1. Summary Care Record (NYHDIF)
A Mechanism for Effective Data Sharing - March-17
presented by Patrick Nolan & Robert Jordan SCR Delivery, North of England

2. SCR – Current Status 104,493 weekly
SCR views
weekly
(w/c 20/02/17)
Over 55.2 million patient records
Over 99% of GP Practices in England
Creation
Over 4 million uses during 2016
Use
Reduced medication errors
Reduced consultation time
Changed chosen care pathway
Impact
Over 1500 healthcare settings live with SCR viewing
With ongoing rollout to other settings including Community Pharmacy, Custody Suites, Hospices & Community Care.

3. Current North SCR Viewing w/c 27/02/17
Trust
Views
Hull & East Yorkshire
2717*
North Lincs & Goole
737
Leeds Teaching
1323
Doncaster & Bassetlaw
575
York
1025
Rotherham
289
North Tees & Hart
855
Sheffield (STH)
2388
Sunderland
847
Airedale (via TPP S1)
496~
United Lincs
1783
Durham & Darlington
507
Barnsley
630
Derby (DTH)
782
South Tees
908
Mid Yorks
880#
North-East, East Midlands, Yorkshire and Humberside. *Highest in England ~Average for Jan-17 #Joint SCRa and TPP (Jan-17) Trust and Palliative units

4. SCR with Additional Information
SCR v2.1 - Examples and Description

5. SCR with Additional Information 1.
The technical functionality to allow practices to add further information to the SCR is live in GP Practices.
The information can be added by clicking on a consent radio button in the practice system.
This in turn automatically adds the additional information dataset to the SCR in real time.
The information is updated each time the practice record is updated.

6. SCR with Additional Information 2.
Supporting person-centred coordinated care:
GP practices now have capability to enrich SCRs with a set of additional information with patient consent.
Includes individual coded items and associated free text as recorded in the GP record.
SCRs with additional information include:
Reason for medication
Significant medical history (past and present)
Anticipatory care information (such as information about the management of long term conditions)
Communication preferences (as per the SCCI-1605 national dataset)
End of life care information (as per the SCCI-1580 national dataset)
Immunisations
Example SCR:

7. SCR with Additional Information 3.
Items from the exclusion data set include:
Sensitive items - such as Fertility Treatments, STIs, Terminations and Gender Reassignment
Private/Confidential items - in the GP record are honoured and marked not present in the SCR.
Further content customisation can be offer by:
Adding of Manual items - to support care quality and patient preference such as living wills etc.
Exclude items can be manually added with patient consent.

8. Consent for Additional Information
The Core SCR (Allergies, Adverse Reactions & Medications) is based on implied consent. If a patient does not opt out then they will have an SCR.
In order to add additional information to the SCR the patients ‘explicit consent’ must be sought.
There is no requirement to gain written consent, however a combined information leaflet and consent form is available for GP practices that wish to use it.
CCGs are prioritising the patients who would benefit from AI (Vulnerable, Frail, End of Life, LD, Dementia & new patients).

9. GMS Contract Amendments 2017-18
Identification and management of patients with frailty
From 1 July 2017, practices will use an appropriate tool e.g. Electronic Frailty Index (eFI) to identify patients over 65 who are living with moderate/severe frailty. For those patients identified as living with severe frailty, the practice will deliver:
An annual medication review, discuss any falls in the last 12 months and any other clinically relevant interventions.
In addition, where a patient does not already have an enriched Summary Care Record (SCR) the practice will promote this, seeking informed patient consent to activate the enriched SCR.

10. Identifying priority groups for consent
End of Life
LTCs
Frequent fliers
Mental Health
Over 75s
Learning Disabilities
Frail Patients and Avoiding Unplanned Admissions 2%
Live Viewing Organisations Optimising Benefits of SCR with AI
Acute Trust – A&E and MAU Expand Trust Roll Out – Specialist Services
OOHs Community Services e.g. DNs, LTCs, EoL
Ambulance Service Mental Health Services
MIU Hospice

11. Scarborough & Ryedale Example
CCG steering group setup (Chaired by Ass. Dir of Corporate Affairs).
Monthly Meets (CCG staff inc. comms, NHS Digital & Practice reps).
Letter sent out to practices to explain AI, direction of travel & asking to participate.
Workshops run for practices to cover AI (consent & functionality).
Local viewing sites contacted to begin awareness and to identify further areas for potential SCR viewing.
Practices asked to;
Nominate an SCR AI Champion
Add a consent box to your frailty, long term condition and other relevant care plans/templates
Run a search for patients cohorts to establish a consent baseline.

12. Scarborough & Ryedale Example
The main groups of patients who will benefit from this additional information being available are those who are most vulnerable, and phase one of the project will focus on gaining consent from patients:
on the vulnerable patient list, including palliative care patients
on the frailty register
with learning disabilities
patients with dementia
Consent from new patients registering with the practice and those who regularly attend A&E/Urgent care services.

13. Benefits of SCR with Additional Information
Removes the need to provide information via telephone/fax when patients are admitted to hospital.
Supports local priorities around frailty.
Updates to care plans are automatically shared through additional information*.
Supports end of life care.
Supports the Accessible Information Standard
No change for existing viewers of SCR. They automatically see the enriched SCR with the patient consent.
Most CCGs across Yorkshire and Humber have included SCR with AI in their LDRs and STPs.
*Care plan codes and associated text are available within the additional information held on the patient’s SCR.

14. Future Work
Currently the SCR Application (SCRa) offers users access to
PDS, SCR, CP-IS and FGM information.
Future plans are forming to refresh our Spine Applications including SCRa to include increase functionality such as:
National Record Locator Service
GP Connect
Reasonable Adjustment (LD Flagging)
Non-Smartcard Access to Spine Applications

15. Any Questions?

16. http://systems.digital.nhs.uk/scr @NHSSCR patrick.nolan1@nhs.net