When the Dorset Care Record (DCR) launched in March 2018, it brought with it the many potential benefits of having patient information in one place and available to a broad range of health and social care professionals.
It is described as an electronic repository that provides a consolidated view of information from health and social care systems across the county of Dorset, and currently includes information from hospitals and GPs.
In comparison with a typical summary care record (SCR), the DCR contains much more detail from hospitals, such as a history of hospital ‘encounters’, tests performed — from radiology and pathology — alerts, allergies, discharge medications, letters to GPs and referrals. Not all hospitals currently provide this information in full, but work is under way to increase the scope and consistency of information from hospitals.
In April 2020, I was asked by Andrew Prowse, chief pharmacist at Dorset County Hospital, to support the team at the Dorset Integrated Care System working on the DCR ahead of a wider roll-out to Dorset pharmacies later in 2020.
With the team we worked through the practical aspects of providing secure access to the system from my community pharmacy (Victoria Park Pharmacy in Dorchester) and how to establish read-only access for one or more individual users from there.
And after the preliminary training, which covered patient consent and confidentiality in a similar vein to other pharmacy requirements, I had access to the DCR.
Although the pandemic dampened the demand for clinical information, it is picking up now and my early impression of the DCR is very positive. For patients who have been discharged from hospital, or for those needing regular hospital interventions, there is a good deal of information that provides a chronological overview of events and the ability to drill down on detailed results. Medication history and related comments are easy to find and follow too.
For most patients, only a small amount of the information available will be directly relevant in community pharmacy. But seeing the big picture and, where appropriate, taking a few minutes to absorb an overview, can improve even a simple intervention, making it that bit more personal, joined up and safer.
Access to this kind of information will be key for the national and local clinical services coming our way in the community pharmacy contractual framework and for working in a primary care network.
For the future, there is plenty of potential as the DCR continues to grow. Work is under way to bring in further information from hospitals, community health teams and social care from Dorset councils. Community mental health information is also expected to be incorporated in 2020. Eventually, the local healthcare authorities plan for information from broader sources — such as private hospitals, specialist clinics, maternity units and even community pharmacy — to appear in the DCR. To me, pharmacy interventions through NHS 111 and GP referrals would add significant value to the system.
As part of the broader Wessex Care Record — one of five local health and care records funded by the government — the DCR is now part of the ‘One Medication Record’ project. This will give pharmacies access to a single log of patients’ medicines, which is collated with the prescribing systems used across the whole health service. This should make it easier for pharmacists to spot and confirm medicines changes, track repeat medicines and make clinical assessments.
The Wessex Care Record includes Hampshire and Isle of Wight Health Record (Care and Health Information Exchange), and is therefore an important tool for pharmacies and GP practices in East Dorset that may be serving patients resident in Hampshire as well as Dorset.
These types of shared care systems are being developed across England, from the Bristol, North Somerset and South Gloucestershire Connecting Care project and the North Central London Care Integrated Digital Record, to the Leeds Care Record and Kent and Medway’s Transforming health and social care.
From August 2020, community pharmacies in Dorset are gaining access to the DCR with training webinars and technical support. Given what is already available and what is in store for the system, I would wholeheartedly recommend that pharmacists and pharmacy teams invest the time to gain access to and start using these systems wherever possible.
Robin Mitchell, owner, Victoria Park Pharmacy, Dorchester