Patient records: when will community pharmacies get access?

Despite repeated calls for read-write access and the issue of public safety, the majority of community pharmacies still lack access to patient records.
close up of pharmacist's hands typing on computer

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

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.”

Last updated
The Pharmaceutical Journal, PJ, August 2022, Vol 309, No 7964;309(7964)::DOI:10.1211/PJ.2022.1.153943

1 comment

  • Keith Farrar

    Pharmacists in England have, for some time, been able to create their own contribution (vaccination, emergency supply of prescription items, minor illness contributions, etc) to the patient's record and share this with GPs in both England and Wales, (I have no information about Scotland and Northern Ireland). This is 'write' access. What other information would pharmacists wish to share with the wider clinical community?
    Pharmacists in England also have access to the Summary Care Record, (and the Clinical Portal in Wales), which provides at least a level of 'read' access and is often all an admitting doctor can see when the patient turns up in Accident and Emergency.
    It would be useful to understand what level of 'read' access pharmacists feel they need to see. Most elements of any 'clinical record' (the hospital progress notes or the GP notes) are not 'shared' with anyone else, as they are largely unstructured and thus hard to share, store and make sense of once they are in a central repository.
    The Shared Medicines Record in Wales will provide access to up to date information about medicines for all clinicians (I use this term in its widest sense) who care for patients with medicines.
    Data about radiology or pathology results or pathology laboratory results would be included in the National Data Repository within Wales - and may be included in some ICS-level shared records in England - but are not always easily shared between hospitals and GPs within England, so I'm not sure that community pharmacists are any less well-off (in terms of access to data) than others. This doesn't make it right - merely adds an additional perspective.
    Data that is important to inform decision making is something that we should certainly press for, but we do need to specify what we wish to see (and why) to facilitate the provision of access. This isn't a 'censorship' issue - more a practical issue about identifying information that could (usefully) be made available.
    Structured information, such as laboratory results, are easier to share than 'clinical narrative' that is often recorded in 'the notes'. Data included in centralised 'shared records' could be made available to all relevant clinicians, but understanding what is really important will make it easier for those who are working to make this available.


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