be available for the recording of patient consent preferences. Guidance for GP practices will be released when codes become functional.

22. Creating an SCR

23. When will my Practice start creating SCRs? A Practice will only start creating SCRs (go live) when: There is agreement between the Practice and the PCT to take part Once the practice and the PCT agree that patients have been adequately informed about the process and properly enabled to opt out should they wish They have a GP system that is compliant with SCR Home

24. What happens before we go live? Within your PCT there should be an SCR lead who will work with your site to ensure: All of the appropriate technical checks are carried out All of the staff within the practice are trained All of the staff within the practice have received the information to enable them to deal with any queries patients may have about SCR Continued over Home

25. What else happens before we go live? Within your PCT there should be an SCR lead who will work with your site to ensure: All staff are compliant with local PCT best practice e.g. Patient Demographic information management All staff have been issued with smartcards with the correct roles and there are process for issuing smartcards/new roles for new and temporary staff The appropriate data quality standard is reached The new patient process are operational

26. Managing New Patients The recommended approach for managing new patients joining a practice is that they are given information about the SCR and informed of their options For new patients who want more time to think about their options, current guidance recommends that they are marked as opted out* of the SCR until such a time that they make their preference known to the practice Under these circumstances, a reminder or recall should be set to contact the patient again to confirm their preference Home * Practices should ensure that they understand the implications of opting a patient out

27. What happens when we go live? There will be an “initial upload” of the three key core data items (allergies, adverse reactions & current medications) for each eligible patient who has not opted out of having an SCR This is a one off event How this upload happens is dependant on your GP clinical system supplier but in all circumstances: The upload will be scheduled at a time convenient for the practice You will be consulted about all activities being carried out at the site and who will be undertaking them You will be supported by your system supplier and/or PCT during the initial upload Home

28. What happens after we go live? Staff must follow all of the processes that were explained during the supplier training e.g. using smartcards If staff believe that the system is not working as it should be then they should follow normal processes e.g. log a call with the supplier helpdesk/PCT IT helpdesk Always ensure that there is SCR information in patient packs for patients that register with the practice Should practice staff receive a query that they cannot answer they should contact the PCT Home

29. How are SCRs updated? After the initial upload, SCRs are updated every time: a change is made to the core data set an additional data item is marked to be included or excluded from the patient’s SCR e.g. a diagnosis (This only results in an SCR update if the patient is set to explicit consent) Updates are only made if the user is authenticated with their smartcard and the patient’s local demographic details are matched to the Patient Demographic Service The SCR is date and time stamped so that anyone viewing the SCR knows the date and time it was last updated Home

30. Practice Activities

31. The following activities will need to be considered when implementing the SCR: Nominating a Practice Expert Managing Data Quality Managing Patient Demographic Service Information Consistent use of Smartcards Handling Returned Mail Managing Patients Preferences Supporting Children & Vulnerable Adults Viewing SCR for Temporary Resident Patients Dealing with SCR Deletion Requests Home

32. Nominating a Practice Expert Some practices have found benefit in having a member of staff who acts as an SCR expert and/or a single point of contact. This means that they can deal with: Difficult or complex queries Discuss GP Summary content Support other practice staff Home

33. Managing Data Quality SCR Data Quality guidelines exist to ensure that GP practices have reached a minimum data quality standard before going live with SCR The implementation of these data quality standards are managed locally by the PCT Your PCT will be able to advise what is required Home

34. Managing Patient Demographic Information Patient demographic information held by the GP IT system must match that held in the Patient Demographic Service (PDS) for SCRs to be updated This is known as PDS synchronisation Where discrepancies exist, they need to be resolved to enable clinical information to be sent to the SCR Home

35. Consistent use of Smartcards A Smartcard is required to maintain/send any updates to existing SCRs When a user of a GP IT System is not logged on with a valid Smartcard, the GP system will not be able to update the PDS or SCR A process is required to ensure that patient records accessed by staff who don’t have a Smartcard (e.g. new starters or locums) are then updated and sent to the SCR

36. Handling Returned Mail FP69 is an existing NHS process whereby patient records are marked with a “FP69” status if there is any doubt about their correct address The PIP may result in returned mail which may trigger the FP69 process The process for managing this returned mail should be agreed with your PCT Marking a patient record with FP69 prevents those patients records being uploaded Home

37. Supporting Children & Vulnerable Adults Children DO get an SCR but do not get a letter Children and vulnerable adults can be opted out Guidance and legislation exists to support GPs decision making regarding supporting children and patients who may lack capacity For children this may include assessing their competence (known as Gillick competence) and considering their best interests For adults who may lack capacity, the Mental Capacity Act should be referenced Home

38. Viewing SCR for Temporary Residents Patients A practice may feel that there is benefit in viewing SCR to support clinical care for patients that are temporarily registered with the practice Your PCT will be able to assist if this is appropriate Home Future versions of GP systems will allow SCRs to be viewed directly from within you practice clinincal system

39. Dealing with SCR Deletion Requests Once an SCR has been created it is possible for a patient to request that it is deleted Patients should contact their GP practice if they wish to request that their record is deleted The practice should contact the PCT with this request An investigation then takes place to see if the SCR has been used If the record has not been used it can be deleted If the record has been used it cannot be deleted Home

40. How the SCR looks…

41. Core Information in an SCR Home Time and date is clearly visible indicating when the GP Practice last shared this summary Medications, allergies and adverse reactions

42. Additional information in an SCR Home Example: End of life care information added

43. What does it look like if the patient is no longer registered? Home When a patient leaves (deregisters) from their GP practice, a note is added to their SCR to indicate that the patient left the practice Below is an example of the note that is added: When a patient registers at their new practice, a new SCR is sent from that practice

44. Your name Address Postcode GP Practice Practice meets all Data Quality and Technical requirements and Authorised to ‘Go Live’ FP69 Following the end of the Public Information Programme… Let your GP Practice know your decision to opt out (mail back the opt out form freepost) and they will opt you out in their system, ensuring an SCR is not created for you. Don’t do anything and one will be created for you! Decision made PCT No - I don’t want a Summary Care Record Yes – I want a Summary Care Record I’ve considered my options. Summary of GP Practice, PCT & Patient Activities Home Patient What should I do? SCR CREATION The creation of SCRs will only take place when a practice and their PCT agree that patients have been informed and enabled to opt out should they wish.

45. Further Information

46. More Information GP Practice Support www.connectingforhealth.nhs.uk/systemsandservices/scr/staff/gppracinfo/index Data Quality www.connectingforhealth.nhs.uk/systemsandservices/scr/staff/impguidpm/dq Frequently Asked Questions www.connectingforhealth.nhs.uk/systemsandservices/scr/staff/faqs SCR Main Site www.connectingforhealth.nhs.uk/systemsandservices/scr Home