MPs call for pharmacists to have access to CRS

Tags: CfH DH GP Pharmacists Pharmacy

03 Jul 2007

Pharmacists in primary and secondary care must be given read-write access to the NHS Care Records Service (NCRS), according to a report from MPs.

The All-Party Pharmacy Group’s (APPG) report on the Future of Pharmacy argues that pharmacy needs access to the NCRS to realise its potential as a health service provider and criticises Connecting for Health (CfH) over lack of consultation with pharmacists

The report states: “We do not believe that CfH has engaged adequately with the profession or its representative bodies and we are concerned that pharmacy is not being regarded by CfH as an essential participant in the NHS’s IT connectivity programme.”

The report’s eight recommendations on IT include:

• Pharmacists in both primary and secondary care must be given role-based, read-write access to patient’s Care Records as well as the NHS Spine

• Pharmacists must also be given the ability to make entries on the records if they are to provide maximum support to patients and the winder healthcare network

• NHS Connecting for Health muse hold more extensive consultations to engage pharmacy

• There must be clear communication to the public to explain which healthcare professionals have access to their Care Record and the reasons behind this access, to allow an informed debate.

Dr Howard Stoate MP, chairman of the APPG and a former GP, said almost all those who gave evidence to the APPG were in favour of pharmacy access to the NCRS.

He told EHI Primary Care: “It’s absolutely essential – GPs and pharmacists can’t share care of patients if neither knows what the other has done.”

The report says the British Medical Association told the APPG inquiry that it questioned how much of the record pharmacists should be able to access and had concerns about pharmacy’s ability to protect patient confidentiality, particularly within a commercial environment.

The MPs says they were unconvinced by those concerns. The report adds: “Confidentiality is an issue for all those health professionals accessing the Care Record. We do not see it as a greater challenge for pharmacies than it is for GP surgeries and we see no reason why effective protocols cannot be implemented by pharmacists to ensure that patients are reassured that information is accessed appropriately.”

Dr Stoate said he had already spoken Department of Health (DH) officials and DH ministers about the report and the government had promised that it would respond to the recommendations when it had had time to consider them.

The report says that Jeanette Howe, head of pharmacy at the DH, confirmed to the APPG that the DH was committed to connecting pharmacy to the NHS in an appropriate role-based manner.

The APPG report claims that consultation and engagement with pharmacists by CfH has been disappointing and h focused largely on the Electronic Prescription Service (EPS) while largely ignoring wider connectivity issues and the Care Record.

The report adds: “We were surprised and concerned to hear that stakeholders not involved in the consultation process included multiple pharmacy chains, independent local pharmacies, local pharmaceutical committees and pharmacy system suppliers.”

The report claims progress on EPS has been “slow and erratic” and says CfH’s original target that EPS would be fully operational by the end of 2007 is unlikely to be met.

The MPs argue that there is also an urgent need for a structured and unstructured message exchange facility between pharmacists and GPs and other primary care professionals and that the NHS should provide support, guidance and training to pharmacists on IT, particularly for independent pharmacies and small multiples where there is no central IT function. They say the costs of NHS IT implementation should be shared by pharmacy and the NHS but with a significant majority of the cost being met by the NHS.

Dr Stoate told EHI Primary Care: “We felt that everything was taking too long and was too patchy with not enough uniformity. I’m pretty sure everything will happen but I want it to be sooner rather than later . We need everyone to up their game to make it happen much more quickly.”

Link

The All-Party Pharmacy Group’s (APPG) report on the Future of Pharmacy

Reader's Comments

Electronic links

john.bishop@leics-his.nhs.uk

03 Jul 07 12:07

'The MPs argue that there is also an urgent need for a structured and unstructured message exchange facility between pharmacists and GPs and other primary care professionals'

I hope this gets sorted - one example pharmcists are doing MURs (Medication Usage Reviews) and need to pass the information back ELECTRONICALLY to practices, not print it off and give to the practice to scan in. Same for all the other services pharmacies are now offering.

We managed to link all the practices with the labs for pathology, so if someone can design structured messages, we can do the same for practices and pharmacies (via DTS, so it's encrypted).

Oh, and can you please sort out discharge letters - I might retire before we get them up and working and I've been in NHS IT for nearly 18 years!

John Bishop EPS lead, Leicestershire HIS

The art of the possible...

03 Jul 07 12:07

>>Pharmacists in both primary and secondary care must be given role-based, read-write access to patient’s Care Records as well as the NHS Spine<<

It would be helpful if these requirements could be compared to what is (or conceivably might) be available from NCRS in the foreseeable future.

In particular the faltering of NPfITs 'vertical integretation' policy (i.e. that Lorenzo and Carecast [and now Millenium] would be extended out to non-hospital sites and users) has impacted on what can be achieved.

When will NPfIT publicly document what divergences there have been since the Output Based Specifications in 2003. All we get at the moment is the heavily spun "GP Summary=NCRS delivered".

Records for retailers?

03 Jul 07 17:07

Does this mean that everyone's medical record will be available in high street shops such as Boots and Superdrug? Maybe beauty salons and nail bars next? And restaurants to check for nut allergies??

Yes that's what it means

03 Jul 07 21:07

Yes that is what it means. It also means a High St shop will have access to ex directory and mobile phone numbers as well as information about mental health, drug and marital problems! Nice, perhaps the check out at Asda will have access to Spine too in case put Aspirin in your food shopping and are taking Warfarin. May be the Check Out girl can tell you about the interaction while you are paying with your debit card!! They can flag an alert with the read/write access that Aspirin is in your food shopping!

Childish comments...

04 Jul 07 11:07

Publishing such childish uninformed comments on such an important subject is disapponting. Pharmacists are among many professional groups including nurses, radiologists, microbiologists, ECG technicians, physiotherapists, dieticians etc who need basic information on their patients - Active Problems, Allergies, Adverse Drug Reactions, Current Medication - to do their job properly and safely. Let's move on from these facile comments and start real discussion on how best to achieve the IT integration and support which our patients expect and are usually suprised to find out that it isn't already in place.

Childish or pompous?

04 Jul 07 11:07

Some comments on this post may appear childishly expressed (I didn't make them). But the problem for CRS advocates is that they are, in essence, true. If CRS advocates wish to make progress in rendering their proposals acceptable to the public, they will have to engage with the real difficulties presented - however childishly - and find responses that are more convincing than pompous dismissals of real problems.

Re: Childish comments

04 Jul 07 11:07

Sarcasm may be the lowest form of wit but serious appeals (and more subtle forms of humour) appear to have been lost on CfH in seeking robust reassurances on who will have access to CRS! Boots outlets in most towns are primarily shops (selling everything from chocolates to batteries): the pharmacy function is typically relegated to a small corner of the retail unit. So there is a legitimate issue about developing a shared understanding of where the boundaries should be drawn in extending access to CRS, both geographically and in terms of individual practitioners.

The previous comment resonates with CfH's failure to recognise and address the ongoing concerns of many people about who will access their data as well as the unease about the fact that the list is still growing.

I'd also challenge the assumption that there is a core set of basic health data that all practitioners need. A previous history of a sexually transmitted disease may be of great relevance to a microbiologist and probably a radiologist. But an ECG technician or a dietician to do their job safely? I'd take some convincing!

Ex directory

04 Jul 07 12:07

Pharmacists have had access to ex-directory numbers for at least the past seven years. People always seem to whine when something they thought didn't happen (but actually does) is in the public eye again.

Multiple connections

gjamie@doctors.org.uk

04 Jul 07 21:07

Pharmacists are already connected directly through modems or corporate networks to wholesalers and central management. I will be interesting to see how a full CRS connection can exist on the same computer as all of the other pharmacy management functions. There is a lot of data moving about in proprietary forms.

Medicines Review, Networks and security

06 Jul 07 09:07

I mused a while ago about how Pharmacists might conduct an effective Medicines Review without access to the clinical records (and NCRS may not be the right one at all).

This could be a new benefit of the technology, but do they really need to see the GP record, or the Summary Care Record ? And how complex does GPSoC, and a splintering NCRS make this ?

On networking. For ETP, larger pharmacy chains have been routed through their corporate networks, and these interlinked with N3. For smaller pharmacy chains, they are advised to take a connection to one of 4 ISPs approved for the purpose. These links are unlikely to be adequate for full interactive use.

On Security, let us not forget that for ETP, because this does not give them access to anything other than the script, a single Smartcard for the pharmacy, signed on and left in all day, has been accepted. This will have to change.

And we are told that performance is dreadful, so many pharmacists have done the test barcode, taken the money, and reverted to handling paper scripts.

Such is the lack of joined up thinking in, delivery from, and ability to support a changing NHS under the CfH regime.

Access to CRS core data set

06 Jul 07 10:07

Obviously more work needs to be done to accurately define exactly what data will be included in the CRS core data set and how much access each professional group/specialty will have to this data. Should a dietitian or EGC technician be able to view the same information as a pharmacist, should a pharmacist working in secondary care have more access than in primary care? These are important - possibly medico-legal - issues and CfH must engage with the various clinical professions and the public to decide what level of access is deemed reasonable for each professional group.

In the interests of Patient care!

10 Jul 07 23:07

I am shocked and suprised at some of the comments made by supposedly intelligent and well informed indviduals, unfortunately this makes me agree with Mr Grangers comments today about supposed professionals. Do we forget that improving Patient care is one of the key goals of the National Program and that access to a summary record by highly qualified Pharmacists to ensure that the drugs dispensed are correct and do not conflict with other drugs or problems the Patient may have is a good idea for me and you? Do people not realise current Pharmacy systems (and many other systems including non healthcare related) contain demographic information (and suprisingly much more) about the Patients anyway including all dispensed drugs etc?? Would it not be better to ensure this data is upto date and securly accessed by relevant staff via RBAC (please note a Pharmacy system is not connected to the tills at the front of a shop, as suggested, and many Pharmacists would be annoyed if they saw people suggesting that they are only shop keepers). Can we stop wasting time, get on with our jobs and remember the next time you go to the Pharmacy it would be really good if the Pharmacist picked up you were allergic to an an ingredient in a drug which had been Prescribed, instead of ending up in a local hospital Emergency Department or worse!

Re: In the interests of patient care

11 Jul 07 08:07

As the originator of one the "offending" comments can I perhaps offer a perspective? I'm equally shocked by the non-critical way in which some professionals have bought into the CfH storyline on NCRS.

Firstly, A & E departments are not full of patients who are allergic to pharmaceutical ingredients. Neither are the coroners' courts dealing on a day-to-day basis with deaths from these. So let's not overstate the problem. Secondly, many people (myself incuded) remain to be convinced that the proposal CRS will address this hypothetical problem: how will it be kept up-to-date, for example? And what about concerns about security and confidentiality? So let's not under-estimate the challenges of implementing the proposed solution.

Pharmacists as shop-keepers? Go and look at what's on sale in your local chemist's shop!