Select Committee on Health Written Evidence


Evidence submitted by South East Health Ltd (EPR 13)

1.  EXECUTIVE SUMMARY

  We are a not-for profit limited company, providing out of hours primary care services to a population of over 900,000, covering parts of East Kent, together with the East Sussex coast including Brighton. Our services are commissioned by four Primary Care Trusts (Eastern & Coastal Kent PCT, East Sussex Downs and Weald PCT, Hastings & Rother PCT and Brighton & Hove City PCT.)

  We note the focus of this new inquiry and our written evidence relates to three of the five areas given in Press Notice No. 12, namely:

    (a)  Who will have access to locally and nationally held information and under what circumstances.

    Our submission below stresses the importance of our out of hours primary care service having access to "in-hours" patient records, and in particular, those held by the patient's GP Practice.

    (b)  What patient information will be held on the new local and national electronic record systems

    Our submission below indicates that generic patient details should be accessible for matching and verification. We also advocate that a patient summary should be made accessible to the clinicians of our out of hours service, compiled from information stored in the computerised GP Practice patient record.

    (c)  Current progress on the development of the NHS Care Records Service and the National Data Spine and why delivery of the new systems is up to 2 years behind schedule.

    Our submission below stresses the importance of delivering the new systems in the out of hours context. We mention some previous complaints concerning the out of hours service which have highlighted the problems which can arise when continuity of patient care is jeopardized by lack of access to previous medical history.

2.  SUBMISSION

(a)   Who will have access to locally and nationally held information and under what circumstances.

  South East Health Ltd welcomes the interest of the Committee in this area of focus. Our organisation is commissioned by a group of Primary Care Trusts (PCTs) to provide an out of hours primary care service to their combined populations in East Kent and East Sussex. The total population served is around 900,000.

  The demography is diverse in terms of age ratios, population distribution and culture. Large parts of the Romney Marshes and the Rother Levels are rural, thinly populated areas. In contrast Brighton is densely populated, multi-cultural and cosmopolitan.

  As a result of the new General Medical Services Contract 2003, GP practices were no longer obliged to provide patient services in the evenings, or at weekends or Bank Holidays. The responsibility for such provision, which had previously been handled by groups of practices working together as GP Co-ops, was now passed to the local PCT. The PCT then commissioned the service from out of hours provider organisations such as South East Health Ltd.

  The Department of Health and indeed HMG, have been concerned to stress the importance of a 24/7 Health Service. This cannot work effectively without continuity of care.

  South East Health Ltd employs doctors on a sessional basis, to cover its evening/overnight and weekend shifts. The likelihood of a GP seeing one of his/her practice patients when the GP is working for South East Health Ltd as an out of hours duty doctor, is remote.

  The out of hours duty doctor will have the following patient information available to him/her when a telephone advice consultation or a face to face patient consultation is about to be made:

    (i)  generic details of the patient—name, date of birth, address, own GP

    (ii)  current symptoms/health problem(s) (as described by the patient or their carer, to the South East Health Ltd call operator)

    (iii)  references to previous calls, if any, made to South East health Ltd.

    (iv)  special Notes if any—essentially, attention flags for the information of the clinician, provided by and at the discretion of, the GP practice or other healthcare provider, eg if the patient has been removed from a practice list and is subject to a local violent patient scheme.

  It follows therefore that medical history details, including operations, illnesses, allergies, allergic reactions to medications, etc, etc, could be of significance in the context of the out of hours consultation, and under existing arrangements, may well not be known to the out of hours clinician.

  At best this situation compromises continuity of health care—at worst it is dangerous and might be life threatening.

  We would therefore strongly urge the Committee to be mindful of the need for access to GP practice patient information by the out of hours service.

(b)   What patient information will be held on the new local and national electronic record systems

  We hope that we have justified our need for access to patient records out of hours, as in 2a) above.

  The out of hours clinician needs to have historic details of the patients and details of recent healthcare events or episodes. The natural source of this information will be the patient's computerised GP notes. For example, a patient who has contacted the out of hours service for advice/treatment might have had a recent hospital episode.

  The patient or carer may not be fully aware of the details of this episode. However, a discharge summary will have been sent by the acute hospital to the GP practice, and the details will have been captured and stored within the GP patient record.

  We would advocate that an extract summary of the patient's GP record should be routinely posted on the National Data Spine so that it can be made available to the out of hours clinician.

  An extract summary could include:

    —  Generic patient details

    —  History of illnesses

    —  History of other significant events eg pregnancies

    —  History of medical treatments

    —  List of current medication (Repeat and Acute)

    —  Immunisation record

    —  History of operations

    —  Allergies

    —  Recorded reactions to medication

    —  Medications contra-indicated

    —  Summary of hospital episode(s)

    —  Existing Special Notes / Management protocols

(c)   Current progress on the development of the NHS Care Records Service and the National Data Spine and why delivery of the new systems is up to 2 years behind schedule

  In common with other out of hours providers, South East Health Ltd (formerly Seadoc Ltd and Brightdoc Ltd) has file records of a number of complaint cases in which the continuity of care had been compromised by the lack of access to previous medical history. In a minority of cases the complaint had escalated to the Healthcare Commission and in two instances, to the Parliamentary & Health Service Ombudsman.

  In such cases we have been at pains to point out that we have promoted and implemented upgrades to our out of hours database software to go as far as we can in minimising the risk of repetition. For example the system now alerts clinicians to previous out of hours contacts (last six calls).

  However we have also respectfully pointed out that the lack of access to GP practice summary patient extracts is outside our control.

Ron Owttrim

Chief Executive, South East Health Ltd

March 2007





 
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