Local Health and Care Records (LHCRs)

Local Health and Care Records (LHCRs)

NHS England previously announced areas chosen to become Local Health and Care Record Exemplar (LCHREs) project areas. LHCREs are a group of organisations working in collaboration to create a safe, secure and trusted information-sharing environment. These partnerships received funding to put in place an electronic shared local health and care record which makes relevant patient records available more quickly to those involved in that patient’s care and support.

PSNC is supportive of Local Pharmaceutical Committees (LPCs) and local pharmacy contractors supporting community pharmacy involvement and ability to access and record into LHCRs so that pharmacy team members can access or record information at the right time to better support patient care.

LHCRs could provide an additional back-up for Summary Care Records (SCRs) and also the NHS Long Term Plan had suggested that LHCRs may eventually replace the need for frequent use of the SCR.

Why pharmacy LHCR access is crucial

LHCRs contain extra information compared with SCR with Additional Information – e.g. important vaccine information.

LHCR project teams plan to get more information into LHCRs beyond the limited GP record and to include more hospitals information, community health teams and social care, specialist clinics etc. to enable those caring for patients to have a fuller picture – reducing the need for patients to repeat themselves and protecting them from higher risks when medicines information is ‘missing’ to the community pharmacy.

Case study: Dorset Care Record

Community pharmacy contractors in Dorset are connecting to health and social care records held within the Dorset Care Record (DCR), a type of LHCR system.

Background

Primary care professionals, including community pharmacists, have been creating electronic records of their interactions with patients for many years. Previous consideration was given to the NHS creating a national comprehensive records system, collating information from different types of care settings, but the NHS Long Term Plan changed the focus to continuing and expanding the LHCR projects being undertaken across England.

LHCRs pull together information on a patient from several sources, such as GP and hospital records, so they contain extra information compared to the NHS Summary Care Record. In time it is hoped that pharmacy systems may be able to display medicines information from LHCRs and more professionals across multiple care settings will be able to share their patient records held in their clinical systems via LHCRs.

PSNC and the Community Pharmacy IT Group (CP ITG) encourage contractors and LPCs to get involved with LHCR projects within their area.

What is the Dorset Care Record (DCR)?

The DCR collates records from hospitals, GPs, local authorities and Dorset HealthCare, so it contains extra information when compared with the NHS Summary Care Record Additional Information (SCR AI). Community pharmacists have been given access to the DCR to give them a fuller picture of the patient’s medical and care history. The record reduces the need for patients to repeat themselves and lessens the risks of medicines information not being visible to the pharmacists and technicians.

Benefits

Community pharmacy professionals can use DCR to:

  • get an idea about medicines adherence before speaking to patients, which helps optimise consultations and the provision of services;
  • care for those patients after discharge from hospital;
  • check blood results to assist with medicines discussions;
  • support professional decisions regarding emergency supply options;
  • see why a particular medication was started (sometimes missing from SCR AI); and
  • carry out an additional check if medicines have changed or stopped, to help make sure that the right medicines are available for the patient.

Community pharmacy is the first sector outside the acute and community hospital and social care settings to be given access to the DCR portal, and Dorset Local Pharmaceutical Committee (LPC) has been actively supporting the project.

Reflection on community pharmacy access to the DCR

Robin Mitchell, from Victoria Park Pharmacy in Dorchester has been using the DCR and  reflected that:

“Access to the DCR provides community pharmacists with detailed information that complements other sources such as SCR and will be very relevant to situations such as hospital discharge or minor illness consultations. A welcome resource.”

Amanda Moores, Chief Officer at Dorset LPC added:

“We are very pleased that community pharmacies will have access to the DCR. This supports their integration in the local health and social care system. Community pharmacies play a key role in supporting patients to make the most of their medicines and manage long term conditions. The DCR supports patient care by providing pharmacies with access to up to date information, which is crucial, especially in these challenging times.”

And Peter Gill, DCR Senior Responsible Officer said:

“We are also introducing discharge medications into the Dorset Care Record from Dorset County Hospital and this will be particularly beneficial for community pharmacies.”

Advice for contractors within Dorset

Community pharmacies across Dorset have been contacted about how to connect to DCR and obtain login details. Contractors within the area can find out more at Dorset LPC’s DCR webpage, the DCR website or by contacting the DCR project team.

Further info

Read more about records projects and how to get involved at: On this webpage; Electronic health records; and PSNC’s list of local and national record projects.

LHCR areas and pharmacy LHCR champions

The announced areas:

Local Health and Care Record Exemplar areas may include: Local Pharmaceutical Committees (LPCs) areas may include: Community Pharmacy LHCRE champion(s) include:
Yorkshire and the Humber (covering West Yorkshire, South Yorkshire, North Yorkshire and Humberside) Community Pharmacy Humber; Community Pharmacy West Yorkshire; and Community Pharmacy North Yorkshire David Broome
Thames Valley and Surrey (covering Buckinghamshire, Oxfordshire, Berkshire and Surrey, Wessex) Bucks LPC; Pharmacy Thames Valley; and Community Pharmacy Surrey & Sussex James Wood
Greater Manchester Greater Manchester LPC (Being selected)
Wessex Dorset LPC, Community Pharmacy South Central Amanda Moore (Chief Officer, Sefton LPC) and Deborah Crockford (Chief Officer, Community Pharmacy South Central)
One London

South London: Bexley, Bromley & Greenwich LPC; Croydon LPC; Kingston, Richmond & Twickenham LPC; Lambeth, Southwark & Lewisham LPC; and Sutton, Merton & Wandsworth LPC.

 

North London: Barnet Enfield and Haringey; Brent and Harrow LPC; Camden & Islington LPC; City & Hackney LPC; Ealing, Hammersmith and Hounslow LPC; Hillingdon LPC; Kensington, Westminster & Chelsea LPC; Middlesex Group of LPC; and North-East London LPC

Vikesh Patel

Contacting LHCR champions: LHCR project teams that would like to get in contact with the pharmacy LHCR champion for their area can contact it@psnc.org.uk so that PSNC can connect the LHCR team to the pharmacy LHCR champion(s).

Digital Health News reported further areas expected to be funded may include: Lancashire and South Cumbria plus Cheshire and Merseyside, the Great North Care Record and the South West. Those areas might be subject to change.

Media updates: Dorset Care Record blog update.

List of LHCRs/EHRs

Supporting pharmacy LHCR access (info for LPCs/others)

PSNC encourages organisations that are working on local record sharing initiatives to contact local community pharmacy contractors and Local Pharmaceutical Committees (LPCs) to discuss how they may be able to participate in local developments. PSNC has also prepared a PSNC Briefing: Principles for implementing pharmacy access to local EHRs or LHCRs.

Pharmacy contractors or LPC representatives that attend LHCR-related events may wish to familiarise themselves with the briefing above.

LPC chief officers and members, as well as pharmacy contractors supporting pharmacy access to LHCR information may also request to join the Community Pharmacy Digital Local Health and Care Records (LHCRs) sub-group. Please contact PSNC’s IT team with ‘LHCR group’ in the title to ask to join.

Technical challenges: If the LHCR information is stored within the ‘nww’ area of the internet given that community pharmacies do not yet have access blanket access then the supplier’s aggregator may need to whitelist the relevant nww addresses. A list of pharmacy aggregators is found at: HSCN/N3/aggregators. If your system supplier is managing your HSCN/N3 connection they can contact the aggregator to ask that relevant nww addresses are fully whitelisted. Your pharmacy system supplier might also need to whitelist addresses as well. For a template form contact it@psnc.org.uk to assist with this process. The LHCR managers may need to provide a complete and stable list of nww addresses for the aggregators to use.

LHCR events

(No upcoming events have been reported to PSNC as occurring soon.)

Please contact PSNC’s IT team if there is an upcoming LHCR event that is open to volunteers, and which can be listed here.

Standards and LHCR contents

The Professional Record Standards Body (PRSB) is working with NHS England to support LHCREs. This work aims to standardise the core information that’s shared in a local health and care record so that the information that’s needed by health and care professionals can be available at the right time to better support patient care. PRSB’s view is that it is also important that information can be easily accessed even if a patient is in a different part of the country.

PRSB explain their intention with the development of their standard for a LHCR core dataset.

Frequently asked questions on the topic have been answered on their PRSB LHCR FAQ webpage.

Data security

An LHCRE IG steering group has been developing a LHCRE IG framework working document. The steering group includes IG Leads for each LHCRE area. The framework will incorporate comments from others.  The framework is intended to help LHCRs to demonstrate compliance with the law, gain trust from patients and provide consistency of approach and reduce burden for patients and healthcare professionals. PSNC has pressed for the framework to be compatible with the principle that information that’s needed by health and care professionals can be available at the right time to better support patient care.

LPCs, where required, can contact PSNC’s IT team if they become aware of LHCR managers that state to LPCs in writing that IG reasoning is delaying pharmacy access to LHCR information. PSNC can use such email examples during its discussions with the NHSX LHCR team.

When to use LHCRs?

LHCRs provides additional information in comparison to Summary Care Record (SCR).

Pharmacy teams report that there are scenarios for them in which viewing LHCRs is a good alternative instead of having to access the  SCR or contact the GP practices.

The Royal Pharmaceutical Society (RPS) has published a one-page factsheet which explains the scenarios in which to use the health records. The decision as to when to use health records is a professional one.

RPS using EHRs tool thumb

Listed scenarios

Checking medication details
• Prescription unclear
• Patient can’t remember/unsure about medicines
• Emergency supplies
• New patient to the pharmacy
• Checking possible dispensing/prescribing error
• Checking interactions with:
• Prescribed medicines
• OTC medicines
• Herbal products and supplements

Checking information about the patient
• Drug allergies
• Previous ADRs
• ‘Additional information’ such as care plans/blood test results, immunisation history, intolerances

Other:
Check eligibility for other pharmacy services (e.g. NHS flu jab)
• Supporting self-care
• Access to clinical information out of hours
• Safe and efficient alternative to contacting GP for clinical information

Supplier integration/info

In the future, pharmacy system suppliers as well as other clinical system suppliers may be able to display information from LHCRs. Initially it is expected LHCRs will mainly be used in many sectors via online portal systems.

Integration standardsCommunity Pharmacy IT Group (CP ITG) have identified that there needs to be a standard approach for supplier integration with any LHCR system so that the same supplier can easily integrate with many of the LHCR systems if integrated with a single one of them. This feedback was passed to NHS Digital to help inform its standards work.

Regulatory

Beginning to access LHCRs

PSNC’s recommendations are that:

  • contractors within areas in which pharmacy contractors have ability to access the LHCR system, urgently take up this important opportunity; and
  • contractors and LPCs continue to support pharmacy access.

PSNC and RPS wrote to NHS England and NHS Improvement (NHSE&I), NHS Digital and NHSX to explain that all pharmacists need be able to access LHCR systems wherever they are put in place and whichever pharmacy clinical system is being used. Read the letter in full here.

Liability

The General Pharmaceutical Council comments regarding liability:

“Pharmacists’ access to patient medical records is a welcome and positive step towards enabling pharmacy professionals to deliver improved outcomes for patients. We believe that access to records will increase dialogue and communication and improve collaboration with other healthcare professionals. Whilst this is not a new area for some of the profession, for example those working in hospitals or those who work as prescribers, we recognise that this is a developing area for community pharmacy.

A pharmacy professional’s responsibility is to make the care of patients their first concern. Pharmacy professionals who can access patient medical records must ensure that they apply the principles and requirements of conduct, ethics and performance to any additional information that they can access as result of these changes. Our standards make clear a Pharmacy professional’s responsibility in relation to confidentiality and consent, as well as ‘getting all the information you require to assess a person’s needs in order to give the appropriate treatment and care.

Pharmacy owners are required to meet the GPhC’s Standards for Registered Pharmacies. Under the first principle in those standards, concerning governance, standard 1.7 requires information to be managed so as to protect the privacy, dignity and confidentiality of patients and the public who receive pharmacy services. Our inspectors would explore the pharmacy team’s use of the record as one evidence source when assessing the pharmacy’s performance against the standard.”

LHCR and SCR access

Contractors with access to LHCRs may opt to access a patient’s LHCR record as an alternative to accessing a patient’s SCR record, for relevant scenarios, given that LHCRs contain more and richer information. However, even contractors with a LHCR system available to them, and that use LHCRs often, SCR is a useful back-up (in case the LHCR system experiences an outage).

An ability to be able to access to SCR is also part of the pharmacy terms of service.

FAQs

Q. What clinical information is within patients’ LHCRs? Why would I use them?

LHCRS records may include more than SCR with Additional Information records i.e. the LHCR ‘fields’ may include:

medicines, allergies, notes, adverse reactions, reason for medication, immunisations, significant diagnoses / problems, significant procedures, end of life care information and patient preferences, other anticipatory care preferences, and more.

The Professional Record Standards Body (PRSB) worked with health and care staff to develop an expected template for that information which can be accessible within LHCRs. That ‘LHCR standard’ may be further developed as LHCRs becomes more widely used. In the years ahead health and care staff may access systems that enable the right information to more easily be recorded into the right place of the LHCR (e.g. greater use of ‘structured’ relevant fields and lesser use of ‘free-type’ notes fields.

Q. Would accessing a patient’s LHCR provide an alternative to accessing their SCR?

If you have access to LHCRs within your area, then use of the LHCR may provide an alternative to use of SCR for some situations.

There is a requirement in the terms of service for NHS pharmacists who use SCR to use it, if they consider, in their clinical judgment, that it is in the best interests of the patient to do so. However, many contractors will opt to use LHCR as an alternative and may therefore determine they will not need to also access the SCR, depending on the scenario.

From 9th November 2020, pharmacy contractors have also had to ensure that relevant staff working at their pharmacy can access SCR and that access is consistent and reliable during the pharmacy’s opening hours, in so far as that is within the control of the contractor. This requirement remains in place given that:

  • SCR provides a contingency option to a pharmacy contractor with access to a LHCR system (in case the LHCR system goes down);
  • many pharmacy contractors do not yet have access to LHCRs; and
  • there might be scenarios where a contractor with knowledge of their LHCR system and knowledge of SCR and its interface, opts to use SCR.

Pharmacy contractors have also reported to PSNC that in future they would like for clinical systems to be able to integrate with SCR/LHCRs so that separate portal access would not be needed.

Q. Are there standard data security and information governance (IG) arrangements which support the appropriate use of LHCRs?

NHSX developed a LHCR IG Framework. It intends to support appropriate operational and technical arrangements but enable health and care staff have the necessary access to information for providing patient care.

Q. Will PMR suppliers and other clinical suppliers be able to read LHCR information and enable health and care staff to also record into LHCRs?

Initially it is expected LHCRs will mainly be used in many sectors via online portal systems. In the longer term, pharmacy system suppliers as well as other systems used by other clinicians may be able to display information from LHCRs as well as enable health and care staff to record relevant auditable data into the records. PMR suppliers may increasingly enable integration with SCR and LHCR information in the future.

PMR suppliers have reported to the Community Pharmacy IT Group (CP ITG) that they would like for NHSX and NHS Digital to further explore whether a standard process should be developed for integrating with any LHCR project. This would enable clinical system providers to more easily integrate with multiple LHCR projects.

Further info

Read more at:

If you have queries on this webpage or you require more information please contact it@psnc.org.uk. LPC chief officers and members, as well as pharmacy contractors supporting pharmacy access to LHCR information may also request to join the Community Pharmacy Digital Local Health and Care Records (LHCRs) sub-group. Please contact PSNC’s IT team with ‘LHCR group’ in the title to ask to join.

 

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