Pharmacists may get access to patient care records

07 Apr 2008

The government has announced it will investigate how community pharmacy access to the NHS Care Records Service could be achieved.

The news comes despite BMA concerns about the impact on patient confidentiality of extending access to an additional professional group working in the commercial sector.

The newly-published white paper on community pharmacy, Pharmacy in England: Building on strengths - delivering the future, outlines the government's plans to look at pharmacy access to the CRS as part of its aim to extend pharmacists’ role within the NHS. It wants to give pharmacists a greater role in treating minor ailments, supporting patients with long term conditions and providing health promotion.

The investigation into pharmacy access to the CRS will include work with an early adopter PCT for the Summary Care Record (SCR) to look at the benefits, governance and practical arrangements of community pharmacists having access to the SCR.

The white paper adds: “This work and experience will be used to inform a key programme to consider how community pharmacy’s access to the Care Records Service might be achieved. This programme will include the Clinical Reference Panel, the National Advisory Group and Patient Advisory group, together with professional and representative organisations.”

Pharmacy bodies and MPs have been pressing for role-based read and write access to the CRS which they argue would enable better coordinated care between hospitals, GPs and pharmacies.

However the BMA has expressed reservations about the potential impact on patients’ confidentiality, particularly in a commercial environment.

The white paper acknowledges that there have been specific concerns about pharmacy access to the CRS and says it will be important to ensure mechanisms are in place to address concerns about patient consent and maintaining confidentiality.

The white paper also says that the government will look at how community pharmacists can access other parts of the NHS IT programme such as Choose and Book as they offer more clinically-orientated services.

It says further work is also exploring how the Electronic Prescription Service (EPS) could be developed to enable pharmacists to use it for other services that may involve the supply of a medicine, such as minor ailment schemes.

The white paper outlines the government’s intention to promote closer working relationships between GPs and pharmacists and says NHS Employers will set up a working group including pharmacy, medical and public representatives. The working group will start by looking at repeat dispensing and the EPS.

The white paper states that only 1.5% of prescriptions are currently issued for repeat dispensing which it describes as “disappointing.” It says that although prescribers may be waiting for release 2 of EPS before starting repeat dispensing there are issues that need to be tackled, such as patient recruitment and communication between prescribers and dispensers, whether prescriptions are issued on paper or electronically.

The white paper outlines a role for pharmacists in contributing to public health and says CfH will be asked to scope arrangements for electronically capturing information centrally about interventions made or advice given by pharmacists as part of the promotion of healthy lifestyles.

However it says electronic data capture will not be available immediately and adds: “Local work needs to start now on how best to support the recording of information using, for example, appropriate patients information where needed (such as the NHS number) and recognised clinical coding such as the Dictionary of Medical devices(dm+d) and Systematised Nomenclature of Medicines (SNOMED).”

The white paper further states that the government is also recommending that the GS1 system for radio frequency identification and barcoding should be adopted through the healthcare system in England for both products and coding systems used within healthcare settings such as patient identification codes on wristbands.

It says the use of auto-identification and data capture (AIDC) technologies in health care has been limited but that there is evidence of improvements to patient safety when coding systems are used to match patients to their care. Benefits include reduction in medication and dispensing errors, reduced risk of wrong-site surgery, accurate tracking and tracing of surgical instruments, equipments and other devices and much better record-keeping.

The white paper adds: “The case for coding is compelling but all patients need to work to commonly agreed standards if the benefits are to be realised fully.”

The government will now hold a series of public events on the white paper for patients and NHS professionals beginning on 1 May and intends consult on the key proposals later this year.

Related documents

Pharmacy in England: Building on Strengths-Delivering the Future

Reader's Comments

Where do we reaaly want to go?

dyfrig@bryndarland.co.uk

09 Apr 08 09:04

Who is going to train, review and support all these parapharmacists to see and treat 'minor illness'? Will they have indemnity insurance? Is it needed or is at another attempt to break a perceived monopoly? How far do you want the government want to spread your private information? I suppose that soon it will be quicker to count up the people who don't have access over those who do.

Commercialisation

09 Apr 08 10:04

Re comment "the BMA has expressed reservations about the potential impact on patients’ confidentiality, particularly in a commercial environment".

Aren't most GPs independent contractors?

This again smacks of protectionism to me rather than what is best for the patient.

Would access to the SCR be enough for safety?

maryhawking@tigers.demon.co.uk

10 Apr 08 08:04

There are a number of practical problems which would appear to be being ignored in this proposal, including not only confidentiality but the degree of access and the working patterns of pharmacists. Does anyone know how smartcards and RBAC are going to be managed for this scenario? Under ETP v1, the pharmacist logged on with the smartcard and all the dispensers used his/her logon. I understand that this was to be changed in ETPv2 - but has it, and how would the ways of working in pharmacies fir with the individual logons we use in the NHS? As a GP, I find that the pharmacies in my area seem to run largely on locums - especially the large chain ones: is it the intention that all pharmacists should be able to provide these minor illness, screening and LTC management services - and what training would be involved? Finally, how useful would the *current* version of the SCR be? It is only a summary, and the most ambitious extension so far is to include diagnoses agreed by the patient. I just cannot see that the contents of any SCR could ever be sufficient for the safe management of any long term condition! Role on patient handheld records for patients with long term conditions if they are to be managed in different environments: SCRs won't be adequate, and some patients might feel that giving unknown locum pharmacists access to the whole of their records as the quid pro quo for having their BP check might be a bit over the top!

Not on network

10 Apr 08 09:04

Why do pharmacists not use EPS ? Because they are not on the N3 network (with a complicated chain of networks to link them in), and because their dispensing systems have generally not been well integrated with the Spine (with a few exceptions). There seems to be far too few levers or incentives to make this better.

As comment 2, GPs are also independent contractors. If the government truly wants pharmacists (and opticians) to undertake wider roles, they should start with the basic infrastructure, perhaps reinvesting some of the savings from GPDSL to provide secure access.

They then need to create sensible working with the pharmacy system suppliers. And doubtless will dump the expanded needs for IT support on the local NHS organisations.

Not Connected?

ted.yeoman@nhs.net

16 Apr 08 14:04

When I parted companywith the EPS Project most Pharmacies in the PCT Area were connected to N3, Few Were using it but the connection was there. Of more concern is who is going to take responsibility for controlling access to patients records by Pharmacy staff when they move out of area? retire? locumn in other PCT areas? get struck off or are suspended? These Govenance concerns need to addressed in detail sooner rather than later.