“At Christmas, I bought my wife an Apple Watch,” says GP William Lumb. “I got it from China, and I could track it as it left China, arrived in Kazakhstan, then left again for distribution in the UK … I could see it on every step of the journey.”
The NHS cannot track its referrals, treatments and discharges in the same way. Traditionally, if a GP wanted to send a patient to hospital, then he or she would send a consultant a referral letter.
And if a hospital treated a GP’s patient, it would send him or her a paper summary of what had happened. These documents might never arrive; and if they did, they might be illegible or incomplete.
Moving to fax and, to a lesser extent email, has helped. But both need somebody to send and receive them, they don’t necessarily contain more information, and they don’t make it easier to work out where a patient is in the system.
These problems show up particularly in out-of-hours services, such as A&E, and when other agencies need to get involved. A&E staff can spend hours calling GP surgeries or standing by faxes waiting for notes. Patients can be stuck on wards waiting for social care assessments.
More information means safer care
These issues have led some areas of the country to start experimenting with information-sharing and shared care record projects. A good example is Bristol, which has been working on a project called Connecting Care for several years.
Programme manager Jocelyn Palmer explains that the project has had two phases. The first phase was a pilot focused on sharing GP-held patient data – such as patient details, and whether they were taking any medication – with out-of-hours and A&E services.
The pilot, which went live in 2013, fed information from local GP IT systems into a portal, enabling urgent care staff to see it, as long as they had the right job role and the patient gave their consent.
The second phase, which started in 2015, scaled up the system and is now extending it to more services. Mental health, community care and social care are all on board.
“At every stage of the project, we have heard similar things,” Palmer says. “Clinicians say they can deliver safer care, because they have more information in front of them.
“So, they might be able to prescribe more safely, because they know a patient is already on a particular drug, or treat more safely, because they know of a particular risk.
“Efficiency also comes through quite strongly, because the system is dominated by faxes, and having access to information electronically is just so much quicker. We get feedback from people saying ‘you have changed my life’.”
Bristol has further plans for Connecting Care. Its sustainability and transformation plan talks about putting citizens at the heart of the record. Palmer says this won’t just mean sharing information with them, but letting them add data and share it with clinicians – perhaps through approved apps.
Putting people on the right pathway
There are similar information-sharing schemes in Liverpool and parts of London. Hampshire has taken a slightly different route, creating a new record, the Hampshire Health Record, that different services can access.
Other areas of the country, such as Airedale, are encouraging services to use one electronic patient record system. Cumbria has a shared care record on much the same model as Bristol’s, which started in 2012.
Uniquely, however, it has also developed a system known locally as “air traffic control” and that Lumb, who is also the area’s chief clinical information officer, calls a “logistics solution”.
As the name implies, the idea is to make sure that patients are referred to the right service, and that everybody knows what is happening to them as they move along the relevant pathway.
Although it’s early days, the system is designed to be used at scale – Lumb reckons that once all the referrals around health and social care are counted up, there could be as many as 300,000 a year in the area that it covers.
It’s also designed to be used by a wide variety of people; Lumb also wants patients to be able to refer themselves to some services, such as physiotherapy, via a portal.
And it’s absolutely intended to improve efficiency; Lumb describes a dashboard that will let him see which of his detox patients are in treatment, and flag up if they are not getting the treatment that local agreements say they should be getting.
“Having a shared record and a logistics solution are both fundamental,” he says. “But one does not replace the other. A shared record is the right thing to do, but you will not get all the benefit you could out of it without having people on the right pathways.”
It’s a big shift in thinking – some sustainability and transformation plans can only talk about implementing the level of information-sharing that has been pioneered in Bristol, Hampshire or Liverpool. But Lumb argues that further innovation will be transformative: “We just need people to understand what is possible.”
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