Patient records: when will community pharmacies get access?

There has been a series of big promises on extending access to patient records from government ministers, but community pharmacies in most of the country are still waiting.

In 2013, then health secretary Jeremy Hunt promised “interoperable” medical records that enabled health information to “follow patients around the health and social care system”, as part of his ambition to create a paperless NHS.

A few years later, in 2018, NHS England injected £7.5m into each of five areas — London; Yorkshire and Humber; Thames Valley and Surrey; Greater Manchester; and Wessex — to implement what were then called ‘local health and care records’.

These records were expected to improve a patient’s experience with the NHS by removing the need for them to repeat the same information to multiple healthcare professionals, while also protecting patients by providing everyone involved in their care with reliable allergy, medication and diagnosis information in one place.

But, despite repeated calls for read-write access to records for community pharmacy staff and warnings that a lack of access presents a public safety issue, the profession has largely been an after-thought on both a local and national level.

When the Department of Health and Social Care (DHSC) published its white paper ‘Health and social care integration: joining up care for people, places and populations’ in February 2022, it included a target for all 42 integrated care systems (ICSs) in England to ensure that their constituent organisations are connected to ‘shared care records’ — as they had been renamed — by 2024.

At the time, the DHSC told The Pharmaceutical Journal that this would not include community pharmacy and it was not until a further paper on the government’s ‘Plan for digital health and social care’, published in June 2022, that a target of March 2025 was given for “seamless” pharmacy access to shared care records.

Speaking to The Pharmaceutical Journal, Daniel Ah-Thion, community pharmacy IT policy manager for the Pharmaceutical Services Negotiating Committee (PSNC), says there are “many places where pharmacies are at an early stage of engagement”.

“It is a long-term project to get access to these records for local pharmacies, given the technical work necessary,” he says, adding that local pharmaceutical committee (LPC) teams in many areas “often have an agreement in principle” with shared care records teams to pursue pharmacy access to records.

Ah-Thion says that each shared care records system “has some differences in regard to the set-up and deployment process” but, since the COVID-19 pandemic began, there has been a shift “to focus on clinical uses” for the care record.

“There could be various public health uses if you’re analysing anonymised versions of it. So, if anything, the pandemic has probably sped up the route to try and roll it out to extra sectors.”

But the roll-out to community pharmacies has not been fast enough, says Thorrun Govind, chair of the Royal Pharmaceutical Society’s English Pharmacy Board.

“The COVID-19 vaccination roll-out showed just how important it is for pharmacists and all health professionals to be able to update a clinical record, so it is disappointing that we have not seen faster progress towards shared care records.

“While there may be challenges around data standards and legacy systems, the government must reinvigorate its commitment to this programme, which will improve patient care and unlock the potential of the whole of the health and care workforce,” she says.

“Interoperability of patient records will be essential for new ICSs and this will become even more critical if the government and NHS want to maximise the clinical role of the next generation of pharmacist independent prescribers.”

The picture in the devolved nations is not much better, with the RPS in both Scotland and Wales calling for pharmacy teams to be able to read and write on to centralised electronic patient records by 2030 – something the RPS has been calling for across Great Britain since 2015.

Similarly, community pharmacy representatives in Northern Ireland say efforts to open the national electronic care record — a centralised record of a patient’s medication, test results and hospital discharge letters — to all community pharmacies is still “in the pipeline”, despite ongoing calls for access dating back to 2016.

While the government drags its feet, a handful of local areas are leading the way — or making steady progress — on enabling pharmacy access to a shared care records system, with LPCs telling The Pharmaceutical Journal that some pharmacies now “couldn’t survive without it”.

Amanda Moores, chief officer at Dorset LPC, which was one of the first areas in England to enable pharmacy access to the local shared care record, the Dorset Care Record, said progress towards pharmacy access had been “slow”.

“It’s been easier to get the smaller chains and the independents [involved],” she says. “There are huge challenges for the multiples … we have to remember they’re having to deal with 40+ different shared care records,” one for each ICS. But for those that do have access, Moores says: “They love it, and they now use it every day.”

“One of its most significant benefits is as part of the discharge medicines service,” she says, referring to a service where a pharmacy staff member can check that any medicines awaiting collection are still appropriate for a patient after discharge from hospital. The information provided in shared care records about medicines given to patients after discharge “has been one of the key areas” for inclusion, she says.

“Obviously, it’s a huge issue and also, in terms of patient safety, it’s probably one of the key areas where a difference can be made.”

For the patient, if the pharmacist can access information from primary care, secondary care, the community mental health trust, social care and soon from drugs and alcohol services, “it feels more joined up”, Moores says.

“Whichever healthcare setting you attend, somebody has the ability to access a fuller picture.”