Ash Soni, president of the Royal Pharmaceutical Society (RPS), has questioned whether it is in the best interests of patients to seek consent each time their summary care record (SCR) needs to be accessed.
Source: Simon Wright Photography / The Pharmaceutical Journal
Soni told a meeting in London on NHS IT developments on 9 February 2016 that community pharmacists in England are keen to access the SCR by July 2016, with full rollout completed by March 2017. But he hinted that the burden of information governance could prevent pharmacists from helping patients to get the most from their medicines.
“We need to get patient consent but it may or may not be in the interest of the patient,” he said.
The SCR, which is sourced from the GP record and contains some clinical information (such as recently prescribed drugs, allergies and adverse reactions), can only be accessed by a pharmacist with a patient’s consent.
Soni told the meeting, hosted by Westminster Health Forum, that there have been concerns that pharmacists may not be clinically capable or trusted with the SCR. This was reflected by the lengthy process for pharmacists to be accredited to access the SCR, which involved pharmacists taking a test.
He highlighted the potential for pharmacists to have access to a patient’s enhanced SCR, which contains additional information such as a patient’s diagnoses and any tests that have been carried out.
“[This] will help me as a pharmacist to provide better care [to patients],” he said, but warned that the current ‘opt-in’ approach required patients to have direct contact with their GP. “[We] would like to see it opt out [instead].”
The conference heard concerns about pharmacists having ‘write access’ to the SCR. One GP, who said he “loved his local pharmacist”, was worried about allowing pharmacists to add information to the SCR.
But Soni replied that when he used the SCR he annotated his name like “anyone in a GP practice”. “Would you say the same thing about a hospital doctor,” he asked. “When we are working collectively we share accountability. I show patients what I am doing as part of my transparency. We worry about professional consequences but we need to work through that rather than see a block.”
Beverley Bryant, director of digital technology at NHS England, told the conference that she was intrigued that Soni appeared “irritated” that pharmacists have to ask for patient consent. Hospital doctors “don’t sell shampoo”, she said, so the context of consent was important.
Speaking to The Pharmaceutical Journal at the event, Bryant said that NHS England recognises the value of rolling out the SCR in pharmacy, especially if a patient comes in with a concern and the pharmacist can access the record. “We think that is a massively positive thing,” she added.
But she stressed the importance of seeking consent to access the SCR. “It is important to ask the patient every time,” she said. “The first reason is context. The issue they have may differ from visit to visit and also we need to make sure that we safeguard.”
Responding to Bryant’s comments after the event, Soni told The Pharmaceutical Journal that rather than seeking consent every time, there should be a way to have “enduring” consent.
“This is particularly important if, for example, the patient had been discharged from hospital and medication had been changed,” he said. “It would be appropriate to check on the SCR the correct current medication but the patient themselves may not be well enough to come to the pharmacy. This is compromising patient care rather than enhancing it.”
Soni added that he had “no issue” with seeking consent. “It’s just that it fails to recognise in how many cases the patient doesn’t come to the pharmacy themselves, so they would need to be contacted because I can’t accept consent from the representative.”
On the ‘shampoo’ jibe, Soni said that undermining the credibility of a pharmacist as a clinician was concerning and failed to recognise the professional requirements of being a pharmacist as a regulated profession.
At the event, Bryant told The Pharmaceutical Journal that people were concerned that, as retailers, pharmacists could use patient information for marketing purposes. “We know that is not the case; we have already agreed with the RPS that will not happen, but we do have to make sure that message goes out to the public in a safe way.”
Asked about pharmacists’ ability to write on the SCR, she said: “If a pharmacist has useful information about a drug they have dispensed or sold to the patient, it feels to me useful and helpful as a reciprocal arrangement between GPs and pharmacists to transfer that information.”
Lord Warner, a former health minister, told the conference that the issue around patient trust about data sharing was important, and he supported the idea that patients could control who has access to their records through technology. “There is no reason we can’t do it, electronically… if they don’t like pharmacists having access to data, it’s up to them,” he said.
Clare Marx, president of the Royal College of Surgeons and chair of the strategic clinical advisory group at the National Information Board, said: “We need to accept other healthcare professionals inputting into the record and adjusting our approach because of it.”
More than 96% of the population have an SCR and it is already being used in other settings across the NHS, such as A&E departments, hospital pharmacies, NHS 111 and GP out-of-hours services.