GP bodies clash on SCR

Tags: Confidentiality consent GP GPs PCTs RCGP Safety SCR Security Summary Care Record

23 Jun 2009

The Royal College of General Practitioners has publicly backed the Summary Care Record following criticism of its consent model by GP representatives from the British Medical Association.

Professor Steve Field and Dr Clare Gerada, chair and vice chair of the RCGP, have written to the BMJ. arguing that the need for a shared record is compelling.

They add: “The Royal College of General Practitioners supports the use of the Summary Care Record (SCR). We had concerns over this scheme initially, but now believe there are enough checks and balances to make it a significant move forward in patient safety and clinical care.”

The letter was prompted by a motion at the National Local Medical Committees’ conference earlier this month. This said that patients’ data should not be shared on an implied consent basis. The motion was overwhelmingly backed by the GP representatives.

Widespread concern about the implied consent model for the SCR led NHS Connecting for Health to introduce changes to the system last year.

These mean that while information is still uploaded with implied consent, patients must give clinicians ‘consent to view’ their SCR at each medical encounter.

Drs Gerada and Field say patients can still refuse to have a summary record, can change their minds at any stage and can limit what is being shared.

They add: “We believe this is a reasonable model offering the best protection of confidentiality balanced against the best access to information when appropriate.”

The two leading doctors from the RCGP also argue against LMC representatives’ concerns about data security and the impact on GPs’ professionalism.

They say: “Some general practitioners see this as a threat to their position as guardians of the continuous health record, arguing that if other providers of primary care can access the patients health record one of the key tenants of general practice will be lost.

“We recognise this fear, but have more confidence in the intrinsic value of general practice - a value that far exceeds access to clinical records.”

The RCGP’s letter was backed up by letters of support for the SCR by some GPs but criticised by others.

Hampshire GP Dr Neil Bhatia, a campaigner against the SCR, said GPs and patients had severe misgiving about the programme.

He added: “The assertion that ‘the College’ supports the use of the SCR highlights once again how hopelessly out of touch the RCGP is with frontline general practice.

No one has asked me - as a member of the college - whether I support the SCR either in principle or in the way in which it is being rolled out in those few PCTs so far.”

His view was supported by Dr Peter van Kaehne, a GP in Scotland, who said the RCGP had never asked its members what position to take on the SCR.

He added: “A centrally kept care record is at its core a mean to break the continuity of care by GPs, disempower patients and allow government and commercial monitoring and data mining of the most intimate and confidential data one can have. It should never happen.”

Link: BMJ letters on the SCR

Fiona Barr

Reader's Comments

SCR and Consent Model

gji@nhs.net

23 Jun 09 20:06

I did not find the Conference of LMC's motion to be incompatible with the current SCR Model.

The motion argues against implied consent, but the current SCR model relies on an informed consent (to access) model.

The motion did not refer to upload, but to the sharing of information (which happens when the SCR is accessed).

Grant Ingrams Chairman, GPC IT Subcommittee Co-Chairman, JGPITC

LMC Motion

23 Jun 09 23:06

Dr Ingrams,

Exactly what bits of :

"believes an opt-in approach by the patient (or their appropriate representative) empowers patients to understand the implications of any transfer of patient identifiable clinical information from their record to a third party"

"believes that when releasing information on named patients it is not sufficient to assume implied consent "

do you think do not apply to the uploading of data to the SCR?

I think you know what the LMC conference was stating.

maybe not

cunpr@globalnet.co.uk

24 Jun 09 08:06

Sharing = distribution. SCR is a pre-emptive distribution in anticipation of sharing, otherwise why have it? Ergo the LMC confernce motion is incompatible. Also when broken down into its component parts the implied consent upload element is clearly incompatible. Difficult things motions, the point of the article was about RCGP Leaders making claims about those they represent that are at best untested. Regards Paul Cundy

please explain...

24 Jun 09 16:06

“A centrally kept care record is at its core a mean to break the continuity of care by GPs, disempower patients and allow government and commercial monitoring and data mining of the most intimate and confidential data one can have. It should never happen.”

How does the SCR break the continuity of care? I would have loved the various consultants I've seen during a recent period of care to have access to important things like a couple of allergies which caused delays to treatment while alternatives were arranged.

How does the SCR disempower me as a patient? I can't see or amend my records at a GP as it is.

How is this any different to GP's allowing third parties access to their data for commercial reason (apart from said GPs no longer getting paid for this)?

Finally, and this is a Scot asking, why should GPs or clinicians in Scotland be involved in discussions on a project based in England? Is Scotland finally joining the project?

GP records

Neil.Bhatia@nhs.net

24 Jun 09 16:06

"I can't see or amend my records at a GP as it is. "

Yes you can.

You just have to ask your GP if you want to see your records.

If you believe that aspects of it are incorrect, discuss it with your GP.

http://www.ico.gov.uk/upload/documents/library/data_protection/introductory/subject_access_rights.pdf

http://www.bma.org.uk/images/accesstohealthrecordsdecember2008_tcm41-183583.pdf

Technical points on patient's rights to change their mind or limit what is being shared.

30 Jun 09 10:06

From the article above (response from RCGP to LMC motion): --- "Widespread concern about the implied consent model for the SCR led NHS Connecting for Health to introduce changes to the system last year.

These mean that while information is still uploaded with implied consent, patients must give clinicians ‘consent to view’ their SCR at each medical encounter.

Drs Gerada and Field say patients can still refuse to have a summary record, can change their minds at any stage and can limit what is being shared." --- The point about changing minds and limits to sharing needs rigorous qualification as Dr Gillian Braunold, clinical director for the SCR - quite reasonably pointed out back in May. --- "Now patients who initially opt to have an SCR created will be able to request that their SCR is deleted unless the SCR has already been accessed, in which case the SCR will remain archived on the system."

Patient's therefore only have the opportunity to change their minds if the record hasn't been accessed (from the spine I think that implies) up to the point that it is first accessed.

see - http://www.ehiprimarycare.com/news/4872/patients_will_be_able_to_delete_their_scr --- What isn't made clear here is whether an access made by the patient themselves to view their own record via an advanced healthspace account would then also preclude the record being deleted, does anyone know?.

Regarding the RCGP statement that patients "can limit what is being shared" this also needs qualification.

How will that be achieved? Who knows how to achieve it? - (one assumes the RCGP know)

If that is via the concept known as 'sealed envelopes' - I'd suggest that is years away at best to be both reliable and consistent (I'd like to be wrong on that!!).

My own view is that having a sufficiently detailed record available to share amongst providers to sustain quality and safe care is (of course) a good thing - however, explicit patient opt-in and complete honesty and transparency about what is possible in terms of 'limits to what is shared' and the extent to which retrospective deletion is possible are essential if the public's trust is to be won.

To ponder - if it is not explicit opt-in how will patients decide on the limits of what is to be shared. Also while a

From a structural perspective and responding to other comments made in and responding to this article, it's probable that the original goals of the NCRS were an attempt by the government to 'disintermediate' the traditional GP role as keeper of the continuous record - this would also tie in with the emergence of PCTs around the same time and the increased role that they were expected to play. Clearly with the demise of the DCR (the original central goal of the programme) and the changing face of PCTs since then that has not happened (the DCR was too difficult - some things are - and the public clearly still want a relationship with their GP, I'm not a GP BTW) we are therefore left with an ugly compromise.

In summary - it appears that there is a 'real' conflict of views between LMCs and the RCGP and that this almost certainly revolves around detail and rigour rather than the general principles of appropriate sharing.

Valid points

Neil.Bhatia@nhs.net

30 Jun 09 15:06

"explicit patient opt-in and complete honesty and transparency about what is possible in terms of 'limits to what is shared' and the extent to which retrospective deletion is possible are essential"

Quite right, though I personally suspect much of the public will still not trust HMG with their info.

The BMA (and many of us GPs) have called for an explicit opt-in right from the start. So much for "clinical and stakeholder engagement".

Complete honesty and transparency - if only... one reason why I have tried to fill my site with as much information (and yes, my own personal opinions too) about the SCR, gleaned almost totally via the FOI Act (and sometimes not without difficulty).

There are now no "limits to sharing" - the "Red/Amber/Green" concept has gone. if you have a SCR, you agree to it being shared (whether or not you are asked for your permission before it is accessed). And as for sealed envelopes....my guess, it'll never happen. I suspect CfH will state that it is up to the GP to determine what is uploaded further ("enriched") to the SCR so the need for sealed envelopes is no longer.

Neil www.nhsdatabase.info