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

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

Introduction to theSummary Care Record (SCR)

GP Module

SCR Concept Training GP Module Self Run v1.0 01-04-11

Page 2: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

• 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

Page 3: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

Contents

Practice Activities

How the SCR looks

Creating the SCR

Informing Patients

Recording Consent

Consent Model

Content of SCR

Further Informatio

n

Introduction

Page 4: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

Introduction

• 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

Page 5: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

Min 12 weeks to decide

GP Practice

Patient

Summary - SCR

Home

Emergency Care

Your nameAddressAddressPostcode

Permission to View granted

GP Summary UpdateContaining:

•Core Data or

•Core Data & Additional Information

GP Summary UpdateContaining:

•Core Data or

•Core Data & Additional Information

Page 6: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

SCR Consent Model

Page 7: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

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.

YES NO

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

Page 8: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

Informed implied consent:

Do you want to have a Summary Care Record?

YES NO

Do nothing and a record will be

created for you.

Inform your GP Practice of your choice and

no record will be created.

Home

Page 9: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

• 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

Page 10: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

Home

• 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)

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

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)

Page 12: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

Content of the SCR

Page 13: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

• 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

Page 14: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

• 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

Page 15: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

The Public Information Programme (PIP) in GP Practices

Page 16: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

PIP in GP PracticesIn 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

Page 17: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

Recording SCR Consent

Page 18: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

Recording ConsentConsent preferences can be recorded in two

ways:1. By adding the relevant code manually to

a patient’s record2. 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

Page 19: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

Codes for patient preferences

Consent Preference Code*

Action Read 2 CTV3

Implied Consent to the SCR

No Code

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) 93C2

XaKRx

“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)

93C3 XaKRy

“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.

Page 20: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

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.

Page 21: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

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.

Page 22: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

Creating an SCR

Page 23: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

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

Page 24: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

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 overHome

Page 25: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

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

Page 26: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

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

Page 27: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

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

Page 28: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

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 PCTHome

Page 29: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

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 updatedHome

Page 30: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

Practice Activities

Page 31: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

Practice ActivitiesThe 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 RequestsHome

Page 32: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

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

Page 33: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

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

Page 34: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

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

Page 35: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

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

Page 36: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

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

Page 37: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

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 referencedHome

Page 38: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

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

Page 39: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

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

Page 40: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

How the SCR looks…

Page 41: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

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

Page 42: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

Additional information in an SCR

Home

Example:End of life

care information

added

Page 43: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

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

Page 44: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

Your nameAddressAddressPostcode

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 RecordYes – I want a

Summary Care RecordI’ve considered

my options.

Summary of GP Practice, PCT & Patient Activities

Home

Patient

What should I do?

SC

R C

RE

AT

ION

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.

Page 45: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

Further Information

Page 46: Introduction to the Summary Care Record (SCR) GP Module SCR Concept Training GP Module Self Run v1.0 01-04-11

More Information

• GP Practice Supportwww.connectingforhealth.nhs.uk/systemsandservices/scr/staff/gppracinfo/index

• Data Qualitywww.connectingforhealth.nhs.uk/systemsandservices/scr/staff/impguidpm/dq

• Frequently Asked Questionswww.connectingforhealth.nhs.uk/systemsandservices/scr/staff/faqs

• SCR Main Sitewww.connectingforhealth.nhs.uk/systemsandservices/scr

Home