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 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 (Being selected)
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

(Being selected)

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 (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.

Supplier integration/info

In the future, pharmacy system suppliers as well as other clinical system suppliers may be able to display information from LHCRs. Intitially 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.

FAQs

Q. What clinical information is within patients’ LHCRs?

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. 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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