Shared Care Records (ShCR/LHCRs)

Shared Care Records (ShCR/LHCRs)

Shared Care Records (otherwise known as ‘ShCR’, ‘Local health and shared care records’, ‘LHCRs’ or simply ‘records’) are patients’ electronic health records. ShCRs include information from multi care settings e.g. GP practice and secondary care. The majority of English patients live within an area with a records project ongoing.

Shared care records are emerging across the country and the IT has been maturing so that over time more health and care professionals can access these and more easily. In some areas LPCs have identified their ShCR project team from the records list and worked with the ShCR project team so that pharmacy teams can access ShCRs.

PSNC is supportive of Local Pharmaceutical Committees (LPCs) and local pharmacy contractors supporting community pharmacy involvement and ability to access and record into these records so that pharmacy team members can access or record information at the right time to better support patient care. ShCRs provide a back-up for Summary Care Records (SCRs) but also include richer information compared to SCR. The NHS Long Term Plan set out that ShCRs should eventually replace the need for frequent use of the SCR.

Overview

NHS England previously announced areas chosen to become ‘Local health and shared 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.

Why pharmacies need access?

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

ShCR project teams plan to get more information into records 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 studies

Community pharmacy contractors in Dorset are connecting to health and social care records held within the Dorset Care Record (DCR), a type of ShCR 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 records projects being undertaken across England.

ShCRs 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 ShCRs and more professionals across multiple care settings will be able to share their patient records held in their clinical systems via records.

PSNC and the Community Pharmacy IT Group (CP ITG) encourage contractors and LPCs to get involved with records 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.

How one North Dorset pharmacist used DCR?

David Rose, who runs the independent Marnhull Pharmacy in North Dorset, says his pharmacy, which is next door to the village surgery, has been massively busy.

“We’ve found that patients have come to us rather than to the GP surgery to help them with their prescriptions. Sometimes, they’ve found that the computer has said “no” and we’ve had patients who don’t understand why. We can look at the DCR to get an idea about their medicines before speaking to patients, which helps improve consultations.”

Some examples of how the pharmacy has used the DCR recently to resolve issues include:

  • Looking at letter from Dorset County Hospital which are visible on the DCR. A patient was asking if eye drops had been prescribed after an ophthalmology appointment. The patient had phoned the GP surgery but had not waited as had been told he was twelfth in the queue. The letter said no treatment needed now but will be reviewed a follow up appointment.
  • Helping a patient deal with a GP prescription for two strengths of Co-Beneldopa which did not make sense. The DCR showed the GP had forgotten to cancel the lower strength prescription.
  • Aiding a patient who had not received an expected prescription despite having telephone consultations with their GP. The DCR GP record section showed the prescriber sometimes forgot to issue.
  • Telling a patient that they could not issue Methotrexate for rheumatoid arthritis – the pharmacist could see on the DCR that a blood test was overdue.

His team is using the DCR regularly and he believes it contains extra information not available in other systems that they use and helping ensure patient safety: “We are using the DCR to ensure we prevent errors before they occur.”

And he has also been encouraging other pharmacists to use the DCR more often – saying the up to date information, particularly around discharge medications is extremely useful.

Other reflections 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.

Areas & champions

The announced areas:

Local health and shared 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 pharmacy records champions: ShCR project teams that would like to get in contact with the pharmacy records champion for their area can contact it@psnc.org.uk so that PSNC can connect the records project team to the pharmacy records 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.

Even non-exemplar areas will have local records project (see the ‘List of records projects’).

Records lists

Engagement & events (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 records.

Pharmacy contractors or LPC representatives that attend records-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 records information may also request to join the Community Pharmacy Digital records sub-group. Please contact PSNC’s IT team with ‘Records group’ in the title to ask to join.

Technical challenges: If the records 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 ShCR managers may need to provide a complete and stable list of nww addresses for the aggregators to use.

ShCR events

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

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

Standards

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 local records core dataset.

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

IG and regulatory

IG

NHSX with the support of a ShCR IG steering group has developed a ShCR IG framework (first published September 2021). The framework is intended to help Integrated Care Systems (ICSs), ShCR project teams, LPCs and others 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 ShCR managers that state to LPCs in writing that IG reasoning is delaying pharmacy access to ShCR information. PSNC can use such email examples during its discussions with the NHSX ShCR and data policy teams.

Beginning to access local records

PSNC’s recommendations are that:

  • contractors within areas in which pharmacy contractors have ability to access the ShCR 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 ShCR 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.”

Local records and SCR access

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

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

Using records

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

Pharmacy teams report that there are scenarios for them in which viewing ShCRs 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 ShCRs. Initially it is expected ShCRs 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 ShCR system so that the same supplier can easily integrate with many of the ShCR 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’ ShCRs? Why would I use them?

ShCR records may include more than SCR with Additional Information records i.e. the ShCR ‘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 ShCRs. That ‘ShCR standard’ may be further developed as ShCRs 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 ShCR (e.g. greater use of ‘structured’ relevant fields and lesser use of ‘free-type’ notes fields.

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

If you have access to ShCRs within your area, then use of the ShCRmay 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 ShCRas 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 ShCR system (in case the ShCR system goes down);
  • many pharmacy contractors do not yet have access to ShCRs; and
  • there might be scenarios where a contractor with knowledge of their ShCR 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/ShCRs so that separate portal access would not be needed.

Q. My service specification or SOP states that I need to check SCR, but I have access to the ShCR and my ShCR has the same info and more. Can I use ShCR instead of SCR?

Yes. Many specifications and SOPs will reference SCR given that ShCRs are a new development and given that many areas do not yet enable ShCR access by the community pharmacy professionals.

Over time, specifications and SOPs are anticipated to be updated to specify that a relevant record (e.g. SCR/ShCR) will be able to be used. See also: the FAQ immediately above.

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

NHSX developed a ShCR 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 ShCR information and enable health and care staff to also record into ShCRs?

Initially it is expected ShCRs 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 ShCRs 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 ShCR 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 ShCR project. This would enable clinical system providers to more easily integrate with multiple ShCR 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 ShCR 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 ‘ShCR group’ in the title to ask to join.

 

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