BMA says 'suspend SCR roll-out'

Tags: BMA CfH Data GPC GPs O'Brien SCR

10 Mar 2010

The summary care record roll out

The British Medical Association has written to the government calling for the roll-out of the Summary Care Record to be suspended.

In a letter to health minister Mike O’Brien, the doctors’ union claims the roll-out of the SCR has been accelerated before sufficient independent evaluation of the pilot areas has taken place.

It calls on the Department of Health to consider halting implementation in areas where Public Information Programmes have not yet started.

Dr Hamish Meldrum, BMA Council chairman, said: “The break-neck speed with which this programme is being implemented is of huge concern. Patients’ right to opt-out is crucial and it is extremely alarming that records are apparently being created without them being aware of it.

“If the process continues to be rushed not only will the rights of patients be damaged but the limited confidence of the public and the medical profession in NHS IT will be further eroded.”

A spokesperson for the Department of Health said the SCR was an important patient safety initiative widely supported by clinicians and patients.

She added: "We are surprised to have a five year time frame criticised as a 'break-neck pace' when the programme had been previously cirticised for its slow uptake.

"We absolutely support the right of any patient to opt out of having a summary care record and have provided various options to make this process straightforward."

The BMA said GPs had reported that the roll-out of the programme had left them without time to support patients in making an informed choice and claimed that in some cases records were being created without even implied consent from patients.

The letter, signed by Dr Meldrum together with Dr Laurence Buckman, chairman of the BMA’s GP committee, and Dr Deidre Hine, chairman of the BMA’s Working Party on NHS IT, calls for a halt to the roll-out of the SCR and the inclusion of an opt-out form in the information sent to patients.

It states that the BMA accepted limited roll-out of the SCR following the interim evaluation published in May2008 but wanted a review of the PIP and piloting of the new consent model before further roll-out.

The letter adds: “We are therefore very surprised and disappointed that a much wider roll out was announced in December 2009 and this is in progress counter to the BMA’s position.”

The BMA’s letter says the plan to complete PIPs across five strategic health authorities by the end of March is “impacting upon the level of patient awareness resulting in records being created without even implied or presumed patient consent.”

The letter says the BMA and GPC are also concerned about data quality in SCRs for those practices that did not complete the IM&T directed enhanced service which ended in March 2009 and claims that SCRs will also generate additional work for practices.

The BMA also criticises inclusion of a BMA view relating to the original independent evaluation which it says has been included in a CfB “promotional video” on the SCR.

The letter states: “We request that this BMA comment is removed from the video forthwith to ensure that there is no misrepresentation of the BMA’s position regarding the accelerated roll out.”

Fiona Barr

SCR consent model changes (18 Sep 2008) (7)
Gap between SCR concept and reality (31 Oct 2008) (1)
Letter errors fuel SCR roll-out row (09 Mar 2010) (11)
BMA says SCR roll-out ‘too hasty’ (01 Mar 2010)
London LMCs run own SCR campaign (26 Feb 2010) (11)
London SCR roll out complete in a year (09 Feb 2010) (7)

Readers Comments

Where is the PIP?

10 Mar 10 06:52

Patients are being mailed letters about the SCR with deadlines of up to 12 weeks to opt out should they so wish. Some of these are already known to have been delivered to the wrong addresses. The SCR website includes a lot of information about what should happen in a PIP (Patient Information Program) including publicity and staff and GP practice information and training - patient letters are only a part of this.

Where is the rest of the PIP?

AFAIAA the only element being rolled out is the patient letters...

192.com

10 Mar 10 08:03

Following a programme on last night on the Gadget Show, Channel 5. This showed that more 'less secure sensitive information' about everyone in the country is freely available from 192.com.

The Summary Care Record has been implemented extremely securely using 21st Century Technology, to not allow mis-use of information.

I was suprised to find that I could go to 192.com and find more information about peoples details than, than what is being suggested in the SCR.

SCR roll out

10 Mar 10 10:45

1). There has been extensive research done on the Pilots for the SCR led by UCL which actually incorporated the permission to view model which was adopted.

2). Some areas are rolling out the SCR in Waves. Therefore patients will be captured and have sufficient access to information in their practice, via their PIP letter, in local libraries and stalls will be set up at supermarkets and community centres to get the message across.

3). There will be an opt out form in the Pack sent to the patients.

4). A wave approach is more appropriate as the patients will be informed of the SCR and 12 weeks later one will be created. If you do a mass publicity campaign and contact everyone in the country at once. They may not actually get an SCR for another 2 years by which time they would have forgotten what they had consented or dissented to. People have to realise that not all GP systems are ready for SCR and the data quality may not be sufficient.

5).If a patient does miss the PIP letter or campaigns then there is a Deletion process.

Damned if you do damned in you dont

10 Mar 10 17:23

Wow, another case of Doctors egos trying to take over.

Since 2004 a major part of the entire national program was the summary care record. The delays have been blamed on the vendors and IT departments but I think this article proves that there is something very wrong elsewhere.

I see that this is categorical proof that certain areas of the medical profession have been dragging their feet and causing a lot of the problems we have seen over the past six years.

It has nothing to do with a lack of information from CfH, the Government, LSP's etc it is because some groups do not want to know about technology and how it will improve their working lives.

The entire Legitimate Relationships Service was designed to ensure only relevant people have access to data, then certain groups complained it was too hardcore. Come on, what do you want?

I spend a lot of time with medical personnel and 95% of Doctors especially the younger ones embrace technology, however as usual the 5% shout the loudest.

Instead of sulking can somebody just accept that Doctors are not the only intelligent people on this planet and allow some of the other mortal beings of this world work with you!

Really

10 Mar 10 19:27

Who owns these records, the GP's (who are contractors), or the NHS??? Are they holding out to be paid to supply SCR data, or are some worried people might find out data is inaccurate?

How can anyone honestly suggest that the SCR project is rushed, is this not what CfH have been building up to deliver for the last 5+ years!

Opt out forms and Decoupling

11 Mar 10 10:10

1) Not all areas (in fact I am yet to hear of one) are including the opt-out form in the pack sent out. in this area, patients need to request a form to be sent to them or attend the practice to collect one.

2) Because central funding of the mail-outs ceases on 31st March, many areas have 'decoupled' sending the PIP and uploading of data from practices. This means that, for some patients of practices who have systems unable to upload (eg EMIS PCS) it could be many months between the end of the opt-out period and the upload.

There is also the circumstance where a practices data does not meet the standard fro uploading, yet its patients will still receive the PIP and think they have an SCR.

Whilst I support the SCR, the unseemly rush to send out letters in order to meet the funding deadline is something whith which I disagree.

Not guilty but suffering all the same

11 Mar 10 10:57

I take the point about the CfH funding and feel that the decoupling of the PIPs from the go lives is not a good decision. However even areas where that isn't happening are being tarred with the same brush and having their carefully planned projects being put in jeopardy. Those areas where clinician and practice engagement has been undertaken with great care prior to mailing patients (and with practice agreement I might add) are suffering as a result of the negative press from the BMA statement.

Having read the letter from the BMA to the DH and the GPC guidance there are some discrepancies. In the GPC guidance released the day before the press release they are supportive of SHA wide PIPs but have not connected this with the problem of practices feeling unsupported or the process feeling rushed! If you ask me the main problem is that in some areas this project has been undertaken on a large scale with little or no engagement within the LHC.

The guidance then goes on to say that the GPC (and effectively the BMA) do not want practices to boycott the SCR. But what does the letter say? Oh yes, that's right. Stop everything. Now!

The downright misleading statements being bandied about by the press - patient records uploaded without consent - is a rather radical interpretation of the UCL report. The wonderful figure of 7 in 10 people were unaware of the SCR in early adopter areas was taken from a part of the UCL evaluation where 103 people were sampled, with the authors admitting that they skewed the sample to represent those with low health IQ.

All I'm saying is don't crucify the whole programme just because some areas have not done it well.

Oh and by the way - there is a general election coming up. The timing's a classic from the BMA.

General Election

12 Mar 10 09:21

>>- there is a general election coming up. The timing's a classic from the BMA.<<

Or could it be that Joe Voter is intended to see their letter and think "the big NHS computer system must be working so David Cameron was wrong"

Why do you think there's the unseemly rush to get the notification letters sent out right now - never mind the majority of practices aren't ready and deep concerns about data standards and maintenance remain.

Privacy issues? Maybe but these currently apply only to (ab)uses the records might be subject to by central government (q.v. DVLA records, memory sticks on trains etc)... hardly any clinical users have the facility to view these records!

Sadly there is NOTHING done or said about the NHS that isn't first, second and third a disingenous political gesture. IMO that is the root of the problem :-(

Opt out forms in Packs

12 Mar 10 10:29

This message from CfH is crystal clear that PCTs are not allowed to include opt out forms in the packs that are sent to patients.

Opting or encouraging

12 Mar 10 13:01

Maybe they don't inlcude the form becuase it's not a campaign to encourage people to opt out. Even if some people wish that it was.

SCR – what is all the fuss about…?

13 Mar 10 18:34

I’m 53. I was born in England and have lived here all my life. Iad all my vaccinations when I was a child. When I was in my early teens I had a hospital day operation to remove three teeth.

I’ve been in hospital twice since then, the first following a nasty fall, I fractured my pelvis resulting in a hospital stay for one week. The second as a result of an epileptic fit in 1997. I’ve been on Phenytoin since and my epilepsy is well under control.

I’m a fairly relaxed and open guy and if I’d had a spell of Mental Health problems I’d have been quite happy to include this in this medical resume (but I haven’t had any Mental Health problems). I guess if I’d had some form of Sexually Transmitted disease I’d not be inclined to share that fact. I’d probably not have revealed my true identity to the service or if I had I would have insisted this was not included in any care record.

I live and work in the same area and receive all my health care from providers within 10 miles of where I live. I travel extensively across England in my work, wear a talisman around my neck and would be only too happy for anyone to access my SCR if I got into any health difficulties.

I really fail to see what the big problem is with SCR. It’s my record. The sooner we bring it (SCR) on the better.

Apathy and Opt out

14 Mar 10 22:58

In my PCT, we give out opt-out forms on demand at patient engagement sessions, and we chose to put the form on our website. The opting out rather than in is a practical step. If this can be a useful tool in emergency care, you need it to work for the majority.

Far more people are coming in wanting a Healthspace account than to opt out, and the comments we often get from patients (rather than those claiming to know what they want) are;

a) We thought the NHS was much more joined up than this already.

b) Government will probably mess up this as most big computer systems, but I'd like to see what is on my record.

Where legitimate concerns about access are made, these are often fogged by the misinformation that is flying about, and when you explain honestly what measures are in place: chip and pin cards, auditing like the credit card companies do 'did you make this transaction', the duty on NHS staff to be able to justify what they did, and that it is not possible to run reports extracting lots of patient details at once, or to put the information on removable media, most are satisfied.

Shame that we don't see more GPs in the information sessions, some of which are held in their surgeries.

Happy

15 Mar 10 09:50

" I travel extensively across England in my work, wear a talisman around my neck and would be only too happy for anyone to access my SCR if I got into any health difficulties.

I really fail to see what the big problem is with SCR."

Then give your explicit consent to your GP and opt in, and your wish will be granted....

fo r those with memories.....

15 Mar 10 15:49

.....other things that the BMA has said 'NIET' to at one time or another include:

NHSnet

Email for GPs

NHSmail

Pathology Messaging

Choose and Book (OK, i might give you that one)

they're a trades union. Thats what they do.

Not so fast!

15 Mar 10 16:53

To the last poster, I think you'll find that the BMA called for all pathology messaging to be encrypted

http://www.connectingforhealth.nhs.uk/systemsandservices/pathology/edifact/security/crypto_v5

What's wrong with doing things properly?

It is so easy for the uninformed to simplify the arguments beyond useful discussion and just cry "luddite". Think about it.

for those with even longer memories

rsarson@blueyonder.co.uk

16 Mar 10 11:38

Didn't the BMA fight tooth and nail against the creation of the NHS? Aneuran Bevan only persuaded them by loading them with gold. Maybe, even now, that's the only way to the BMA's heart.

It's my record, not my GP's

salsmith766@msn.com

23 Apr 10 13:44

I think one of the problems with all this is that the BMA continues to ascribe the ownership of the record to GP practices, and to perpetuate the paternalistic role of the GP to his / her patients.

My health records are just that: mine. If my GP, or the practice nurse, psychologist or whoever, makes written or computerised notes about my healthcare, they're still my records. It should not be for them to decide whether or not those records get uploaded to the SCR, except in circumstances where they are using their clinical judgment in leaving out bits that are of questionable quality or relevance. In all other circumstances, it should be for me to decide.

Where is the voice of the patient in all of this? Who is speaking for them? Because for my part, as an occasional user of both primary and secondary healthcare, I can assure the BMA that they don't speak on my behalf. As another observer comments, they are doing what trades unions do.

I accept that not all patients are as security / confidentiality savvy as we are, but neither are the majority of them of below-average literacy or intelligence, so why should their GP be called upon to explain to them the pros and cons of the SCR? I wouldn't dream of making an appointment with my GP to discuss this.

Thinking about my elderly mother's multiple conditions and the problems she has had where one consultant prescribes a medication that is totally contraindicated for another of her health conditions, and which her GP refused to repeat prescribe, and then trying to imagine how much more dangerous the lack of accurate information would be if she was to move around the country, then I would be far more worried about the clinical risk associated with delaying the SCR and any subsequent expansions to it, than I would be about her, my or anybody else's privacy.

Why can't I use my Healthspace account to opt in and give my local PCT a target date for getting my records online?