There are countless reasons why it makes sense for community pharmacists to have access to full patient records.
Promoting antimicrobial stewardship, encouraging adherence and ensuring the safe use of medicines is not just a job for GP practices. Community pharmacists have an opportunity to forge a vital connection with patients at the point when they receive their medicines and many are carrying out this work without all the information they require to support good patient care.
Yes, pharmacists have access to the summary care record (SCR). However, the basic information contained in this – name, address, date of birth, NHS number and information on current medication and allergies – is not detailed enough to support good decision-making.
Although work is ongoing to extend the information available, most SCRs lack vital details, such as indications and diagnostic results. This may be the reason why 85% of pharmacists are not accessing the SCR in a typical week. This would be regarded as unacceptable in secondary care, so why is it accepted in primary care?
As pharmacies carry out more clinical services for the health service, it will become even more pressing for them to be able to directly add information to the patients’ clinical record. NHS Digital promises that community pharmacies will be able send information about flu vaccinations they have carried out directly to GPs during the winter, to prevent duplication of effort. However, it is disappointing that only 40% of GP practices will be able to receive it.
A recent trial showed that allowing pharmacists the ability to see and update patient records in real time helped to eliminate errors with prescriptions
Progress elsewhere is glacially slow. In 2006, the Company Chemists Association told the Royal Pharmaceutical Society (RPS): “Unless full read/write access is granted to pharmacists, patient safety may be compromised.” And we have barely moved on since.
Some areas are taking this situation into their own hands. For example, a recent trial in one community pharmacy in Sheffield — funded by the National Association of Primary Care — found that allowing pharmacists the ability to see and update patient records in real time “helped to eliminate errors with prescriptions”, enabling interventions such as calculating a patient’s kidney function and more accurately adjusting the dose of an anticoagulant.
This evidence has not been published in a peer-reviewed journal, and it is in just one pharmacy, but it showed that read/write access to records was feasible under current structures and suggested it was a “key enabler to unlocking the potential of community pharmacy to deliver more advanced and holistic clinical care”.
Pharmacists in East London will soon have access to the East London Patient Record (eLPR) system, which exchanges patient information between GPs in five London boroughs and four NHS foundation trusts, as well as two local authorities and a hospice. The system uses two central “health information exchanges” to give clinicians a read-only view of patient information held by other providers, although write access may be permitted in the future.
An evaluation in 2018 found that the “the breadth and depth of the information accessible via the eLPR is of significantly greater use” when compared with the SCR. Of nearly 100 clinicians who were surveyed after using the system, 74% said it either increased or significantly increased patient safety.
Other health and care systems, such as in Bristol, North Somerset and South Gloucestershire, and in Wales, access to patient records is being opened up to ensure that primary, secondary and social care services can work in a more integrated way. But, in most areas of the country, pharmacy is left out in the cold.
Community pharmacists are effectively working with one hand tied behind their back, unable to provide meaningful input into some of the major challenges facing the health service. This situation cannot continue. It’s time pharmacists had the full records access that they need to keep patients safe.
Throughout July, The Pharmaceutical Journal will analyse the drive to use digital technology in pharmacy. Click here for more details.