Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
RCGP supports the use of Summary Care Records
- Clare Gerada, Stephen Field, Chair RCGP (16 June 2009)
-
Re: RCGP supports the use of Summary Care Records
- David J Maconochie (17 June 2009)
-
Re: RCGP supports the use of Summary Care Records
- Neil Bhatia (17 June 2009)
-
Sharing of patients' data
- Matthew Curtis (18 June 2009)
-
Continuity of record.
- Jonathan M Orrell (19 June 2009)
-
Harebrained
- Peter von Kaehne (19 June 2009)
-
Royal College is wrong
- Adrian K Midgley (20 June 2009)
-
No enrichment of the summary care record without explicit patient consent
- Chris Woods (30 June 2009)
|
|
|||
|
Clare Gerada, Vice Chair RCGP, Stephen Field, Chair RCGP
Send response to journal:
|
The Royal College of General Practitioners supports the use of the Summary Care Record (SCR). We had concerns over this scheme initially but now believe there are enough checks and balances to make it a significant move forward in patient safety and clinical care. Important changes to security have been made since the scheme was first introduced. The record is now held securely and can only be accessed using computers attached to the NHS Spine Network. An audit trail is produced whenever the record is accessed and a patient can request information about access to their record. A second concern raised is consent. The original model was based on the patient opting-out, but this has been changed to “consent to view.” Patients will now, except in certain circumstances, always be asked before their record is accessed. Patients can still refuse to have a summary record, can change their minds at any stage and can limit what is being shared. We believe this is a reasonable model offering the best protection of confidentiality balanced against the best access to information when appropriate. The third issue relates to professionalism. Some general practitioners see this as a threat to their position as guardians of the continuous health record, arguing that if other providers of primary care can access the patients health record one of the key tenants of general practice will be lost. We recognize this fear, but have more confidence in the intrinsic value of general practice - a value that far exceeds access to clinical records. With the variety of different care on offer and the range of conditions that patients suffer from, the need for a shared record is compelling. The SCR will produce faster access to up-to-date information about patients, improve the ability to deliver safer, more effective care, wherever the patient chooses to access that care. Competing interests: None declared |
|||
|
|
|||
|
David J Maconochie, GP Perth, Australia
Send response to journal:
|
The assumed benefits are minuscule, the cost utterly disproportionate and the implications for condfidentiality very real. The simple fact that it is possible to make inappropriate use of the record should be enough to persuade most people. It is a fact of human nature that if something can be abused then it will be abused. To say that it is a good thing because there are sufficient safeguards in place or that a patient must be consulted each time his record is accessed shows a disturbing level of naivetee, or worse complicity in political interference. Does any right thinking person really suppose that a GP record stating that a patient has a history of paedophilia, drug abuse, HIV carrier status, mental illness or any other stigma condition will remain confidential. Are we really to belive that in 5, 10 or 20 years the political climate will not have changed and that the police and social services will not feel entirely comfortable accessing anyone's health record on spec? Does anyone seriously believe that the option to opt out or to have the right to query the audit trail is going to be sacrosanct for very long? The answer is probably quite a few people. Those who will lose our freedom and privacy for us. Competing interests: None declared |
|||
|
|
|||
|
Neil Bhatia, GP Hampshire
Send response to journal:
|
The assertion that "the College" supports the use of the SCR highlights once again how hopelessly out of touch the RCGP is with frontline general practice.
No one has asked me - as a member of the college - whether I support the SCR either in principle or in the way in which it is being rolled out in those few PCTs so far. GPs - and their patients - have severe misgivings about this programme. Whilst some GPs accept that, for a few people, increased availability of certain aspects of their medical data might possibly be useful, the SCR is not the only way, and for many there are better ways of achieving this whilst ensuring that the patient remains in full control of all aspects of the data being shared and that trust between GP and patient is maintained. The decision as to whether their information should or needs to be shared widely, and by what means, should be an explicit decision for the patient to make in conjunction with the person that knows their medical history the best - their GP. Many GPs - and the LMC conference reflects this - do not accept that the SCR should be created with implied consent, requiring patients to opt out to prevent their data being processed in this way, and do not accept that a patient's SCR should be "enriched" without their explicit consent. Patients "cannot change their mind" because once their SCR has been accessed, or "should have been accessed" (whatever that turns out to mean), they will not be able to get their SCR completely deleted. They will not be able to place themselves in the same position as they would have been had they opted out of a SCR creation in the first place. The college hierarchy - including Dr Gerada and Professor Field - may have their own personal views on the SCR, and they are entitled to express them. But to state that the college as a whole is supportive is blatantly untrue - because the members of the RCGP have never been asked whether they support the SCR in principle and/or the policy of implied consent for SCR creation and enrichment. Competing interests: MRCGP and author of www.nhsdatabase.info |
|||
|
|
|||
|
Matthew Curtis, GP Partner Holycroft Surgery, Oakworth, BD21 1SA
Send response to journal:
|
The Summary Care Record Scheme is an important stepping stone on the way to a truly shared health record rather than the fragmented jumble of paper and partially computerised records that currently exists in most of the NHS. I am fortunate enough to work in an area that has been using shared records for a decade. I can view what has happened to my patients when they are seen by my colleagues working out of hours, in palliative care teams, in community nursing and medical outpatients to name but a few. More importantly these colleagues have access to the information that enables them to do their job more safely and efficiently. Most importantly my patients get better care and they know it. Competing interests: I am an Associate Clinical Lead (IT) for NHS Bradford & Airedale. |
|||
|
|
|||
|
Jonathan M Orrell, GP 25 Crescent Street, Weymouth, DT4 7BY
Send response to journal:
|
I totally agree with the careful and considered stance adopted by the RCGP. The safeguards are strong and sufficient now. In conversations with the general public most assume the NHS is a national health outfit that is working together to look after them. They do not appreciate its tribal nature with waring factions who do not willingly communicate vital information about drugs and allergies with fellow health professionals. It is time we dragged ourselves into the 21st century communications age. GPs no longer work 24 hours a day 7 days a week doing their personal on call. We need continuity of the patient record now we do not have continuity of personal care. I look forward to the improved care of the dying once this sensible scheme benefits more of the population. Competing interests: MRCGP Clinical lead NHS Dorset |
|||
|
|
|||
|
Peter von Kaehne, GP Scotland
Send response to journal:
|
The Royal College has never asked its members on what position to take in this matter. It has a proven track record to sign up to every stupid, harebrained and obnoxious government initiative. It also has a proven track record of producing even more harebrained, stupid and obnoxious ideas quite on its own. May I remind the readership of Michelin stars for GPs.... The college's credibility in this matter is therefore approaching zero. A centrally kept care record is at its core a mean to break the continuity of care by GPs, disempower patients and allow government and commercial monitoring and data mining of the most intimate and confidential data one can have. It should never happen. I applaud Dr Bhatia for working so ceaselessly to expose and sabotage the introduction of central care records and just hope that - irrespective of college pronouncements more and more GPs and patients will see this matter in the right light - a massive intrusion into our privacy without any real medical value. The LMC conference motion suggests that most of us GPs agree. Competing interests: None declared |
|||
|
|
|||
|
Adrian K Midgley, GP Exeter EX1 2QS
Send response to journal:
|
I think the Royal College is wrong about the sufficiency of safeguards. I think that CfH is wrong about the technical approach. Competing interests: None declared |
|||
|
|
|||
|
Chris Woods, general practitioner Bolton BL1 3RG
Send response to journal:
|
I am a Bolton GP and spoke at the recent LMC Conference. The Bolton motion was "that a patient must give explicit consent before their information is uploaded to create an 'enriched' summary care record." An enriched record contains additional significant information such as a disease summary as well as drugs and allergies. The BMJ kindly reported on the speech(1). The report mentions that "only 13 out of 55 practices in the area have so far agreed to go ahead because of concerns about confidentiality." There are a number of reasons why Bolton GPs are not uploading patient data. Bolton PCT was the first to pilot the summary care record and after careful consideration at that time, ie in 2007, the LMC opposed it on grounds of consent, confidentiality, cost and data security. The RCGP now appears to support the summary care record(2). As a College member I am concerned that the process of 'enrichment' may not have been dealt with comprehensively by the College. Bolton LMC opposes the enrichment of the summary care record without explicit patient consent. The Government has a poor record on the handling of personal information. Less than a third of patients are aware of their summary care record(3). It is not clear which groups will have access to the record. There may well be merit to the summary care record but patients need to know what is happening to their data. Let patients decide. No enrichment without explicit patient consent. Chris Woods general practitioner, Bolton, BL1 3RG (1) Cole A. Sharing patient data should not be based on implied consent. BMJ 2009;338:b2441 (2) Gerada C, Field S. RCGP supports use of summary care records. BMJ 2009;338:b2516 (3) Greenhalgh et al. Summary Care Record Early Adopter Programme. An independent evaluation by University College London. May 2008 Competing interests: None declared |
|||