Pharmacy guide

It is important that pharmacy professionals are able to use the SCR to support them in delivering safe and effective healthcare. 

phone-advice

Usage of the SCR by pharmacy professionals remains low. We understand misinformation has been generated and often it isn’t quite clear how and when you can access the SCR. This quick reference guide will support you in understanding how SCR can be used and also help dispel myths and misconceptions surrounding SCR.

What is a summary care record?

The Summary Care Record (SCR) is a ‘read only’ electronic patient summary containing key clinical information. It has been created with information held by a patient’s GP practice and is updated whenever there is relevant change. 

As a minimum the SCR contains: 

  • Medicines: Acute, repeat and discontinued repeat items (discontinued items will be dependent upon the GP system which created it)
  • Allergies
  • Adverse reactions

Additional information

Patients can choose to include additional information in their SCR. This includes information such as details of long-term conditions and significant medical history. You can find further information on additional information on the NHS Digital website.

Benefits to practice 

PATIENT SAFETY:

  • Reducing prescribing errors
  • Reducing patient harm and therefore reducing hospital admissions
  • Ensuring medication that is clinically appropriate is given to the patient
  • Better understanding of patient health. 

EFFICIENCY:

  • Reducing the number and duration of phone calls to the prescriber
  • Reducing assessment time
  • Being able to access required clinical information instantly
  • Reducing the number of faxes for communicating information.

EFFECTIVENESS:

  • Reducing patients' need to visit another care setting
  • Supply provided sooner
  • Enhancing customer loyalty
  • Improving advice given about medication
  • Increasing confidence in the profession
  • Improving patient convenience
  • Supporting seven day services.

Meeting the GPhC Standards for Pharmacy Professionals: 

In addition to supporting patient safety and practising efficiently and effectively, using SCR can also help you to meet the GPhC Standards for Pharmacy Professionals, namely:

There are other standards which you may also meet through use of SCR and other standards you will need to consider when using SCR, for example:

When should I use the SCR? 

These videos provide examples of how SCR can be used to support your professional practice. We would like to thank pharmacy colleagues from ASDA for developing these videos. 

To support with delivery of a Medicine Use Review To support with delivery of a Medicine Use Review

Patient prescribed antibiotics for a urinary tract infection at a home visit, but prescription had not arrived at a pharmacy. SCR helped to issue emergency supply Patient prescribed antibiotics for a urinary tract infection at a home visit, but prescription had not arrived at a pharmacy. SCR helped to issue emergency supply

Patient visited from out of town, used SCR to confirm medicine has been prescribed before to issue emergency supply Patient visited from out of town, used SCR to confirm medicine has been prescribed before to issue emergency supply

Call from NHS 111 requesting if an emergency supply can be issued. SCR used to confirm patient’s medications for emergency supply Call from NHS 111 requesting if an emergency supply can be issued. SCR used to confirm patient’s medications for emergency supply

When a new blood pressure medicine is prescribed, establish that previous blood pressure medicine has been discontinued When a new blood pressure medicine is prescribed, establish that previous blood pressure medicine has been discontinued

Confirm eligibility for flu vaccination Confirm eligibility for flu vaccination

Non-urgent situations such as supporting delivery of a medicines use review, new medicines service and over the counter sale of medicines Non-urgent situations such as supporting delivery of a medicines use review, new medicines service and over the counter sale of medicines

Patient going on holiday, prescription had not arrived, used SCR to confirm prescription was issued and was able to issue an emergency supply Patient going on holiday, prescription had not arrived, used SCR to confirm prescription was issued and was able to issue an emergency supply

Summary Care Record Decision Tool - RPS decision tool to support professional judgement for use of Summary Care Records (SCR) - England

 

decision-making-tool-2018

 

 

 

 

SCR Myths and Misconceptions

The SCR can only be accessed in urgent situations The SCR can only be accessed in urgent situations

Access to SCR can be very useful in urgent situations, however the SCR can be accessed in situations which are not considered urgent, for example to confirm eligibility for the NHS influenza vaccination service or even to check that a prescription has been issued by a prescriber.

You can only access the SCR for patients you have seen face-to-face You can only access the SCR for patients you have seen face-to-face

It is not mandatory to obtain face-to-face consent to access a patient’s SCR, consent can be given over the phone or a patient could even give ongoing consent (extended permission to view) for the pharmacy to access the SCR as appropriate. Refer to your organisation policy and standard operating procedure on accessing the SCR.

Patients cannot give you ongoing access to the summary care record Patients cannot give you ongoing access to the summary care record

Patients can give extended permission to view their SCR. This is particularly useful for patients with repeat prescriptions who do not often visit the pharmacy.

We are aware that some pharmacists feel uncomfortable accessing the SCR for patients who have provided extended permission to view, but they have not obtained consent from them personally.

It is of course necessary for the pharmacist to be satisfied that adequate consent has been provided for them to access the SCR. It is useful for anyone obtaining extended permission to view to keep appropriate records of this on the patient's PMR, so others who feel it is necessary to access the SCR, feel reassured that adequate consent has been given. Extended permission to view should be reviewed on a regular basis, so when this is discussed with the patient, it may be helpful to record this on the PMR.

You can find further information on extended permission to view in the consent section of this quick reference guide. 

Care home staff cannot give you permission to view by proxy for their patients on an ongoing basis, once they have got permission from their patients Care home staff cannot give you permission to view by proxy for their patients on an ongoing basis, once they have got permission from their patients

Care home staff can give permission to view by proxy for their patients. Permission should be obtained from patients or their carers and this can be used on an ongoing basis. You can find further information on extended permission to view by proxy in the consent section of this quick reference guide.

You shouldn’t access the SCR too many times You shouldn’t access the SCR too many times

There is no limit to how many times you can access the SCR. Pharmacy professionals should feel confident in using SCR to support delivery of safe and effective care in all situations where it is appropriate to do so.

 How to access the SCR

  • Ensure your smartcard is working. Contact your local Registration Authority for help with any issues with your smartcard
  • Complete the CPPE online SCR training 
  • Request the correct Role Based Access Control (RBAC) added to your smartcard profile. You will need to complete the form to request the SCR role addition to your smartcard. 
  • NHS Digital has produced Summary Care Record access guidance for locums in community pharmacy 
  • Make sure you know who your Information Governance/Privacy Officer is and their contact details and any associated process requirements specific to SCR
  • Make sure you are aware of your pharmacy’s Policy/Standard Operating Procedure regarding SCR access
  • Ensure you are logged in with your own smartcard
  • Access the portal at https://digital.nhs.uk/summary-care-records and then select “Launch Summary Care Record”. It is advisable to save this to your desktop or favourites
  • Search for the patient, ideally using NHS number but if this is not yet known, using surname, DOB, postcode etc
  • Select the right patient
  • Click the button ‘view SCR’
  • Enter brief reason for access (optional) e.g. MUR
  • Record permission to view
  • The SCR can now be viewed.

Consent

✓ Access records for patients to whom you have a legitimate clinical need

✓ Access records with informed, explicit consent. This is usually verbal but can be written consent - written consent may be agreed locally but is not necessary

✓ Remember to record the SCR access and associated advice/action on PMR

✓ Access SCR when logged on with your own smartcard

✓ Use emergency access when required for the patient’s best interest.

There are three types of consent that can be obtained from a patient:

  • Ask the patient directly each time
  • Get extended permission to view – useful for patients with repeat prescriptions
  • Get permission to view by proxy – useful for care home patients

Ask the patient directly for permission to view

You can get consent by talking to the patient face to face, or over the phone.

Most patients will not be familiar with the term ‘Summary Care Record’, and it will help them understand if you phrase the question to refer to their ‘GP Medication Records’ and also include why you need to view this. For example, “Mrs Jones, may I view your GP Medication Record? It will help me to check which prescription items you are on, so that I can offer a choice of painkillers that will be suitable for you to buy.”

Get extended permission to view

This is most appropriate for patients who have a lot of repeat prescriptions, and who you might not see face to face very often.

You can ask a patient once if they can give you permission to view their summary care record on an ongoing basis. If they agree, you should note this on their PMR and let them know they can change their mind at any time. You should also review this with them on a regular basis.

Get permission to view by proxy

This method helps community pharmacies provide services to patients in care homes.

Care home staff can give permission to view by proxy for their patients. They should get permission once from patients or their carers, usually as part of normal admission procedures, which can then be used on an ongoing basis. It is important that the care home makes sure patients understand:

  • the scope of the permission (one named individual or a range of authorised staff)
  • the length of time this permission will last
  • that they can refuse permission or change their minds and that their choices will be respected

This patient leaflet can help care homes explain summary care records to patients and make sure they fulfil Data Protection Act rules on fair processing.

The pharmacy and the care home need to establish their own procedures for recording and changing consent, to make sure patients’ choices are upheld and they are not bothered unnecessarily. Permission to view by proxy should be recorded on the patient’s PMR when it’s set up.

Governance

Patient identifiable data used by pharmacists and pharmacy technicians, whether accessed from national NHS care records or stored in local or networked systems is subject to relevant NHS IG requirements and existing GPhC standards on patient confidentiality. These cover many aspects of good practice in information management and security including prevention of accidental disclosure, security of hardware and software, staff training, management of critical incidents and various others.

Troubleshooting

If you are experiencing technical difficulties and can’t access SCR, please contact:

  • For smartcard issues - your local Registration Authority
  • Your usual IT helpdesk
  • National SCR programme. 
Details
 
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