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NHSCRS

The NHS Care Records Service (NHS CRS) is an electronic record management service that is being designed to allow authorised care professionals access to an individual’s medical record 24 hours a day, seven days a week. It is a nation-wide system that will help join-up care across the NHS including primary and secondary care and social services. Protected by a range of access controls, the system comprises both detailed records which will be made available to be shared within a locality and a summary record, held nationally on the system’s central ‘Spine’.

The Summary Care Record is currently being piloted but no deadlines have yet been set for full implementation of the service. It was originally intended that the dispensed notification issued by pharmacies via the Electronic Prescription Service would populate the Summary Care Record. For technical reasons, this will now not happen for the foreseeable future but remains a long term goal.

The Government has committed to consulting on what elements of patient information community pharmacists may need in order to deliver appropriate healthcare services as part of the NHS pharmacy contractual framework. PSNC (along with the other pharmacy bodies) have been involved in initial discussions with the Department of Health on this issue. A key reason for the delay to this consultation document being published is the wider public sensitivities around the care record service and who is able to access patient information. Commenting on this at the 2007 British Pharmaceutical Conference, Health Minister Ben Bradshaw MP said that ‘I have no doubt that pharmacists will be able to play their part in the fullness of time’.

EPS Release 2 will provide pharmacies with access to one component on the NHS Care Records Service, the Personal Demographics Service (PDS). This contains no clinical information. It is anticipated that when a policy decision is made on wider pharmacy access to the Care Records Service, this will be delivered in the same way as EPS functionality, through setting national standards and undertaking compliance testing of pharmacy systems. 

How will the Service Work?

It is proposed that the NHS Care Records Service will contain two key elements: a Summary Care Record and a Detailed Care Record.

The Summary Care Record is designed to be a source of information to support first contact care and less complex care across organisations. This could include out-of-hours, accident and emergency care, ambulance services, treatment of temporary residents or when a patient first presents at an organisation for care.

It is anticipated that in the long term, the Summary Care Record will contain information on significant aspects of a person's care such as major diagnoses, procedures, current and regular prescriptions, allergies, adverse reactions, drug interactions and recent investigation results.

The Summary Care Record is likely to be derived from the records of different organisations delivering care to a person, for example there would be a GP component aswell as components from several hospitals that the patient may have attended, a mental health trust, dental practice and possibly a community pharmacy. In each organisation, the patient's record would clearly indicate which items were included in that organisation's contribution to the Summary Care Record.

Organisations such as GP practices or hospitals will continue to maintain their own records linked to episodes of care, these will be supplemented with key information from other organisations providing care to a patient to form the Detailed electronic Care Record. Except where two organisations share an integrated care record, a care professional in one organisation will not be able to see the whole record within another organisation.

In May 2006, CfH announced that access to an individual's detailed Care Record would be limited to NHS organisations using the same CfH local data store that links to the Spine (referred to as an 'instance'). If an organisation, for example a GP Practice is in a different 'instance' from an organisation with detailed information on the patient - either within the same cluster or where the organisation is in a different cluster - it will not be possible for the organisation to access the detailed care record. This will not apply to the Summary Care Record which will be available for authorised access anywhere in England.

The system is reliant on rigid standards being implemented and adhered to by diverse clinical systems in different parts of the Health Service. The NHS Number will provide the unique, reliable identifier that will identify a patient's record on the NHS Care Records Service. Snomed CT (replacing READ codes) has been adopted as the NHS Standard for clinical terminology and the Dictionary of Medicines & Devices (DM&D) will become the NHS standard for medicines and device identification.

Patient Access?

The Government have committed to giving patient's access to their own Care Record. This will be done via NHS 'HealthSpace'. An initial version of HealthSpace already exists as a personal health organiser. Over time the services it provides will expand including allowing patients to nominate a pharmacy to receive their prescriptions electronically and providing patients with a link to their summary care record (estimated 2008).

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Pharmacy Access?

• Providing community pharmacists with appropriate role-based read and write access to both detailed and summary care records has the potential to greatly improve patient safety, support the development of new services for patients, improve interdisciplinary working and increase the quality and continuity of care provided to patients.
• To maximise patient safety, community pharmacists must have access to a pre-determined core data-set, for example the medication profile, active clinical conditions, allergies and previous adverse reactions. It would be beneficial for patients, the NHS and pharmacists if supplementary information, such as access to laboratory test results, is also available to pharmacists to use where appropriate and with patient consent, to support a particular role they are undertaking, for example, the provision of an anticoagulation monitoring service.
• All community pharmacies have robust systems in place for handling patient confidential information and are subject to a wide range of legal, ethical and professional requirements. PSNC, the NPA, the CCA and AIMp welcome the proposed additional safeguards to protect patient confidentiality including role-based access controls and the ability for patients to choose to dissent from their information being shared.
• Community pharmacists should be involved at an early stage in the implementation of the NHS Care Records Service to study the benefits and challenges that arise in joining-up care and to provide learning to support the wider roll-out of the Service to other professionals and organisations within the NHS.

The full submission can be viewed by clicking on the link below:

PSNC/NPA/CCA/AIMp Submission to the HSC on Access to Patient Records

Consent and Confidentiality

The NHS Care Record Guarantee sets out the rules that will govern information held in the NHS Care Records Service. This will form an important part of the public information campaign about NHS Care Records.

The Guarantee covers people’s access to their own records, controls on others' access, how access will be monitored and policed, options people have to further limit access, access in an emergency, and what happens when someone cannot make decisions for themselves.

NHS Care Record Guarantee (PDF)

There will be a variety of options available to patient's to limit their participation in the NHS Care Records Service.

Sealed Envelope Concept

In the long term, the NHS CRS will include 'sealed envelopes' where patients can chose to lock access to certain information. There is also expected to be a 'clinician's sealed envelope' which would allow information to be locked by the clinican, if it was appropriate and in the interests of the patient. Click on thew link below to download a CFH briefing paper on sealed envelopes:

CFH Sealed Envelopes Briefing Paper (PDF File)

Ensuring Confidentiality

One of CfH's main work streams is Information Governance. Information Governance includes data protection, data integrity, data quality, security and confidentiality and is included in every area of CfH's work.

There are numerous measures being put in place to protect confidentiality including the requirement that staff use smart cards and pin numbers to access the system.

The concept of a ‘legitimate relationship’ has also been emphasised by CfH as one way of ensuring confidentiality. Health professionals should only access a patient record where there is a link between a user (eg. pharmacist), workgroup (eg. pharmacy) and patient. There will be multi layered audit facilities built into the system so that data can be mined in a pseudo-anonymised form, unusual trends could be identified and then investigated further, for example by a Caldicott Guardian

More Information