“Inadequate records are a risk to everyone,” said Nigel Clarke, outgoing chairman of the General Pharmaceutical Council (GPhC), at the Pharmacy Show before urging the case for pharmacists to have read-write access to medical records.

 

The history

 

The suggestion that pharmacists should have the ability to record in medical records (“write access”) has been a recurring theme in the last decade. On April 1, 2016 pharmacists were given read access to summary care records (SCR); this access is now part and parcel of the pharmacist role. In 2020, a requirement for consistent and reliable access was rolled out by amendment to the Terms of Service, and during the pandemic there was an expansion of the information that could be added to the SCR.

 

Legal next steps

 

Before write access can be implemented, much needs to be put in place. From a legal point of view, first the terms have to be defined. The Specialist Pharmacy Service has commented, when talking about retention of patient records, that “the definition of the ‘patient medical record’ is unclear”. Read access was given for SCR only. There needs to be a decision on whether write access will be implemented for SCR only, SCR with additional information or shared care records across the board.

Changes to legislation may depend on the model adopted, but at the very least they will involve amending the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 to update the Terms of Service.

Professional conduct and standards will have to reflect the expanded responsibilities. There are already standards for those using records (for example the new version of the NHS Records Management Code of Practice 2021 was published last month), but will the GPhC follow the General Medical Council (GMC) and the Nursing and Midwifery Council (NMC) and issue specific standards on recording information?

The importance of contemporaneous records was recently highlighted in a challenge to the suspension of the registration of a cosmetic surgeon, where it was clarified that the first step in determining the facts of a case is to establish what contemporaneous records say before considering the evidence from a witness.

Clarification on information governance issues would be required and building patient trust to obtain informed consent would be important.

 

Liability

 

From a legal point of view access is, of course, not without its problems. Professional regulation cases seem to fall into situations where pharmacists should have looked at the records, but didn’t (eg out of hours dosage and strength issues) and where pharmacists shouldn’t have looked at records, but did (eg Data protection or information governance issues). There are also potential liability issues if the records are considered, but the information in them is not used appropriately. Liability and professional concerns will, of course, became greater with additional access. The GMC regularly scrutinises inadequate and inaccurate record keeping.

As pharmacists’ clinical role develops further and prescribing rights become widespread, the question of pharmacists having write access to medical records is an important one. It could be said that this is an inevitable next step, but before that happens there needs to be a conversation about the legal small print.

 

Susan Hunneyball is a consultant solicitor at Gordons Partnership law firm.

The is a general overview and any views or reflections are the author’s own