Viewing Summary Care Records (SCRs) for Non GMS patients within TPP SystmOne

Within TPP SystmOne, it is possible for GP practice staff and other SystmOne end users to view SCRs for patients, when the patient gives their permission to do so. This increases the quality of information available to the clinician at the point of treatment, and reduces the need to contact the patient’s registered practice by fax or telephone. Where the patient cannot give their permission, the clinician treating the patient can still access the SCR where it is deemed in the best interests of the patient. In this instance an alert will be generated.

GP practice staff are able to benefit from viewing SCRs for temporary residents (Non-GMS), with permission from the patient. However, they do not need to obtain the patients permission for their own GMS patients due to the fact that they are fully registered (GMS) at that practice.

The functionality can also be beneficial for treating new patients to your practice that are not yet fully registered. Often these patients will arrive with a request to register and need an immediate prescription or treatment. In these cases, the patient’s current SCR can be accessed prior to completion of registration and before detailed records arrive from their former practice or via GP2GP.

In line with the usual governance associated with the accessing of patient records, the Caldicott Guardian within each organisation has a responsibility for protecting confidentiality when it comes to SCR viewing for organisations viewing SCRs for non-GMS patients, it is mandatory for the organisation to have at least one nominated Privacy Officer in place. This may be the same person who currently manages alerts that TPP SystmOne already generates, however the alerts generated when viewing SCRs are managed and closed via the NHS (Spine) portal.

The Privacy Officer will need to manage any alerts that are generated via the Alert Viewer system on the NHS Spine Portal. It is worth noting that the Alert Viewer will not allow alerts to be closed by the same individual who created them, therefore practices may wish the Privacy Officer to be an appropriate member of staff who will not normally access SCRs. For further information regarding the setup of a Privacy Officer please see page eight of this document.

Viewing is available for patients with any of the following registration types:

a) Temporary Residents (TRs)

b) Immediate Necessary Treatment

c) Private Registration

d) Referral In

e) Walk In Patient

 f) Other

This viewing pack contains information for you to be able to:

• order the enablement of the functionality within TPP SystmOne
• request or set up the necessary Role Based Access Control (RBAC) codes
• view the Summary Care Record & record permission to view (PTV)
• manage alerts using the Alert Viewer on the NHS Portal

1. Contact the SCR Team on [email protected] with the site name, organisation code (ODS) and desired go-live date. If the site is a non-GP TPP unit you will require the 12-digit workgroup code instead of the ODS code (these are available in the F4 directory within TPP SystmOne).

2. Check that the SystmOne unit you are requesting the viewing functionality for is RBAC enabled. To do this, log into SystmOne and navigate to:

Setup > User & Policy > Organisational Details

Navigate to the Spine tab. The organisation must be in Enabled or Smart Card Only mode to order SCR viewing functionality, as below.

3. A member of the SCR Team will then complete the booking with TPP.

4. A member of the SCR Team will then confirm the booking with you or discuss any issues which may have arisen.

Staff involved in viewing SCRs or managing alerts may need additional roles or activities added to their smartcards, so it is recommended you discuss your requirements with your local Registration Authority as soon as possible.

View Summary Care Records and emergency access (clinical staff)

• B0370 (View Summary Health Records) - gives access to the SCR Viewer
• B0168 (View when permission could not be requested) - emergency access to view the SCR
• B0082 (Legal Override of Consent) - legal access to view the SCR (Optional)

View and manage Alerts (privacy officer)

• S8002 : G8003 : R0001
• Admin and clerical : Admin and clerical : privacy officer

Where possible, privacy officers should not have any access to view SCRs.

On the agreed go-live day it is recommended that one user checks the functionality has been enabled correctly. It is usual for TPP to enable functionality between 9am and 12pm on the go-live date. Users may need to log in and out of SystmOne to see the new functionality.

Once the SCR functionality has been enabled on the day of the upload, the relevant node can be added to the Clinical Tree for all appropriate members of staff:

1. Open a Patient Record and right click on the Clinical Tree.

2. From the menu displayed, left click on Tree Configuration.

3. Select Tree configuration from the right-hand side of the new dialog box.

4. Select the tree configuration from the centre pane you know to be the one used by your staff, for example [Service Name] Tree or similar and click on Amend Setup. 

Note: The tree configuration set by the system administrator is presented in bold and is usually the main tree configuration used by staff.

5. After selecting to amend, type in the ‘Summary Care’ into the search box and click search.

6. Double click on the ‘Summary Care Record’ node to move the node into your clinical tree configuration.

7. Use the arrow icons to move the SCR node either up or down the clinical tree. Once the icon is in the correct location, click OK.

8. The SCR node will now be available to all staff using this clinical tree configuration.

Note: Some staff may have access to create and amend their own tree configurations due to their job role. These staff may require you to manually add the SCR to their personal setup on an individual basis.

9. Upon the retrieval of your next patient the SCR node should be available to use.

Before accessing the Summary Care Record the patient must be registered in SystmOne as one of the above mentioned registration types by being traced and synchronised with the Personal Demographics Service (PDS) using a smartcard, so that an NHS number is available.

1. Search for a patient record by any search method.

2. Retrieve the desired patient record.

3. Navigate to the Summary Care Record node on the clinical tree.

4. The Permission to View screen is displayed.

5. You must now ask for the patient’s permission to view their Summary Care Record. Examples of how you might ask are as follows: “Can I view your Summary Care Record to help with your care?” or “Can I view your GP medications record to see your medical history and help with your care?”

• Yes (View Record): if you select this option, you can type additional information and then view the patient’s SCR
• No (Access Refused): if you select this option, you can type supporting information, but you cannot access the patient’s SCR
• Emergency Access: This is available if you have RBAC rights allowing Emergency Access viewing. When selecting this option, the free text box must be used to explain why the Emergency Access function is being used e.g. ‘the patient is unconscious’ you can then access the SCR. An alert will be sent to the Privacy Officer of the organisation and your comment will explain the reason for viewing the SCR
• Access for Legal Reasons: if you select this option, you must select the reason for access. This option is used in rare cases when the SCR is being viewed outside of a clinical consultation such as audit or investigation. Note: This option is only available if you have RBAC activity B0082 Legal Override of Consent in your role profile.

If a patient has opted out of Summary Care Records, there will be no clinical information to view.

The Summary Care Record (SCR) consists of the following core data items from the patients GP record:

• allergies and adverse reactions
• acute medication – prescribed in last 12 months (unless otherwise specified in the SCR)
• repeat medication – All current repeat medications
• discontinued repeat medication – repeat medication which has been stopped in the last 6 months

In addition, further useful additional information may be included with patient consent.

Changes made to data items in the GP record will be updated in the SCR automatically.

Below is an example of a SCR Record from within SystmOne.

When viewing Summary Care Records it is important to note:

• SCRs do not remove the requirement for verbal medical history taking where possible
• always check the date stamp of the SCR - this may determine whether the SCR is current and up to date
• the SCR may display either the Last Issue Date or First Added Date for medications
• some SCRs may not include Discontinued Repeat Medication
• text may be displayed to show that the patient is newly registered at their own practice, so the SCR may not yet be fully up to date
• text may indicate that some items may have been deliberately withheld
• text may also, indicate that the SCR is no longer being updated by the practice

Completeness and data quality

Additional Information added to the SCR include data items defined in the SCR inclusion set or specific to the supplier’s GP system implementation of SCR. The quality and completeness of the SCR is dependent on a number of factors including the underlying clinical record, data quality and confidentiality. As a result, SCR viewers should be aware that the SCR potentially may not be complete. The SCR is a valuable source of information but clinicians should aim to validate this information through discussion with the patient, family, carers or GP practice.

If a patient has opted out of SCR then the following message will be displayed upon attempting to access the SCR:

The Privacy Officer RBAC codes will automatically give access to the Alert Viewer on the NHS Spine, this does not need to be requested separately.

It is recommended that the Privacy Officer regularly access the Alert Viewer in order to manage Alerts that have been generated. This can be through checking on a regular diary date or alternatively setting up email alerts via the Spine Portal.

To set up email alerts please see the Alert Preference User Guide.

Once set up, any alerts that are generated will prompt an email to be sent to the Privacy Officer(s).

Find out more about information governance for Summary Care Records (SCR).

Privacy officers are responsible for managing and closing down alerts generated by their SCR viewing organisation.

Privacy Officers should read the Alert Viewer User Guide which details how to access, manage and close Alerts.

Only one alert type will be generated when viewing SCRs for Temporary Residents using TPP SystmOne:

Where the SCR is viewed using the Emergency Access or the Access for Legal Reasons option on the Permission to View Screen. This is known as an Access Alert.

If you have any queries, require support or further training please contact: [email protected]