This site is intended for Healthcare Professionals only

Patient records: sharing the caring in pharmacy

Analysis bookmark icon off

Patient records: sharing the caring in pharmacy

At the end of January this year, nearly 50 million people in England had a shared care record and over 135 pharmacies were involved in a project that allowed them access. So how is the pilot shaping up?

 

For years now, whenever it has been suggested that pharmacy could do more to improve patient outcomes, reduce GP workloads and make a bigger contribution to the NHS, one of the barriers that invariably gets mentioned is IT and, in particular, access to patient records. Now, finally, something is happening.

Slowly but surely, pharmacies are trialling access to electronic information about patients – with their consent, of course – mostly pulled from GP records, and on a read-only basis. The initiative that has the potential to affect the greatest number of people is England’s Summary Care Record (SCR) programme.

Proving the point

For one of the five areas in which pharmacies are currently undertaking a ‘proof of concept’ project, it has been a long time coming. Bradford was chosen as the first pilot site for SCRs back in 2010, but this was suspended when the focus for the project was shifted to emergency and urgent care. Now 135 pharmacies in West Yorkshire, Sheffield, Northamptonshire, North Derbyshire and Somerset have been enabled for SCR viewing and interim results are promising (a final report on the findings is expected at the end of this month).

The interim results, based on 126 encounters that took place in October and December, show that in the majority of cases the pharmacist was able to meet the patient’s needs there and then. Without access to SCRs, the pharmacists felt that, in almost three-quarters of encounters, they would have had to signpost the patient to another setting, such as an out-of-hours service or walk-in centre.

Access also proved beneficial in identifying prescribing errors – in over half of the cases the pharmacists felt they had been able to reduce the risk of patient harm. Some of the audit results were a little surprising. The Health and Social Care Information Centre (HSCIC), which is running the project on behalf of NHS England, had anticipated that community pharmacies would mostly be accessing SCRs to assist in the provision of emergency supplies to confirm what a patient was taking and at what dose.

While a substantial proportion of the encounters included in the audit were for this purpose, it was less than half (47 per cent). What wasn’t expected was that nearly a quarter of the encounters audited were concerned with repeat dispensing.

Mohammed Hussain, systems commissioning manager in strategic services and technology for NHS England and a community pharmacist in West Yorkshire involved in the proof of concept project, says that routine care is where the real value of SCR access for community pharmacy lies. Examples he has come across that have informed this opinion include the management of repeat prescriptions, which can be tied in with the Electronic Prescription Service (EPS) for a streamlined service, providing advice on OTC medicines and provision of advanced and enhanced services such as medicines use reviews, the new medicine service and also influenza vaccination.

“[SCR access] is a giant leap for community pharmacy,” he says, because with more information, pharmacy can not only “do more” but “do better”. Pharmacies piloting SCRs have reported feeling more confident in dealing with queries, rather than referring patients back to their GP. Patient satisfaction levels have also been high.

It’s a nobrainer to use technology to help deliver services

 

Key facts 

  • 135 pharmacies have been enabled for SCR viewing
  • Nearly a quarter of the encounters audited were concerned with repeat dispensing
  • The DH is also proposing that pharmacists verify the prescription charge exemption status of patients

 

Challenges and solutions

The introduction of SCRs into his pharmacy has not been without its challenges. Mohammed says the team took a while to remember that they had access to SCRs and could deal with queries then and there, rather than sending patients to other services or providers. 

Sharon Wilson, SCR community pharmacy programme manager at HSCIC, agrees that use of SCRs needs “embedding in normal processes” and offers reassurance to those concerned at the extra time it might take to check information. “It is not expected that SCRs will be used every time – it is up to the professional to decide when it is appropriate.”

Sharon says that the pilots have proved useful in highlighting issues that need to be overcome before pharmacy access to SCRs could be rolled out further. These include a need to speed up the process by which roles are added to NHS Smartcards in order to allow SCR access, improved guidance and support for pharmacy professionals who have been granted access, particularly with regards to obtaining patient permission, and starting discussions with pharmacy systems suppliers regarding if and how SCRs could be integrated with patient medication records.

Be prepared 

In the meantime, she says, there are several steps pharmacies can be taking to ensure they are prepared if further roll-out is approved, such as finding out who in their local area will be responsible for implementation, checking that all members of staff who need them have NHS Smartcards, identifying who is responsible for adding roles to NHS Smartcards, as well as the person who is the point of contact for any problems that arise.

Heidi Wright, practice and policy lead for England at the Royal Pharmaceutical Society, is encouraged at the success of the SCR proof of concept project and says that lessons have been learned from the somewhat awkward deployment of the Electronic Prescription Service (EPS).

“The way the pilots have been done has been really good, as it includes independents right up to large multiples, to make sure it can be scaled up,” she says. “There has also been good two-way dialogue between the sector and HSCIC, so hopefully the roll-out will be smoother than EPS has been.” Heidi hopes that improved access rights will follow.

“This is only a stepping stone because we want full read and write access for the profession and more information available than is currently in the SCR. As patient access to their own health records increases, as outlined in Five Year Forward View paper, there is nothing to stop them sharing them with healthcare professionals – pharmacists included.”

Her thoughts are echoed by John Palmer, national IT lead for Pharmacy Voice. “One of the questions about the roll-out is whether it happens as it is now, that is browser-based, or whether they will take a longer-term view and integrate with PMRs, which would avoid rekeying errors. With fuller integration, there is also hope for greater inter-professional referrals and communication.”

One issue that also needs consideration is interoperability between the UK’s devolved nations, says John. “We are all excited about the SCR project, but England is actually playing catch-up, because Wales already has individual health records, Scotland has emergency care summaries and Northern Ireland has its own version of electronic care records. With all patients having a NHS, CHI or Health and Care number, it is not beyond the bounds of possibility for pharmacies to have PMR systems that can access more than one national system.”

Connectivity is the driving force in health IT development

Pushing boundaries

National IT programmes – such as the SCR project in England – have no choice but to proceed cautiously because of the sheer scale and complexity of wider implementation. Healthcare IT companies are less constrained and can therefore try things out on a much smaller scale. Such work provides useful data on just what can be achieved. The partnership that exists between Rx Systems and EMIS, systems suppliers to pharmacies and GP practices respectively, is a good example.

A system called Pharmacy Access allows pharmacies that are ProScript EPS R2 enabled to link securely with GP surgeries that run EMIS Web – assuming both pharmacy and GP practice are willing and patient consent is obtained. This can be done via two applications: Medicines Manager, which allows pharmacies to electronically order repeat prescriptions, and GP Record Viewer, via which selected parts of the patient record can be looked at.

Raj Radia, pharmacist proprietor of Spring Pharmacy in Hackney, describes the system as “working a treat”. He uses Medicines Manager with his four closest GP surgeries. “We can request items from our end and add information to a free text box; for example, if items are out of sync or if the patient might be suitable for repeat prescriptions, which the surgery then accepts or rejects. I still tell patients to allow 48 hours for repeat prescription requests, but if everything works well, I can actually have the prescription within an hour.”

Spring Pharmacy uses GP Record Viewer with three of the GP practices, which Raj says is incredibly useful. “I can see a patient’s medication record and their blood test results, for example, like HbA1c and cholesterol levels, and other readings such as blood pressure measurements, so I can explain things to them if they haven’t understood it at the surgery, or use the information when I’m conducting a MUR.”

As a Numark member, Raj can also get his patients to use the virtual chain’s mobile phone app, My Local Pharmacy, to request prescriptions and see when they are ready. “It’s a nobrainer to use technology to help deliver services,” he says.

Andy Charlesworth, IT services manager at Numark, says such applications offer a glimpse of the future. “The more prolific EPS2 is – and some tough targets have been set by HSCIC for GPs on this – there will be a groundswell in pharmacies who have to use it. As they see the benefits of prescriptions coming down electronically, they will get the appetite for adding other things to the process.”

Meanwhile Cegedim Rx is piloting Healthi, an online software platform for supporting clinical services provision. The trial version includes functionality to help pharmacies provide winter flu jabs, MURs and NMS. Future releases will include appointment booking, billing and reporting features. Healthi also enables patients to book appointments with their pharmacist and add biometric data to help with adherence to personal health plans.

 

The burden of exemption checking 

Last year ended with the DH announcing plans to give pharmacists access to an electronic database to verify the prescription charge exemption status of patients. At the moment, the NHS Business Services Authority runs checks after prescriptions have been submitted for payment, but the DH says this system is not timely enough and therefore liable to abuse by individuals who deliberately and dishonestly claim free prescription items knowing that their exemption status will not be checked in any detail at the point of dispensing.

Although details about the proposed national database have not yet been released, what is known is that the penalty for making bogus prescription exemption claims will be up to £150 and repeat offenders could face fines of up to £2,500 and a criminal record. While few could argue against the principle of trying to cut NHS fraud – the DH has said that the scheme could save around £150 million a year – concerns have been raised across the profession about the plan.

PSNC chief executive Sue Sharpe has warned that increasing the “administrative burden” of pharmacists in such a way could impact on the amount of time they have to spend with patients. David Branford, chair of the Royal Pharmaceutical Society’s English Pharmacy Board, was even blunter, denouncing the move as “totally unacceptable” and one that could “disrupt and distort the relationship between pharmacists and patients, impacting on the trust that currently exists and creating a culture of fear and uncertainty”.

Pharmacy Voice chief executive Rob Darracott suggests that a better option might be to overhaul the system and do away with prescription charges altogether. Information about the proposed system can be found at:psnc.org.uk/our-news/plan-for-electronic-system-to-monitor-prescription-charge-exemption-checks/

Copy Link copy link button

Analysis

It’s time to delve deeper into health discussions. Broaden your understanding of a range of pharmacy news and topics through in-depth analysis and insight.

Share: