Transforming End of Life Care in Acute Hospitals AM Workshop 5: Summary Care Record and highlights from updated Toolkit for Commissioning Person Centred End of Life Care presented by Dr Robert Jeeves, Health and Social Care Information Centre and Dianne Murray, NHS England

1. The NHS Summary Care Record
Supporting person centred coordinated care
Nov 2015 v1.3

2. www.hscic.gov.uk/scr scr.comms@hscic.gov.uk @NHSSCR
Current status
• SCRs are an electronic
record of key
information from the
patient’s GP practice
• As a minimum contain
medication, allergies
and adverse reactions
96%96%
SCR creationSCR creation
of patients
have had an
of patients
have had an
SCR created (55 million)SCR created (55 million)
96%
SCR creation
of patients
have had an
SCR created (55 million)
2.5m2.5m
SCR utilisationSCR utilisation
SCRs
accessed last
SCRs
accessed last
year to support urgent and
emergency episodes of care
year to support urgent and
emergency episodes of care
2.5m
SCR utilisation
SCRs
accessed last
year to support urgent and
emergency episodes of care

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SCR benefits
“While I use SCR relatively
infrequently, on EVERY occasion
it has directly informed, changed
and better aided patient care …
when we use it, it counts
enormously and directly saves
lives.” ED consultant
“While I use SCR relatively
infrequently, on EVERY occasion
it has directly informed, changed
and better aided patient care …
when we use it, it counts
enormously and directly saves
lives.” ED consultant
“While I use SCR relatively
infrequently, on EVERY occasion
it has directly informed, changed
and better aided patient care …
when we use it, it counts
enormously and directly saves
lives.” ED consultant
2929minutes time
saved per patient
minutes time
saved per patient29minutes time
saved per patient
49%49%
of patients
guided to a
of patients
guided to a49%
of patients
guided to a40%40%
of patients
have a
of patients
have a40%
of patients
have a
medication error identified
when SCR is used
more appropriate care
pathway when SCR is used
undertaking a medicines
reconciliation
(feedback from 999 clinical hub users)(feedback from A&E clinical users)
(audit results 2014)
Efficiency
EffectivenessSafety

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• Over 85% of GP
practices now have
capability to enrich SCRs
with a set of additional
information - with patient
consent
• Includes individual
coded items and
associated free text as
recorded in the GP record
• Reason for medication
• Significant medical history
(past and present)
• Anticipatory care information
(such as information about the
management of long term conditions)
• Communication preferences
(as per the ISB-1605 national dataset)
• End of life care information
(as per the ISB-1580 national dataset)
• Immunisations
SCRs with additional
information include:
SCRs with additional
information include:
• Reason for medication
• Significant medical history
(past and present)
• Anticipatory care information
(such as information about the
management of long term conditions)
• Communication preferences
(as per the ISB-1605 national dataset)
• End of life care information
(as per the ISB-1580 national dataset)
• Immunisations
SCRs with additional
information include:
SCRs with additional information
Supporting person centred co-ordinated care

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SCR and local information sharing
The SCR, now and in the future, will:
• Provide a nationwide data sharing solution – a foundation
for access to a key set of common information that all care
settings need to access
• Complement local record sharing - complex care co-
ordination will still occur at a local level using local systems
• Provide a cost effective solution for settings that have lower
digital maturity and where local solutions are not in place
• Provide a cost effective opportunity for health communities to
accelerate local record sharing by enriching SCRs with
additional information

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These are key extracts from an example SCR with additional information
SCRs with additional information
Supporting end of life care

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• Palliative Care Team
offer Tom the choice
to have an enriched
SCR at his review.
• Tom agrees and his
consent status is
changed.
• Important additional
information from his
GP record is now
automatically included
in his SCR.
• One night Tom’s
condition worsens, his
breathing deteriorates
and he coughs up
blood.
• Joan wants to support
Tom’s wishes to
receive care at home
so calls NHS 111 for
advice.
• The call is transferred
to the GP OOHs team.
• A GP calls back and
accesses Tom’s SCR.
• Tom’s preferences can
be seen and
information about
anticipatory
medication.
• A district nursing team
is contacted and
administers the
medication relieving
Tom’s symptoms.
Tom has lung cancer and the disease has progressed to a terminal
phase. He has a life expectancy of a few months. Together with his
wife Joan, Tom has made a competent decision to receive best
supportive care and to die at home.
SCRs with additional information
Scenario 1: supporting end of life care

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Dr Bee Wee
NHS England Director for End of Life Care
* The SCR provides the end of life preferences entered in the GP practice system
- complementing local Electronic Palliative Care Co-ordination systems (EPaCCS)
SCRs with additional information
Supporting end of life care
“The Summary Care Record provides a great opportunity
for everyone to have their views and preferences digitally
recorded by their GP practice*, and viewed when
necessary, during the final stages of their life. This can
bring enormous peace of mind to these individuals and
those close to them, and help professionals who are
trying to deliver care in accordance with the individual’s
needs and wishes.”
“The Summary Care Record provides a great opportunity
for everyone to have their views and preferences digitally
recorded by their GP practice*, and viewed when
necessary, during the final stages of their life. This can
bring enormous peace of mind to these individuals and
those close to them, and help professionals who are
trying to deliver care in accordance with the individual’s
needs and wishes.”

9. www.hscic.gov.uk/scr scr.comms@hscic.gov.uk @NHSSCR
SCRs with additional information
Supporting those with long term conditions
These are key extracts from an example SCR with additional information

10. www.hscic.gov.uk/scr scr.comms@hscic.gov.uk @NHSSCR
• As a patient with multi-
morbidity Kate was
identified by her GP
practice as someone
who could benefit from
an enriched SCR.
• A note was added to
Kate’s record to offer
her the choice next
time she presented.
• When asked Kate
provided her consent.
• Kate is out shopping
with a friend when she
feels shaky and weak.
• Kate’s friend drives
her to the nearest
A&E department.
• By the time she
arrives her speech is
slurred. Staff identify
that she is suffering a
hypoglycaemia
episode.
• Kate’s SCR is
accessed and
contains information
about her diabetes
and contact details for
her liaison nurse.
• Kate’s insulin dose is
adjusted and her
liaison nurse confirms
that this is not unusual
and Kate does not
need to be admitted.
Kate is a busy working mother of three children. She has type 1
diabetes, complicated by neuropathy, eye disease and early stages of
kidney disease. The last thing she wants is to be admitted to hospital.
SCRs with additional information
Scenario 2: supporting those with long term conditions

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Dr Martin McShane
NHS England Director for Long Term Conditions
“Continuity of information is a vital contributor to
continuity of care and better outcomes. The ability to
enrich Summary Care Records beyond medications,
allergies and bad reactions mean that more and more
relevant information from the GP practice will
be potentially available wherever a patient is receiving
treatment in the NHS. This will improve safe, effective
care and contribute to a positive experience for patients.”
“Continuity of information is a vital contributor to
continuity of care and better outcomes. The ability to
enrich Summary Care Records beyond medications,
allergies and bad reactions mean that more and more
relevant information from the GP practice will
be potentially available wherever a patient is receiving
treatment in the NHS. This will improve safe, effective
care and contribute to a positive experience for patients.”
SCRs with additional information
Supporting those with long term conditions

12. www.hscic.gov.uk/scr scr.comms@hscic.gov.uk @NHSSCR
The British Geriatrics Society
‘When treating older patients, the Summary Care Record,
enriched with additional information gathered during the
process of Comprehensive Geriatric Assessment, or as part of
the proactive care processes within the primary and community
care setting, can be used to support decisions from the
beginning of any new episode of care. This will increase the
likelihood that complex conditions are accurately recognised
and more appropriate treatment plans put in place. This will
contribute to safer, more effective and efficient care for older
people across the urgent care system, potentially avoiding the
need for hospital admission or helping facilitate earlier and
safer discharge’
‘When treating older patients, the Summary Care Record,
enriched with additional information gathered during the
process of Comprehensive Geriatric Assessment, or as part of
the proactive care processes within the primary and community
care setting, can be used to support decisions from the
beginning of any new episode of care. This will increase the
likelihood that complex conditions are accurately recognised
and more appropriate treatment plans put in place. This will
contribute to safer, more effective and efficient care for older
people across the urgent care system, potentially avoiding the
need for hospital admission or helping facilitate earlier and
safer discharge’
SCRs with additional information
Supporting older patients

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Professor Jonathan Benger
NHS England Director for Urgent Care
“Sharing data appropriately is central to the
implementation of the "Keogh" review of urgent and
emergency care. We know that when relevant information
is available to healthcare professionals outcomes, safety
and patient experience are all improved. The ability to
create richer Summary Care Records provides an
excellent opportunity to share additional information such
as care plans, and we strongly encourage primary care
teams to consider processes to seek the required consent
from those patients that would benefit most.”
“Sharing data appropriately is central to the
implementation of the "Keogh" review of urgent and
emergency care. We know that when relevant information
is available to healthcare professionals outcomes, safety
and patient experience are all improved. The ability to
create richer Summary Care Records provides an
excellent opportunity to share additional information such
as care plans, and we strongly encourage primary care
teams to consider processes to seek the required consent
from those patients that would benefit most.”
SCRs with additional information
Supporting urgent and emergency care

14. www.hscic.gov.uk/scr scr.comms@hscic.gov.uk @NHSSCR
Where next for the SCR?
Requirement to expand access and develop the SCR
• National Information Board (NIB) - Personalised Health and
Care 2020 references the need to open up access more
widely and further develop the SCR
• Demand from a range of care professionals
The SCR Expert Advisory Committee
• Ensures proposals to expand the scope of the SCR are
subjected to consultation and analysis
• Membership includes representatives of patients and the
public, clinical professional bodies and Royal Colleges
• Seeks input from wider audiences and advice from relevant
expert stakeholders

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Where next for the SCR?
• Delivery into key areas such as community
pharmacy, scheduled care in hospitals, and
dedicated medical room in police custody
suites
• Discovery work in new environments such as
care homes and social care
• Delivery into key areas such as community
pharmacy, scheduled care in hospitals, and
dedicated medical room in police custody
suites
• Discovery work in new environments such as
care homes and social care
Extend the
benefits to more
care
professionals
Extend the
benefits to more
care
professionals
• Delivery into key areas such as community
pharmacy, scheduled care in hospitals, and
dedicated medical room in police custody
suites
• Discovery work in new environments such as
care homes and social care
Extend the
benefits to more
care
professionals
• Further integration with core systems used by
care professionals
• Improved ‘look and feel’
• Mobile access
• Further integration with core systems used by
care professionals
• Improved ‘look and feel’
• Mobile access
Improve usability
and user
experience
Improve usability
and user
experience
• Further integration with core systems used by
care professionals
• Improved ‘look and feel’
• Mobile access
Improve usability
and user
experience
• Signpost or hold information from other
sources - where it is appropriate to be held on
the SCR
• Flag key information (e.g. learning disability,
SPNs)
• Signpost or hold information from other
sources - where it is appropriate to be held on
the SCR
• Flag key information (e.g. learning disability,
SPNs)
Provide access
to further critical
information
Provide access
to further critical
information
• Signpost or hold information from other
sources - where it is appropriate to be held on
the SCR
• Flag key information (e.g. learning disability,
SPNs)
Provide access
to further critical
information

16. Web:
www.hscic.gov.uk/scr
Email:
scr.comms@hscic.gov.uk
Twitter:
@NHSSCR
Sign up to the SCR bulletin:
http://systems.hscic.gov.uk/scr/signup
Sign up to the SCR bulletin:
http://systems.hscic.gov.uk/scr/signup
Web:
www.hscic.gov.uk/scr
Email:
scr.comms@hscic.gov.uk
Twitter:
@NHSSCR
Sign up to the SCR bulletin:
http://systems.hscic.gov.uk/scr/signup

17. www.england.nhs.uk
Revised Toolkit for Commissioning
Person Centred End of Life Care
Due soon
Dianne Murray, NHS England
Sustainable Improvement Team
18 November 2015

18. www.england.nhs.uk
• First published October 2012
• NHS England formal Action for End of Life Care request to update it
• It is not new or additional guidance.
• Draws together and is grounded in the latest national research and
guidance for local application
• Designed to support Ambitions for Palliative and End of Life Care
• It’s for individuals in health, social care, research and education who
know end of life care backwards and also those starting on their
commissioning career
• Sees providers, commissioners, individuals, carers, voluntary
organisations and the wider health and care system working together
• Lots of weblinks for resources
• Useful for commissioning and also designing care
• About individuals who are, not the
In a nutshell

19. www.england.nhs.uk
Contents page

20. www.england.nhs.uk
Person centred co-ordinated care
from the beginning

21. www.england.nhs.uk
Key publications

22. www.england.nhs.uk
Key publications including RCGP
Commissioning Guidance (2013)

23. www.england.nhs.uk
Start by listening and reaching out

24. www.england.nhs.uk
Provider quality including great
record keeping

25. www.england.nhs.uk
Experience of Care and
staff and volunteer support

26. www.england.nhs.uk
System links – better together

27. www.england.nhs.uk
Person Centred Outcome Measures

28. www.england.nhs.uk
Continuous improvement

29. www.england.nhs.uk
• Care Quality Commission Inspection Reports
• Healthwatch reports
• Look at examples, think “does that happen here” –
how could I, working together with colleagues and
other local organisations, check or change it?
Essential and inspiring reading

30. www.england.nhs.uk
And finally