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Pharmacists 'so nervous' they won't access patient records

Dr Jill Loader said she is "really disappointed" with the low record uptake

Pharmacists are "so nervous" about accessing the summary care record (SCR) that they are only viewing it once a month, NHS England’s assistant head of primary care has said.

Dr Jill Loader said she is "very disappointed" that the average record viewing per pharmacy is "0.3 a week", despite 82% of pharmacies having completed training on SCR access.

It is "very difficult" for NHS England to "make the case for a shared record for community pharmacy" when "no one is really using it", she told delegates at the Pharmacy Show in Birmingham on Monday (September 26).

Accessing the SCR can improve clinical consultations, such as medicine use reviews, said Dr Loader, who also reminded contractors that the £200-worth of free SCR training ends after March 2017.

Only used "in extreme cases"

Former Royal Pharmaceutical Society president Ash Soni, who chaired the event on commissioning at which Dr Loader was speaking, pointed out that “miscommunication” during the SCR training could explain the low uptake numbers.

“I have heard from pharmacists that the training teaches them to access [the shared record] only in extreme cases,” he said. “A lot of people are seeing it as an exception, rather than the norm.”

Dr Loader said she had received “the very same feedback”, and suggested the “big responsibility” of having access to a patient’s medical history is another reason that pharmacists are wary of the SCR.

“People are so nervous that they don’t access the record,” she said. However, pharmacists need to “overcome those fears”, she added.

In August, C+D readers suggested that “clunky processes” and a “fear of the unknown” were contributing to low SCR uptake levels.

 Other pharmacists took to Twitter this week to try to explain the issues with SCR:

What's putting you off from accessing a patient's SCR?

Gerry Diamond, Primary care pharmacist

I use SCR as a triage pharmacist for OOH GP service and patients are always happy to give consent and the triage nurses have to ask and record consent for viewing SCRs. GP practices are different as the patients are registered to the surgery and have an expectation that their records will be accessed. Community pharmacists just need to be bold and access the records as it can really help resolve queries without having to wait for a call back or phone queue to speak to an unhlepful receptionist.

Janet NQ, Community pharmacist

Probably because there is no time

THB _B, Community pharmacist

Scr access is excellent. Since we went live it has helped us on a daily basis support our patients and provide more robust services.

Embrace the opportunity to be better healthcare professionals through the use of better tools. Its a no brainer. I would not go back to be being without scr!

Matthew Edwards, Community pharmacist

This again is a typical example of pharmacy unable to embrace change. Since qualifying I have used the SCR over 60 times as a way of sorting out problems at weekends.  My privacy officer is one of my dispensers and so there are no problems there, pick a member of staff that you know will be diligent and isn't afraid to air their views.  I have found that whilst not essential to my role in its current form it has proved useful.  Instead of moaning about it, use the new tools and suggest improvememts to NHS Digital.  Become part of the solution to improving pharmacy!

Z ZZzzzz, Information Technology

NHSD making changes to access without telling people would be a starter.  System suppliers actually having their software and ancillaries working within the WES (Warranted Environment Specification) specified by NHSD would also help in gaining access, never mind being able to use it for the benefit of patients.  The reason for inter-company POs is that NHSD did not receive any funding for on-going monitoring as they should have.  Instead their no-cost-to-them solution was to spin things so that companies would be their own police.  Yet another wonderfully negotiated settlement by our "friends" at PSNC who's mantra is always "well if we don't do it because it's not the complete package like we would want, then we will never get the DH agree to let us do even more" usually for nothing.  I wish PSNC would wake up and realise that everytime PSNC fool themselves like this the DH will always take advantage and have done for decades.  Ordinary pharmacists can see this, why can't PSNC? 

JOHN MUNDAY, Locum pharmacist

I agree with all the above. I was part of the original trial in Sheffield and was nervous about using it then. On the recent training we were told it was illegal to look at your own SCR then I stopped even thinking about it. We have enough I.G. folks waiting to pounce on us - why give them another excuse to drag you through hell?

David Pomfrett, Community pharmacist

Was told at training that scr use would be monitored and i could be asked to justfy using it
Not worth the hassle so not using it

David Pomfrett, Community pharmacist

Was told at scr training that my usage would be monitored and i would be asked to justify using will not use

Chandra Nathwani, Community pharmacist

I had reservations before on accessing SCR mainly due to liability issues. However, on giving some thought, I considered that the reasons why I access SCR is for clarification of an issue, which even if I did not have SCR access I would probably have to clarify by ringing the surgery. Now with SCR access at least I save the time by not having to queue up on the phone trying to get past surgery reception (which at weekends is not possible). One gripe I have on the quality of the SCR is that not all surgeries update the spine SCR records, in some cases I have found them to be upto 2 weeks old. HSCIC should perhaps try to automate GP uploads real time so what we see is upto date.

max falconer, Superintendent Pharmacist

For me it's all down to liability. This has not been clarified. Currently you would have to be mad to access SCR until this is sorted. First step, before we should even talk about using SCR, is to get dispensing errors de-criminalised.



Boom Shakalaka, Locum pharmacist

Consent issue really is a tedious issue! A one time consent should cover all services offered by pharmacies - simple solution for a "complex" problem

Paul Antenen, Pharmacy Area manager/ Operations Manager

Don't get hung up on the consent, a quick "is it ok if I have a look at your NHS record to check...out" is sufficient. I used it six times last Saturday when I was working, mainly to check if prescriptions had been issued. I find it far quicker to use than the tracker.

Janet NQ, Community pharmacist

I don't think 'checking if prescription is ready' is a justifiable reason to access clinical records

John Urwin, Community pharmacist

The new NHSBSA "Hints and Tips" newsletter disagrees with you!

Matthew Edwards, Community pharmacist

Suppose its better to blindly do an emergency supply?

John Urwin, Community pharmacist

Really? You don't think that having the knowledge that a prescription is in the pipeline might inform your clinical decision whether or not (and what) to supply a patient who has run out of meds at the weekend?

Barry Pharmacist, Community pharmacist

It is "very difficult" for NHS England to "make the case for a shared record for community pharmacy" when "no one is really using it". Can I make a suggestion? Don't make the case! We don't want it as it stands. It's an administrative headache and we need a far simpler system. Another example of the NHS wating money.

Valentine Trodd, Community pharmacist

Well said. I don't think it could be any clearer - pharmacists are not using the system, so they clearly don't want it. Bin it - another waste of money by the NHS.

Bal Singh, Locum pharmacist

Certain pharmacists have been trumping up SCR as their career making step. The lack of success would not benefit their career. 

Clive Hodgson, Community pharmacist

I have always considered SCR access in Community to be very much the case of a solution looking for a problem.

Valentine Trodd, Community pharmacist

I think the over zealous attitude over consent, with the spectre of 'big brother' Privacy Officer (or whatever they called it) looking over your shoulder every time you access the records is a large part of the problem. And of course liability... in a profession that you can still be jailed for an honest mistake. I will avoid SCR like the plague until these issues are sorted out.

If we can access the patients record on our own PMR willy nilly, which has their medication record, allergies, and whatever else miscellaneous info we care to put on why do we need to jump through hoops with consent on the SCR? If I can pick up the phone and ask the surgery if a patient is allergic to penicillin - does anybody ask me did I get consent? It's ridicuous. Everyone at higher levels is so obsessed with covering their backs that all these nonsense rules are implemented which make practical day-to-day use of the system almost impossible. It's the same with SOPs - don't have time to read 'em, not to mind implement them. But... when it all goes wrong, who'll be hung out to dry for not following the SOP? It won't be the area manager...

Dodo pharmacist, Community pharmacist

The main problem is the ridiculous privacy officer rules. We only have one pharmacist and no-one suitable for the privacy officer role, so we cannot access SCR. The other problem is having to get the patient's express consent to access every time. Do GP's have to get the patient's express consent each time to access their patient's records? Thought not. It makes pharmacists out to be second class health professionals having to grovel for consent for something that they consider necessary.

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